Health insurance in Germany: everything you need to know

Germany has one of the oldest and arguably one of the best healthcare systems in Europe. Every resident, including foreigners, must have health insurance for their stay in Germany, either public or private or a combination of both. This article should help you choose the best health insurance in Germany. Who is eligible for which type of coverage? How much does health insurance cost in Germany? What services are covered? Read on to find answers to these and other questions.

Insurance statistics

Since 2009, health insurance in Germany has been mandatory for all residents, including expats and family members from their households. The minimum coverage must include hospital and outpatient medical treatments. Some countries’ national systems can cover health insurance for foreigners in Germany. The first group is the European Economic Area states. The second one is those that have signed a social security agreement with Germany, such as:

• Brazil
• Chile
• India
• Japan
• Uruguay and others.

For expats planning to be employed in Germany, such an agreement is very important to consider. It facilitates the distribution of social security contributions, including those for health insurance for foreigners in Germany, and helps foreign employees to save money, which they can instead add to their retirement funds or send home to support their families there.

Residents can choose between public and private health insurance in Germany. Still, only about 10% of the population opt for the latter. Since every person is required to have health insurance to stay in Germany, some providers also offer special 'expat' insurance. It might be useful in some cases, for example, if you are already in the country but still in the process of selecting/enrolling with a provider of health insurance for foreigners in Germany. There is also a possibility of combining various types of coverage depending on specific medical needs.

In most cases, enrolment in the public system is automatic. It starts once you have signed the employment contract, and your employer registers you for social security contributions, including for health insurance. Either public or private, in both cases, you have the right to choose a provider. Since not all insurers offer English-language support, it might be a good idea to find the one that does to make sure you get the best out of health insurance in Germany. Upon registration, you receive your health insurance number and card, which you need to present at your medical appointments.

Public health insurance in Germany

(Gesetzliche Krankenversicherung – GKV)

The very fact that the overwhelming majority, or close to 90% of the German population, is state-insured might be evidence of the best health insurance in Germany. However, it is mandatory for most people, since only certain categories are eligible for private coverage (more on later).

The contributions are equally shared between the employee and the employer. In contrast, self-employed individuals must pay the full amount themselves. Public health insurance in Germany also covers all dependent members of the insured individual's family, such as spouses and children.

Statutory healthcare is also open for most students under 30, including international ones, which helps them to get the best health insurance in Germany during their studies. Keep in mind that being insured is one of the requirements for a German student visa.

Private health insurance in Germany

(Private Krankenversicherung – PKV)

Private healthcare plays an important role in the German health insurance system. Unlike with statutory coverage, only certain categories of people are eligible to opt for private health insurance in Germany, such as:

• Employees earning over €69,300 (as of 2024)
• Freelancers and self-employed foreigners
• Civil servants
• Students aged over 30 and others, such as international students pursuing a PhD degree programme.

Nevertheless, even if you belong to one of the categories, you can keep your enrolment with the state system and complement it with the best private health insurance in Germany if needed. In many cases, it might be a better option than completely switching to a private provider because getting back to public health insurance in Germany is a highly complicated process.

Private coverage is usually paid for by the insured, but some employers might partially contribute to it as part of their employment package.

Public vs private insurance in Germany

* Some exceptions include, for example, international students over 30.

How much does health insurance cost in Germany?

The social security system, which includes public health insurance in Germany, is based on the principle of solidarity, meaning that every eligible person is entitled to the same social benefits. Each beneficiary pays 14.6% of their gross salary towards their health insurance, and this share is equally divided between the employer and the employee (7.3% each). As such, the amount depends on the size of the salary but is capped at certain thresholds that are revised annually. As of 1 January 2024, the salary threshold for public health insurance in Germany is set at €5,175 a month or €62,100 a year. There is also the so-called additional contribution, the size of which depends on the insurance provider. The average additional contribution for 2024 is 1.7%, which is equally divided between the employer and the employee. In addition, there is 4% in contributions for nursing care, of which 2.3% are paid by the employee and 1.7% by the employer (in Saxony, 2.8% and 1.2% respectively).

There are different conditions for those obtaining education in a German institution, including international students. For those under 23, the monthly cost of health insurance in Germany is €120.34. Students aged between 23 and 29 pay €125.21, but if they have a child, the amount is €120.34.

When it comes to private health insurance in Germany, the cost is not determined as a share of salary but depends on the provider as well as the insured individual's age, pre-existing conditions, and coverage options. The price can be as low as €100 for a young, healthy individual, reaching up to €1,500 a month with age and/or various extras such as advanced dental care. If you are looking to get the best private health insurance in Germany, be ready to pay at least €600-800 a month for an adult. And keep in mind that, unlike with the state system, each member of the family must be insured individually.

Sick leave

Under any health insurance plan in Germany, all employees are entitled to up to six weeks of fully paid sick leave for physical and mental illnesses preventing them from performing their work duties at full capacity. Moreover, if needed, this period can be extended for up to 78 weeks, with a compensation of 70% of the salary covered by the provider. Some employers allow absence from work for up to 3 days without a sick note, but this better be confirmed in advance. In most cases, however, you need to visit a doctor immediately after falling ill for a checkup and to get an official sick note. Also, always inform your employer about your sickness as early as possible, even before going to the doctor.

Pharmacies

Even holding the best health insurance in Germany, it is never a bad idea to know where pharmacies are in your neighbourhood. Keep in mind that most of the outlets are usually closed at nighttime, on Wednesday and Saturday afternoons, and on Sundays. However, some work extra hours; the lists of these change on a weekly basis and can be found online. For example, all-night pharmacies in Berlin can be found here.

Compared to many other countries, the distribution of medical products in Germany is strictly regulated. Some medicines sold over the counter in your home country might require a prescription under health insurance in Germany.

Suppose you are covered by public health insurance in Germany. In that case, you only need to pay a small amount for prescription medicines (usually between €5 and €10). However, suppose you hold private health insurance in Germany. In that case, you pay the full price and will later be reimbursed by your provider (therefore, always keep the receipts to submit with your claims).

Note that pharmacies (Apotheke) should not be confused with drugstores (Drogerie), which sell wellness products, toiletries, and other items.

Helplines

The German number for emergencies is 112, an EU-wide number which in Germany is used to call an ambulance and fire services. If you are lucky, there might even be an English-speaking operator available.

Noncritical medical queries can be addressed at 116117, the 24/7 medical on-call service operated by the German National Association of Statutory Health Insurance Physicians. Unfortunately, the on-call service is provided only in German, but a list of practices where English is spoken can be found on its website.

How to save on cost of health insurance in Germany

Caring for one's health requires money, but there are ways to reasonably reduce expenses. Here are some examples:

• Even if your status makes you eligible for private health insurance in Germany, opting for public one might be better for money, especially if you do not require additional medical services.
• Increasing the deductible size (the amount you are obliged to pay before the insurance coverage is initiated) to reduce your monthly premium is sometimes possible when choosing health insurance in Germany.
• Combining different insurance packages is a smart approach if you want to reduce your expenses on health insurance for a stay in Germany. Instead of buying a comprehensive plan from a private provider, you might remain under public health insurance in Germany and complement it with additional services, such as advanced dental care.
• Use your insurance plan benefits, such as free screenings, which providers often offer. First, timely checkups could prevent medical expenses in the future. Second, many health insurance providers in Germany reward those who care for their health with premium refunds and bonus programmes. For example, a dental treatment record (Bonusheft) is a booklet you can request from your dentist, who stamps it every time you visit. This proves that you take dental hygiene seriously, making you eligible for higher compensation in case you need more serious intervention, such as a dental prosthesis.

As you can see, with some planning and commitment, one can easily reduce the cost of their health insurance in Germany without compromising their health. This is a win-win approach: you stay healthy, your medical needs are insured, and you save money which you can use, for example, to support your loved ones back home (use Profee to add another 'win' here – go to our site or get the app to see for yourself).