Private vs Public Health Insurance In Germany [English Guide]

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Every resident in Germany needs to have health insurance by law. That begs the question, which is the best German health insurance for foreigners? To shed some light on this complex topic, we compare private vs. public health insurance in Germany for expats in-depth. 

Depending on your circumstances, you may have to be insured publicly or you may be able to choose between public and private insurance. For some expats, private health insurance might be the only option in Germany. 

Health insurance options in Germany

Germany has two main health insurance systems: public and private. The majority of Germans are publicly insured, as only 11,9% have private health insurance. Which one is best for you depends highly on your circumstances. 

Compulsory vs. voluntary health insurance in Germany

Compulsory health insurance (pflichtversichert) = you must have public insurance.

Voluntary health insurance (freiwillig versichert) = you can choose between public and private health insurance.

Let’s have a look at when you are compulsorily or voluntarily insured:

  • If you are employed, your income determines your options:
    • Should you earn less than 64.350 euros per year, you are pflichtversichert, and need to have public health insurance.
    • Should you earn more than 64.350 euros per year, you are freiwillig versichert, and you can choose between public and private health insurance. 
    • Should you be a doctor, you are freiwillig versichert, and you can choose between public and private health insurance. 
  • If you are self-employed or a freelancer, you are freiwillig versichert, and you can choose between public and private health insurance. 
  • If you are a student, you are freiwillig versichert, and you can choose between public and private health insurance. If you are under 25 years old, and your parents are publicly insured, you can be insured through your parents for free. 
  • If you are a stay-at-home spouse, you are freiwillig versichert, and you can choose between public and private health insurance. If your spouse is publicly insured, you can join their insurance for free (familienversichert).  

Public health insurance in Germany

Public (a.k.a. statutory) health insurance in Germany is regulated by the government, and it is called gesetzliche Krankenversicherung (GKV). Most employed people in Germany have to be insured publicly, as they earn less than 64.350 euros a year. When you have statutory health insurance, you are automatically also insured for long-term care (Pflegeversicherung).

When a statutory health insurance fund insures you, you receive a health insurance card, which you need to provide at the reception of a doctor’s office or hospital. Through this card, your doctor will automatically bill all costs (that are covered) to your health insurance, so you don’t have to deal with any paperwork.

Your children and your stay-at-home spouse can be insured through you for free.

How much does public health insurance in Germany cost?

As a rough estimate, you can expect the following costs for public health insurance in Germany:

  • Around 300 – 400 euros for employees
  • Around 600 – 800 euros for self-employed or freelancers
  • Around 80 – 150 euros for students, if you can’t be insured for free through your parents

The cost of public health insurance in Germany is between 14,6% – 16,3% of your gross income (on average 15,9%). The exact percentage depends on the public health insurance fund (Krankenkasse) you choose to be insured with. The state contribution rate is 14,6%, and each Krankenkasse has the right to add an additional contribution rate of up to 1,7% (Zusatzbeitrag) to cover its costs. The average additional contribution rate is 1,3%.

By choosing a Krankenkasse with a lower additional contribution rate, you can therefore lower your cost. The best public health insurance providers for foreigners have the following additional contribution rate:

So the higher your income, the higher the actual cost for your health insurance. However, there is a maximum income (Höchstbeitrag) that is taken as the basis for the cost calculation. In 2021 it is an income of 58.050 euros per year, which is 4.837,50 euros per month. Thus, even if your income is higher, you will not need to pay more for your public health insurance. However, the Höchstbeitrag increases every year, so your cost for public health insurance will increase yearly as well.

Example calculation of public health insurance cost

Let’s say you earn 5.000 euros gross a month and are insured with TK.

Maximum salary 14,6% + 1,2% for TKTotal
4.837,50 euros15,8%764,33 euros

If you are employed, you will only have to pay half of it, as your employer covers the other half. So, as an employee, you will pay a maximum of 382,17 euros per month for your German public health insurance. This amount is directly subtracted from your payslip

If you are self-employed or a freelancer, you have to cover the entire cost yourself. This is why public health insurance is so expensive when you are self-employed with a high income, and private health insurance might be a better and cheaper option. Your insurance fund will take the monthly amount directly from your bank account. It is based on your estimated income and will be adjusted at the end of the year.

If you are a student under 25 years old, and your parents are publicly insured, you can be insured through your parents for free. If you have a side job and you make more than 450 euros a month, you need to get insured yourself and pay a reduced student rate of about 104 euros per month. If you are a student between 25 and 30 years old, you also pay the reduced student rate of around 104 euros per monthIf you are a student over 30 years, you can no longer benefit from the reduced student rate, but instead, you will have to pay the minimum contribution of around 180 euros per month. 

The long-term care insurance cost is 3,05% of your gross income if you have children and 3,3% if you don’t have children. As an employee, your employer also covers half of these costs, and freelancers or self-employed have to pay it themselves. 

Maximum salary Long-term care insuranceTotal
4.837,50 euros3,3% without children159,64 euros

As this example shows, the total maximum amount you pay for public health insurance and long-term care in Germany as an employee insured with TK is 461,99 euros per month. If you earn less, you will pay less.

To get an idea of your own costs, here you can find the cost calculator for the expat favorite public health insurance Techniker Krankenkasse.

Which public health insurance should you choose in Germany?

This is absolutely your choice, and as long as you need to be insured compulsory, every public health insurance provider needs to accept you regardless of whether you have pre-existing illnesses or not. Since the government regulates this health insurance, the benefits and costs are similar between the 105 Krankenkassen that exist in Germany. You can find the biggest differences in their bonus programs, customer service, and the additional contribution rate. 

Next to Techniker Krankenkasse, which is Germany’s biggest public health insurance fund, you can also consider AOKBarmer, and DAK, who also offer English-speaking customer service. I have been with TK since 2015 and have also written an in-depth Techniker Krankenkasse review

TK - Techniker Krankenkasse
  • Awarded best public health insurance
  • English customer support
  • Bonus program
  • Doctor appointment service
Get TK Public Health Insurance Learn More
Transparency: We earn a commission if you click this link and make a purchase at no additional cost to you.

Related Guide: TK Insurance Germany – My Honest Expat Guide 

How do you get public health insurance in Germany?

You can sign up to any of the public health insurers via the super-fast and free online services of the expat insurance broker Feather. If you are unsure which one to pick, you can use their free Health Tool to determine which provider is best for you. 

Sign up with Techniker Krankenkasse
Sign up with AOK
Sign up with Barmer
Sign up with DAK

Private health insurance in Germany

Private health insurance in Germany is called private Krankenversicherung (PKV) and is offered by private insurance companies. Only 11,9% of residents in Germany have private health insurance from one of the 42 different private health insurers. As described earlier, only certain people can have private insurance: students, self-employed and freelancers, doctors, and employees who earn more than 62.550 euros a year. 

When a private health insurance fund insures you, you benefit from services and treatments above the statutory regulations. When you visit a doctor, you will have to pay for the costs yourself and then file a claim with your private health insurance for reimbursement. 

Private health insurers usually ask for a medical test or health questionnaire before offering you a contract. Should you have any pre-existing or chronic conditions, they have the right to deny you. You will read many statements that private health insurance is a lot cheaper than public health insurance when you are young and healthy; however, it will become very expensive when you grow old. I believe this statement is too general, and should you qualify for private health insurance, you should absolutely talk to an insurance broker and compare different insurance companies and tariffs. 

Feather is an insurance service provider specialized in expats in Germany who are happy to find your best option, whether it be public or private health insurance. 

How much does private health insurance in Germany cost?

The cost of private health insurance in Germany can range from 150 to 1500 euros per month. According to a comparison done by Focus Money, a 35-year-old could get a very comprehensive cover from 326 to 592 euros. Unlike public health insurance, the cost is not based on your income but your age, health, profession, and tariff options. If you are employed, your employer will still cover 50% of the cost (up to the maximum amount covered if you were publicly insured). If you are self-employed, a freelancer, or a student, you must cover the entire insurance premium yourself. 

A common way to reduce your monthly private health insurance costs in Germany is to accept a deductible as part of your tariff. Let’s say your deductible is 1.000 euros per year; you would cover any medical expenses up to that amount from your own pocket and will only get reimbursed after that. This is great for people who go to the doctor rarely.

What is the insurance cover of private health insurance in Germany?

Generally speaking, private health insurance offers a higher level of service and cover than statutory health insurance. You can choose your cover and mix and match it to your needs. For example, you can get a more comprehensive dental cover, a single or double room in hospitals (compared to a quad room with public cover), faster appointments with specialists, and international cover. 

Which private health insurance should you choose in Germany?

The only private health insurance that offers all of their services in English and 100% digital is Ottonova. If this is important to you, you can schedule a free consultation with them. I have also written an in-depth review of Ottonova and their tariffs.

ottonova - German Health Insurance for Expats

Book your free consultation online and find out, whether ottonova is for you.

Book your free consultation now Learn More
Transparency: We earn a commission if you click this link and make a purchase at no additional cost to you.

Related Guide: Ottonova Review For Expats – An Honest Guide

If Ottonova won’t accept you, after you have consulted with them, you should again consult with a health insurance service provider, like Feather. They will compare the different private health insurers and their tariffs based on your needs and circumstances to find the best option for you.

How hard is it to get German public or private health insurance from abroad?

Once you have decided that you want to move to Germany, you will notice that you will need German health insurance for your visa application. International travel insurance will not suffice.

Should you move to Germany with a job contract that makes you compulsory insured (you are employed and earn less than 64.350 euros a year), you can already sign up with public health insurance. Easy!

Should you, however, want to move to Germany as a voluntary insured (higher paying job, self-employed, or no job yet) person, things can get a bit more complicated. Theoretically, you should be able to choose between public and private health insurance in Germany; however, in reality, public health insurance funds won’t accept you when coming from abroad. Most often or not, the only way you can be insured publicly is if you had been insured compulsorily before. 

Example: You moved to Germany with a job paying less than 64.350 euros, signed up with Techniker Krankenkasse, and decided to become self-employed two years later. In this case, TK would continue to insure you.

Therefore, private health insurance is the only option for many self-employed expats or expats with a high salary. However, you will also notice that most traditional German private health insurers will only insure you once you have a residence permit, which you will only get after moving and registering in Germany

To solve this issue and jump this hurdle, your best option to get your German visa is to sign up for expat health insurance.

Expat health insurance in Germany

Expat health insurance is also called incoming health insurance. It is temporary health insurance that covers you for a maximum of five years. If you are voluntarily insured in Germany, you will make your move here easier by getting expat health insurance.

As a non-EU citizen, you can get quality expat health insurance from Ottonova. What do I mean by quality? The expat health insurance from Ottonova has a full private insurance cover and will allow you to renew your residence permit, should you want to stay in Germany longer but less than five years.

International health insurances like Mawista, CareConcept, or aLC are not approved by the German Federal Financial Services Authority (BaFin). They may work to get your first resident permit, but they will most likely not be accepted by the immigration office (Ausländerbehörde) the second time around for renewal of your residence permit.

Feather also provides expat health insurance. It is 100% approved to get your visa, but will most likely also not get you a renewal of your residence permit. There is no need for a health questionnaire and the sign-up only takes two minutes.

So if you enter Germany on an expat health insurance other than from Ottonova, you need to change to proper German health insurance before your residents permit expires to stay in Germany. 

In either case, you should change to proper German health insurance as soon as your work situation becomes more stable. If you get seriously sick or injured while on expat health insurance, you lower your chances of being accepted by private health insurance in Germany. And if no one will insure you, you won’t be able to extend your residence permit and hence will be forced to leave Germany. That would be unfortunate!

Lastly, the cover of expat insurance is sufficient but not as good as public or private insurance. Long-term treatments and serious illnesses are covered; however, general check-ups or dental treatments are usually not covered.

Here is a list of all BaFin approved German private health insurances. Make sure to consult an independent insurance broker to find the best option for you.

Private vs Public Health Insurance in Germany Comparison

Private Health InsurancePublic Health Insurance
CostBased on your age and health conditionsBased on your income
Family coverageNo family coverageFamily can be insured for free through you
Treatment costsYou pay upfront and ask for reimbursementNo upfront payment
Deductible or no-claim cashbackCan be part of your contractNot applicable
Geographical coverInternational, depending on your coverGermany and in the EU (very basic cover)
Treatment coverComprehensiveStandard
Dental careComprehensive coverBasic cover
In the hospitalChief physician, single or double roomSpecialist physician, quad room
Selection of doctorsFree choiceNo private specialists
Appointments with specialistsShort notice possibleSometimes several months of waiting time
Selection of hospitalsFree choiceNo private clinics
MedicationComprehensive coverOnly prescription medicine with co-payment of 5-10 euros
Glasses and ContactsComprehensive coverOnly for hardship cases
Alternative treatmentsComprehensive cover Sometimes

Combination of public and private health insurance in Germany

Around 36% of all residents in Germany who have public health insurance have an additional supplementary private health insurance. This combination is quite popular, as it allows those that are insured compulsory with public insurance (you are employed and earn less than 64.350 euros a year) to increase their treatment and service cover.

The most popular supplementary private health insurance is dental insurance, followed by supplementary hospital insurance for a single or double room and treatment by the chief physician.

Related Guide: Best Dental Insurance In Germany

Ottonova offers both types of supplementary private insurances. Their information and sign-up page for supplementary hospital insurance is only in German; however, their Concierge service for this insurance is also available in English. 

Sign up for supplementary dental insurance from Ottonova
Sign up for supplementary hospital insurance from Ottonova

How to change health insurance from public to private in Germany

Let’s say you are currently employed and have public health insurance. Your circumstances change because you get a salary increase above 64.350 euros per year or decide to become self-employed. In that case, you now have the choice to stay with public health insurance and become voluntarily insured. You do not need to take action; this transition on paper happens automatically through your Krankenkasse

However, you also have the option to change to private health insurance. As mentioned before, you should consult an independent health insurance service provider to compare your options.

Once you have selected an insurance company and tariff, you will most likely need to provide a medical test or health questionnaire to see whether the private health insurance will accept you. Should all go smoothly, you will sign a new contract with them and send it to your current public health insurance. They will consequently end your health insurance with them. 

When looking into changing to private health insurance, don’t only look at the lowest price, but also at the treatment cover and the long-term premiums.

How to change health insurance from private to public in Germany

Once you have private health insurance, it is tremendously more difficult to change back to public health insurance. If you are over 55 years, it is pretty much impossible to change back to public health insurance.

If you are employed, you can only change back to the public system if your salary decreases below 64.350 euros per year. This could happen because you missed a bonus, you reduce your working hours, or your employer cut the vacation or Christmas allowance.

If you are self-employed, you can only change to public health insurance by becoming employed and earning less than 64.350 euros a year. 

These strict rules are in place because older people are much more expensive for health insurance than young and healthy people. The public health insurance system would collapse, if all young and healthy people change to private insurance because it is cheaper and then decide to change back to public insurance when they are older and sicker because private insurance is becoming more expensive. The public health insurance system needs young and healthy people to support the higher cost of the elderly. 

However, there are always exceptions to the rule, and an independent health insurance service provider can give you personalized advice. As per Statista, the 80s, 90s, and 2000s saw a lot more people switch to private health insurance compared to those switching to public health insurance. Since 2012 that has stopped. Since then, slightly more people per year switch to public health insurance.

Independent health insurance brokers for expats in Germany

To get professional help finding the best matching health insurance in Germany for your circumstances, here is a list of independent insurance brokers who have specialized in expats. Their services are free for you, as they receive a commission from each new customer’s insurances. They receive a lot higher commission for private than for public insurance, so be attentive, whether you are just being pushed to private or whether the broker takes an actual interest in your situation and needs. 

Conclusion

Health insurance in Germany is a complicated and highly individual topic. To get a German work visa and to live in Germany, you need to have health insurance. Whether you choose public, private, or a combination of both depends highly on your circumstances.

To summarize the wealth of information in this article, let me give you a simplified generalization for expats:

  • If you get a job before moving to Germany and you earn less than 64.350 euros a year → get public health insurance
  • If you move to Germany with a higher paying job, without a job, or as a freelancer → get expat health insurance first and switch to public or private once settled
  • If you are already in Germany and have the choice between public and private health insurance, talk to an independent insurance broker to discuss the general statement:
    • If you don’t have any dependents, you are young, healthy, and don’t plan to retire in Germany; then private health insurance might be a better and more economical option
    • If you have dependents, you are older, and you might want to retire in Germany, then public health insurance could be a better and more economical option

I hope I was able to shed some light on this complex topic. Whichever type of insurance you choose, rest assured that the German health system is one of the best in the world, and you don’t have to worry about your financial stability.

Choose wisely and stay healthy!  

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Yvonne
About the author: Yvonne was born and raised in Germany and has lived in the United States, France, and Spain. She understands the struggle of settling in a new home and is happy to share simple services and tips on how things are done in her home country, to help expats get their German experience started.