Brain Dump : Health Insurance in Germany

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This is what we have learned from experiences and asking questions related to our situation around health insurance in Germany. Definitely ask your own questions, but this might give you a basis of understanding. Laws change and every situation is different, as such I make no guarantees for this info.

Health Insurance Requirement

In Germany, there is a requirement that every resident have health insurance. This is also one of the first circles you might find yourself in with looking for a visa. You need insurance for a visa, and sometimes the insurance people want a visa to get you insurance.

Public vs Private

Insurance comes in two types: Private and Public (Gesetzliche).  As far as I understand, if you are employed in Germany earning under about 44K a year, you are required to be in the Public system.  When I first started working, I was able to just send an email to the Krankenkasse with my name and address and I was signed up. I probably had to go in and sign some forms later, but it was fairly painless.

Krankenkasse – Oddly translated as “sickness fund”, this is the word for a health insurance company. There are a number of them in Germany. AOK is the “general public insurance” and has branches in each state.

Private Insurance

This is something I know very little about. I don’t have it, so much of what is here is stories from friends.

  • It is an option for freelancers and employees above the limit for public.
  • There is a health screening which helps determine your premium. I have one friend who was denied coverage for a chronic condition. Another has told me that you need you answer the questionnaire honestly, if you are found to have a condition you didn’t mention they may not cover it.
  • It can be cheaper per month, but can rise as you get older.
  • It is difficult to get back into the public system once you are in private.
  • You pay a lot of things as you go and are reimbursed when you submit the receipts.

Public insurance

It is called Gesetzliche. If you are working for an employer in Germany and earning under a certain amount (44K a year I believe) you are legally required  to be a part of this system. There are a number of different Krankenkassen to choose from. They all cost the same (since 2008) and cover the governmental required things, yet can offer other services. I was also able to be on this type of insurance as an exchange student.

Cost : The price of healthcare is ~15.5% of your income, and yet if you are employed the employer pays half of this. If you are freelancing and still in the public insurance, you pay all of it. There is a minimum and a maximum. Current minimum is 340Euros/month with the maximum running close to 700Euros/month. This appears true whether your employer pays their half or not. So if you are required to pay the max of ~700 and the employer pays half, then 350 is pulled from your check.

Family Insurance : As a part of public insurance you are allowed to have your dependents with you on your insurance for no additional cost, provided they do not earn more than 395Euros (in 2014) a month. This is children and spouses. So while public insurance can be quite expensive, it gets spread out decently if you happen to have a big family.

This earning limit is a pretty strict thing apparently. We asked some questions and were told to report what you earn even if you are under it, giving them an idea of what you are doing. (German society does not endure surprises well.) Apparently you get one month or so of slightly above that limit if the rest are below, so it seems to make sense to be honest. And it apparently is gross income, not any sort of after-tax number.

Pflege Insurance : Part of what you pay is for true health insurance. Another smaller percentage is called Pflegeversicherung (Long Term Care). This is ever so slightly higher if you do not have children. As far as I understand this is an amount of money which is built up to take care of you when you are older. If you potentially need in-home care. Being in my mid thirties, I have not experienced this directly, but that is what I understand.

Krankengeld : If you are sick in Germany, you are sick. A doctor writes you off for an appropriate amount of time for your sickness and you notify your employer. You are still paid during this time and I have not heard of anyone with limited “sick days”. The employer picks up this cost up to 6 weeks of continuous sick time. After which it is taken up by the insurance company.

As a freelancer, I am able to get this “long term” money as well. Up to a year and a half apparently, but as my own employer I would have to foot the bill for the first 6 weeks of sickness. After which they apparently pay a percentage of what I earned beforehand.

Benefits : My experience with public insurance paying has been great. Everything seems to be covered with little to no co-pay. There was a 10Euro a quarter co-pay for doctors, but that got tossed a few years ago. Each night of Ali’s hospital stay was 10Euros as well. You show your card and there are very few extra costs.

Dental is included (-ish). We get one basic cleaning a year covered. It is pretty basic, so I tend to pay for the more thorough ones. I have also heard that you definitely need to do at least the once-a-year ones. If you do not, it reduces what the insurance will cover if there are major problems.

There is no medical questionnaire, so they just cover you and charge based on income.

Disadvantages: It can feel expensive if you are single, healthy and a low-mid earner. Perhaps less service than Private (I have heard that doctors like Private better), but we have not noticed it.

Public Insurance and Freelancers

As of last year, I am a freelancer web application developer in Freiburg. So I had to figure out how to deal with having insurance as such.

From what I understand, if you are in the public insurance and turn freelance (or earn more than the limit) you are allowed to stay in the public insurance. This is what they call Voluntary Insured (Freiwilligversichert), though you are voluntarily with them you are still required to have insurance in Germany. I have heard people mention that no freelancer is allowed in public, but this is definitely not true. It seems you must be in the public system for a certain amount of time prior to that switch, but are allowed to stay. This is my situation. I have heard that if you come in from outside of Germany and start as a freelancer they might not let you in from the outset. Just ask questions.

Creative Freelancers : Check out the Künstlersozialkasse (KSK) (info in English at the bottom of the page).

As per the rules for the self-employed (like freelancers), they shoulder the entire burden of the monthly insurance payments. This is crushing for a lot of freelancers, especially lower earners. It seemed to be a big barrier to being an artist or writer in Germany and it was surprising to me. Then someone on Twitter pointed me to the KSK.

As far as I understand it, the organization is set up for artists, authors, publicists and other creatives that work on a freelance basis. They shoulder the “employers” portion of both health insurance and pension, making it actually viable to be an author or creative.  I don’t know much more about it, but it seems like a great opportunity if you are in that kind of business in Germany.

Apotheke

Not exactly health insurance, but health related, are the Apotheke’s (Pharmacy /Chemist).  Any drugs are only available here, whether prescription or over-the-counter like aspirin. I’ve written more about them here.

Prescriptions from the doctor’s come in the form of small (standardized) slips of paper that you take to the pharmacy to get filled. Depending on the drug, you will either pay a standard fee like 5euros or if the drug is not covered, you pay the full amount. Though the full amounts are reasonable, not insane. I had to get a vaccine for our trip and paid 28Euros. Which is a lot, but probably what I would have paid in the US even with insurance.

After-hours : Apotheke’s are open normal business hours, though some close for lunch as well. This said, nights and weekends, every city will have a rotating plan of which Apotheke’s are open after hours. So if you need something on Sunday or late at night, there are Apotheke’s open somewhere, even if not on every corner. Check out for “Not-Apotheke” signs on the windows of any local one. That should show you which one is open after hours at the moment.

What now?

This is really just a brain dump of what I’ve found out asking questions. If you know things from your own experiences that I have wrong, please let me know. I would like this to be a resource for people.

Here are a few other guides on the subject in English that seemed readable and helpful:

I take no responsibility for these guides either. As I am learning in the expat world, a lot of information is hearsay and different depending on personal situation and whichever person you ask. Do your own research, but let this give you a background.

17 thoughts on “Brain Dump : Health Insurance in Germany

  1. Pingback: The one constant is change - Grounded Traveler

  2. I have been looking all over the internet and all I can find is information about health insurance while working in Germany. My husband will soon be working overseas (not in Germany), and we have hopes of the kids and I living in Germany during this time. We’re looking at approximately a year at this point. I would not be working at all, I would be with the four children, so there would be no insurance through a job. I know that we need to have insurance, but I’m not sure as to how to go about it. Does anyone have any basic information for me to research and get started on? I would really appreciate it. Thanks!

    • Is your husband going to be living in Germany as well? And simply working over the border somewhere else? If so, you might look for the word “Grenzganger” which means “Border Hopper”. There are enough Germans that work over the line that there are plans for them. Though without being German, I don’t know how much they will accept you.

      What is your visa situation like? You will need to show insurance among other things(like enough money/income to support your family) to be able to get a visa to reside in Germany. Also note that home schooling is not allowed in Germany. If your children are of age, you will need to enroll them in school.

      I have heard from others about Insurance Agents (Versicherungsmakler) who can help you choose a plan that fits you. They apparently get paid from the insurance company side, so they are free. Though it probably still is worth finding a decent one. If you have a city destination, you could start looking for one of these brokers and perhaps see if they would give advice by email.

      • Thank you for your speedy and helpful response!

        No, my husband will not be living in Germany. He will be working for three months straight in the Middle East, and then visiting (living?) with us for one month, then working for 3, etc. Kind of strange, I know.

        As of right now, there are no visas. I am in research mode at this point, no action yet since this won’t be happening for a while. I had heard that home schooling was illegal, but I was not sure if that applied if we are not citizens? Regardless, I would want my children enrolled to help them learn the language. We are all working on German right now, but I think being in school would help them immensely (on that note- International School? “Public” school? The internet is surprisingly useless in this area, also, so if you can point me in the right direction, I am eager to research that).

        What a relief to hear about the insurance agents. Thank you so much for that tidbit. I have been reading a lot about individual cities, and will be researching many (can you tell I’m a research nerd? Haha, I love learning everything I can about…everything). Any particular cities you would recommend for a family? I don’t care about “night life” (that seems to be what internet searches seem to think I want). I just want the kids and I to be able to be in a place where we can experience the language, culture, foods, beauty, and schools. Safety is important.

        Thank you for your time regarding this. It’s very kind of you to help a stranger out!

        • I believe the schooling thing applies to residents, not necessarily citizens, so you would indeed be affected as far as I know.

          You really should do some research on the visas. If you will have no job, you may end up with issues despite your husband working. I have no clue what to search for schools. Sorry, I don’t have kids so I know only what I overhear from friends. If you are really interested in Germany and can deal with sifting tons of information check out http://www.toytowngermany.com/. It is a forum, but a large one.

          As for cities, it all depends on what you want to do and what kind of environment you need. I would definitely recommend a city rather than any little village. If you need more expats around, Berlin and Munich are definitely to two larger ones. Freiburg is decent, but quite small for a city. Housing is an issue in most of Germany as well. It is not like the US where you can just find a place and move in quickly. It takes time and some places don’t even get rented with a kitchen.
          Safety is less about which town than which part of town. I have never felt unsafe in Germany.

  3. It has its outstanding things and its bad aspects. Same as the Nederlander system has outstanding and bad aspects. I think it will never be absolutely satisfying for everyone. But it is outstanding that there is a system.

  4. Thank you for this! Currently I am looking into Berlin for a possible base and I know they offer (with certain stipulations) a freelance work visa. But now knowing this about insurance to is a huge help!

    • Certainly do your research when coming in as a freelancer. I have heard friends saying that the rules of being allowed into the public system are different if you didn’t start as an employee of a German company.

  5. It has its excellent stuff and its bad factors. Same as the Nederlander program has excellent and bad factors. I think it will never be completely fulfilling for everyone. But it is excellent that there is a program.

  6. I love reading about how other countries do their health insurance. We definitely do not have it sorted correctly in the U.S. When I was living in England, my mom was so worried something would happen to me and I’d have to use their “terrible” health care system. Sure enough, I fell down a flight of stairs and like destroyed my knee. And they fixed me up quickly, for free. I think they might be onto something.

    • A lot of it is fear. The fear mongers tell stories of grandmothers denied surgeries and waiting ages for doctors. Maybe they exist, but I have seen enough good stories of such systems as well.

  7. An interesting and informative article. As I am Dutch I was comparing the information you described with my neighbor country. I was shocked about the high amount of healthcare that you pay for insurance in Germany. In the Netherlands we pay something between 70 and 150 euro’s, depending on things like deductibles, the insurance company and extra services like dental care.

    Good that a one year check up with the dentists is included in Germany. I find it strange that we have to pay extra for that service in the Netherlands, as in my opinion my teeth belong to my body. So healthcare should cover maintaining them. I guess that is one of the reasons why a German health insurance is more expensive. We used to have the private insurance option but the government dropped it. Maybe for the better.. I remember my mom telling that her dentist would only shake hands with people who where having a private health insurance.

    Another thing I like about the German health insurance that I like is that a small part is set aside for health costs when you are older. It would be nice to have something like that in The Netherlands as well.

    • It is much more expensive, as you say, but it does feel like everything is included. Part of the expense is likely also the ability to have a whole family on one income in some circumstances.
      Germans will complain that the system is broken and failing and blah blah. Not sure if this is true or just a general German tendency to complain. It feels ok from within it.

      • It has its good things and its bad things. Same as the Dutch system has good and bad points. I guess it will never be totally satisfying for everyone. But it is good that there is a system. Now I am living in Thailand where health insurance is not required and a privilege for the rich. Someone told me her child died just because she was not able to afford the hospital costs. I would choose for any kind of healthcare insurance if it would prevent anything like that to happen

        • “Everyone” is always a very wide group. There is pretty much no chance to find an ideal system for that group. The sad part is that most systems benefit the richer just by nature.
          As for Thailand, we were just there (on holiday, so of course different view), but the healthcare seemed really cheap and decent for what we needed. We were told by others that it was pretty cheap as well. Maybe it is still expensive in a fairly cheap country overall, where the wages aren’t that high. That is sad to hear in any country though.

  8. That made my head hurt reading it, but it’s necessary and useful info for those thinking of relocating to Germany. As a digital nomad, this is good to know … thanks!

    • Why did it make your head hurt? Don’t get me at all wrong, Germany is indeed a great place, but it takes some work to get into the groove.

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