Are you aware of the difference between private vs public health insurance in Germany? Which one is better for you? What are the pros and cons of each of them? How to decide which one you should take? In this post, you will find everything you need to know about private vs public health insurance in Germany.
Healthcare system in Germany
Germany has a very comprehensive healthcare system. Health insurance is compulsory for every resident. If you plan to move to Germany, you will need to show valid health insurance to apply for your residency visa.
I actually really like this system in Germany. I know, it is expensive. However, you don’t have to worry when you are sick. In my hometown Hong Kong, health insurance is not compulsory. If you are sick and don’t have a health insurance, you are basically screwed. Many people also delay going to the doctor just to try to save costs. In Germany, you can go to doctors or even specialists whenever you are unwell, without worrying about the costs.
Options of health insurance in Germany
You have three options of health insurance in Germany:
- Public health insurance (Gesetzliche Krankenversicherung, GKV)
- Private health insurance (Private Krankenversicherung, PKV)
- Combination of the two (public health insurance plus supplemental private insurance on top)
Public health insurance in Germany (Gesetzliche Krankenversicherung, GKV)
Public health insurance is regulated by the government. Most people in Germany are under public insurance. You can either be voluntarily public insured (freiwillig versichert) or compulsorily public insured (pflichtversichert).
If you are an employee in Germany and earn less than 62,550 EUR per year or 5,213 EUR per month (year 2020), then you MUST have public health insurance. It means that you are compulsorily public insured.
If you earn over this income threshold, then you can choose between public health insurance or private health insurance. In case you decide to stay in public health insurance, then you are voluntarily public insured.
When you are publicly insured, your dependent spouse or children can be insured under you without additional cost. You need to present your insurance card on every doctor’s visit. Your doctor will get the money from your insurance directly, meaning that you don’t have to pay anything upfront.
If you are outside Germany, you may be able to reimburse your medical costs in other European countries. However, not all costs may be reimbursed and you may only get a portion of the cost back. Therefore, if you plan to have any medical treatments in other European countries, it will be best to check with your public insurance in Germany beforehand to avoid any bad surprises afterward.
How much does public health insurance in Germany cost?
How much you have to pay for your public health insurance is linked to your income. The more you earn, the more you have to pay. In 2020, the rate is around 15.7% of your salary. But don’t worry. There is a maximum amount that they can charge you. The maximum monthly income used to calculate your public health insurance cost is 4,688 EUR per month (year 2020). You will not need to pay more for your public insurance if you earn more than this amount. Besides, a good thing about being an employee is that your employer will have to contribute to half of your health insurance cost.
Example of public health insurance cost:
Let’s say you earn 4,688 EUR per month, you will have to pay around
4,688 EUR x 15.7% = 736 EUR
Since your employer will contribute to half of the cost, the maximum public health insurance cost you have to pay will be 368 EUR per month.
On top of the public health insurance cost, you must also join the government’s long-term nursing care scheme (Pflegepflichtversicherung). In 2020, this is 3.05% of your gross salary, or 3.3% if you do not have kids.
Let’s take the same example again:
If you earn 4,688 EUR and do not have kids, then you will have to pay 4,688 EUR x 3.3% = 155 EUR. In this case, your employer will only contribute up to 71 EUR, meaning that you have to pay 84 EUR yourself.
So, it means that the monthly maximum you will have to pay for your public health insurance plus the long term care cost will be 368 EUR + 84 EUR = 452 EUR. Again, if you earn less, you are going to pay less.
Note that if you are a university student under 30 years old, you can pay a reduced amount to enjoy the same public health insurance coverage. In that case, the public health insurance cost plus the long term care cost is around 100 EUR per month.
Public health insurance companies in Germany
There are different public health insurance companies to choose from in Germany. Since the public health insurance is regulated by the government, the coverage these companies offer is not of a big difference. Some biggest public health insurance companies include TK, AOK, DAK, etc. Be aware that not all insurance companies have English speaking staff. They may also have slightly different rates and incentives.
Private Health Insurance in Germany (Private Krankenversicherung, PKV)
This is the health insurance provided by private companies. The cost and coverage are different depending on the companies and packages. Note that to be accepted by the private health insurance companies, you may need to do a medical test or fill in the health questionnaire.
How much does it cost to have private health insurance in Germany?
Unlike public health insurance, the cost of private health insurance in Germany is based on your age and health instead of your income. If you are young and healthy, you can usually get a cheaper package with better services compared to public health insurance.
You can usually save cost by adding a deductible amount in your private health insurance package. It means that you will only get reimbursed after this deductible amount is reached. And you have to pay the cost yourself if your medical expense is within this deductible amount.
Some private health insurance packages also offer cashback incentives. It means that you can have some cashback if you only reimburse a limited amount from them. You can save money with this if you are healthy.
Note that some portions of your private health insurance cost are also tax-deductible. This further reduces your cost when you have private health insurance.
What is the insurance coverage of private health insurance in Germany?
Private health insurance offers a higher level of service in general. It usually covers more choices for medical treatment and also more geographical locations. Unlike in public health insurance where the coverage is pretty standard, you can choose your own coverage in private health insurance to include those services which are not covered by public health insurance. For example, additional dental services, a private room in the hospital and so on.
Who can choose to use private health insurance in Germany?
As mentioned before, if you are an employee and earn less than 62,550 EUR per year, you MUST join the public health insurance. If you are one of the categories below, you can choose to use private health insurance instead.
- An employee who earns more than 62,550 EUR per year
- German civil servants, e.g. professors
- People who have a mini-job and earn less than 450 EUR a month
- Unemployed people
Private health insurance companies in Germany
There are many different private health insurance companies to choose from. Some big companies include Allianz Private Krankenversicherung, AXA, Barmenia, etc. Different private health insurance can be very different in terms of price and coverage. You can use this website to compare their different offers.
If you are not comfortable with the German language, Ottonova can be a good choice for you. Ottonova is very popular among expats. They have an English website and also 24 hours of English support which makes your life easier. Besides, they have special rates for expats and they also fulfill all legal requirements for your visa. Some other cool functions include:
- English speaking Concierge team to schedule your doctor’s appointment for you
- English speaking doctor on a video call
- Fast reimbursement (within a few hours)
- No paperwork (send your document using their app)
You can check their plans here now.
Combination of private and public health insurance in Germany
This is an option for people who want to stay in public health insurance, but would like to enjoy more coverage than what is offered by the standard public health insurance. What they can do is that they purchase a policy from private health insurance to cover costs that the public health insurance is not covering.
For example, standard public health insurance has very limited coverage for alternative treatment like acupuncture or Chinese medicine, dental treatment, private doctor or private room in a hospital, etc. The supplementary private health insurance can be very customized to your needs.
In my case, I am Chinese and I really prefer Chinese medicine over the conventional one. Without supplementary private health insurance, it will cost me a fortune to have acupuncture or other Chinese medical treatment. With my supplementary private health insurance now, I can visit the Chinese doctors as I like without worrying about the cost.
You can use this website to compare the different packages of supplementary private health insurance.
Change between Private and public health insurance
Change from public to private health insurance
If you are employed and your salary increases to over 62,550 EUR per year, you have a choice to change from public to private health insurance. You can also stay in public health insurance as before, and become voluntarily public insured.
Change from private to public health insurance
To change from private to public health insurance is more complicated. If you are over 55 years old, it is almost impossible to change back. For people who are younger than 55 years old and employed, they can change back to public health insurance if their salary falls below 62,550 EUR per year. This can happen if, for example, the employer reduces the working hours, cuts the Christmas bonus or the 13th-month salary. For self-employed people younger than 55 years old, they can only change back if they become employed and earn less than 62,550 EUR per year.
The reason for this system is that it is much more expensive to have older people than younger people in public health insurance. As mentioned before, for young and healthy people, it is usually cheaper for them to use private health insurance and they also receive better services. If all these young people switch to private health insurance and change back to public health insurance when they are old and sick, it will be a great financial burden for public health insurance. The public health insurance needs young and healthy people to be in their scheme to support those who are old and sick.
It is complicated
Switching between private and public health insurance is a complicated topic and it depends a lot on your individual situation. The condition to change I describe above is only in general and there can be exceptions. It is complicated to put all the rules and situations in words here. It is recommended that you consult an expert in the health insurance industry to advise you on all the details based on your situation.
Private vs public health insurance: Which one is better?
If you have a choice to choose between private vs public health insurance, which one should you choose?
Let’s take a look at some benefits for choosing private vs public health insurance.
Private vs public health insurance: Benefits of having public health insurance in Germany
Cost of public health insurance is based on your income
The cost of public health insurance is directly linked to your income. The more you earn, the more you will have to pay, and vice versa. It means that you are exposed to a lower financial risk because the cost has nothing to do with your age or health conditions.
With private health insurance, the premium rate may be uncertain in the long term. If the rate is too high relative to your income in the future, and you are already over 55 years old, it will be extremely hard to switch back to public health insurance.
Public health insurance covers your family at no extra cost
If you have a dependent spouse or children, they can insure under you without additional cost. This is very attractive, especially for people who have more kids.
Public health insurance is easy to apply
Since public health insurance will cover pre-existing health conditions, your health is not a deciding factor of whether you will be accepted or not. No health test or questionnaire is necessary and it is therefore easy to apply.
You don’t need to pay your medical costs upfront
Once you are accepted by the public health insurance, you will receive a health insurance card. You need to present this card whenever you visit a doctor. Your doctor will get reimbursed by your insurance directly and you don’t need to pay anything to the doctor.
Private vs public health insurance: Benefits of having private health insurance in Germany
You get your doctor appointment faster
Many doctors prioritize patients with private health insurance because they can get paid faster and better. If you have public health insurance, you probably need to wait for weeks to get an appointment with a specialist. On the other hand, you may get your appointment immediately with private health insurance.
It has happened to me many times that when I called to make an appointment with a doctor, they directly asked me what kind of insurance I had. Once I told them that I had public health insurance, they told me that they were full and it was very hard for me to get an appointment.
My friend with private health insurance told me that once he was sick and wanted to book an appointment with the doctor. Once the praxis heard that he had private health insurance, they prioritized him by postponing another patient who was suffering from cancer. He didn’t accept this appointment though as he thought this was wrong. Yes, I think this is very wrong too. Unfortunately, this is the reality.
You have better access to specialists with private health insurance
Since not all the specialists accept patients with public health insurance, you can have access to exclusive and even multilingual doctors who speak your language if you are privately health insured. This is especially beneficial to expats who have limited German knowledge.
Private health insurance often offers better coverage and treatment
Private health insurance often covers medical costs where public health insurance does not cover. For example, dental care like professional cleaning or implants, visual aids like glasses or contact lenses, hospital services like private room or treatment by a chief doctor, etc.
Public health insurance covers only very basic services from dental services. To give you an example, I have problems with my teeth which require me to do dental treatment regularly. With public health insurance, even with co-payment, I have to pay hundreds of Euro every time. Besides, due to my teeth issue, I also have to do frequent professional teeth cleaning which is not covered by public health insurance.
I do not understand why public health insurance is so bad in terms of dental services. For me, those are necessary medical treatment to stop my teeth pain. Even for a person with healthy teeth, they are recommended to have professional teeth cleaning once a year. I wonder how people with financial difficulties will survive these costs. If you have private health insurance, you will usually get much better dental coverage even with the most basic insurance package.
Another example: My friend recently did an eye laser treatment which costs more than 4000 EUR as he has public health insurance. Another college of mine did the same treatment without paying anything because he has private health insurance. This is another great benefit especially if you plan to do such treatment.
You can save cost by opting for a deductible amount or getting cashback
If you have public health insurance, your cost is linked to your income. There is no impact on how much or how little you use the medical services. You are still going to pay the same amount.
With private health insurance, you can pay a lower premium by adding a deductible amount. You will not get reimbursed until this deductible amount is reached. Similarly, you may get cashback by the end of the year if you only reimburse a limited amount from your private health insurance. For healthy people who do not need many medical services, these are good ways to save money.
Private health insurance covers more medicine costs
In Germany, you will not get your medicines directly from the doctors. You will need to go to a pharmacy (Apotheke) to buy your medicines. With public health insurance, many prescribed drugs are covered with a co-payment. You will most likely pay around 5 to 10 EUR in the pharmacy. If you have private health insurance, there are normally more medicines covered than public health insurance. Besides, many alternative medicines like Chinese medicine, homeopathy or acupuncture can be covered by private health insurance as well.
Note also that over-the-counter medicines without doctors’ prescriptions are unlikely to be covered by either public or private health insurance.
Private health insurance has a broader geographical coverage
Public health insurance covers your medical expenses inside Germany and in some cases also other European countries. But you will not be insured when you are outside of Europe. Private health insurance normally covers additional countries, depending on the package you choose.
Private health insurance is usually cheaper for young and healthy people
Since the cost of private health insurance depends on your age and health, you will usually get a cheaper package with better services compared to public health insurance, if you are young and healthy. Besides, you can include or exclude coverage based on your individual needs. It means that your insurance plan is more customized and you are paying the best value for your needs.
Private vs public health insurance: Comparison
|Public health insurance||Private health insurance|
|Cost||Based on your income||Based on your age or health conditions|
|Family coverage||Cover your dependent spouse or children||No family coverage|
|Application||Easy to apply||May need health tests or questionnaire|
|Payment||No payment upfront||Pay first and then reimburse|
|Getting doctor appointments||Slower||Faster|
|Access to specialists||Limited||More choices|
|Coverage and treatment||Limited||Broader|
|Deductible amount or cashback||Not applicable||Can be available|
|Cost of prescribed medicines||Usually co-payment (5 to 10 EUR)||More medicines covered|
|Geographical coverage||Germany and in some cases other European countries||Worldwide, depending on the package|
Read more about ALL types of insurances in Germany: Insurance in Germany – Which one do you need?
Private vs public health insurance: Who is suitable for private health insurance?
People with stable and good income
People with good income have fewer financial risks in the long term. They can choose to have private health insurance to enjoy better services.
People who are not accepted by public health insurance
Well, in this case, there is no choice.
People who are young and healthy
These people tend to pay less and enjoy better services with private health insurance, why not?
People who travel a lot to other countries
If you travel a lot, it makes sense to have a broader geographical coverage offered by private health insurance. This applies especially to non-European expats, who travel back home a lot.
People who do not plan to stay in Germany permanently
If you plan to stay in Germany only for a few years, or if you do not plan to live in Germany forever, it is better to have private health insurance if you can. The young and healthy people are subsidizing the old and sick people in public health insurance. If you don’t live in Germany anymore, you will not be able to enjoy the medical benefits when you get older.
Private vs public health insurance: How to decide?
To summarize, there are several factors you can use to decide if you should go for private vs public health insurance.
Private vs public health insurance: Factors to consider
|Factors to consider||Private vs public health insurance|
|Age and health||Young and healthy -> private health insurance|
|Family status||Many kids or dependent spouse -> public health insurance|
|Salary level||High income -> private health insurance|
|How long will you stay in Germany?||Temporarily -> private health insurance|
|How many service coverages do you need?||Better service coverage -> private health insurance|
As mentioned before, deciding on private vs public health insurance is a very complicated topic and it may affect you in the long term. It is recommended that you consult an expert from the health insurance industry who can advise on your individual situation.
Do you have private or public health insurance in Germany? Are you happy with your health insurance? Leave a comment below and let me know!