Private vs Public Health Insurance: What is Better for Expats in Germany?

This post contains affiliate links. It means that if you click on the links and make a purchase, we will receive a small commission at no additional cost to you. This allows our blog to continue providing you with free information. We only include links and products that we truly believe in. You can read the full disclosure here.

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.

Moving to Germany or new in Germany? Check out our Resources Page for all the help you need!

Table of Contents

Healthcare system in Germany

Germany has a very comprehensive healthcare system (There is even health insurance for pets!). 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).

Income threshold

If you are an employee in Germany and earn less than 69,300 EUR per year or 5,775 EUR per month (year 2024), 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.

Medical costs abroad

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 2024, the rate can be as high as 16.3% 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 5,175 EUR per month (year 2024). 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 5,175 EUR per month, you will have to pay around

5,175 EUR x 16.3% = 844 EUR

Since your employer will contribute to half of the cost, the maximum public health insurance cost you have to pay will be 422 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 2024, this is 4% of your gross salary if you do not have kids, or 3.4% if you have one kid (and 0.25% down for each additional kid)

Let’s take the same example again:

If you earn 5,175 EUR and do not have kids, then you will have to pay 5,175 EUR x 4% = 207 EUR. In this case, your employer will only contribute up to 88 EUR, meaning that you have to pay 119 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 422 EUR + 119 EUR = 541 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 112 – 125 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.

I am insured with TK for 12 years now and my whole family is with TK. If you are looking for public health insurance in Germany, I can highly recommend TK because of its English language, great coverage, and excellent customer support. Check out my TK review here.

You can use the service from Feather to sign up for TK public health insurance. The sign up process is 100% in English. They also provide English support in case you have any questions.

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 69,300 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 69,300 EUR per year
Self-employed
Students
German civil servants, e.g. professors
Freelancers
People who have a mini-job and earn less than 538 EUR a month
Unemployed people

Private health insurance companies in Germany

There are many different private health insurance companies to choose from. 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.

Disclosure: If you click this link and make a purchase, we will receive a small commission at no additional cost to you.

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.

Besides, since the dental coverage from public health insurance is very bad, it is highly recommended to get supplementary dental insurance. I recommend getting a supplementary dental insurance from Ottonova due to its English support, fast reimbursement, and cheap price. You can also use this website to compare different packages of other supplementary private health insurance.

For more details, check this out: Best Dental insurance Germany – Top 3 Comparison

Disclosure: If you click this link and make a purchase, we will receive a small commission at no additional cost to you.

Change between Private and public health insurance

Change from public to private health insurance

If you are employed and your salary increases to over 69,300 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 69,300 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 69,300 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.

If you prefer to get professional advice before buying your insurance, I can highly recommend joining a free English online seminar. The seminar is hosted by financial advisers from Swiss Life Select, one of the largest German financial advisory companies.

By the way, we bought all our insurances via our financial adviser from Swiss Life Select. Our financial adviser does not work for a specific insurance company. Instead, he compares the best offers in the market and gives us independent advice. Besides, he speaks excellent English, which is perfect for expats like me.

You will learn everything you need to know about insurance in Germany in the online seminar. If you want, you can also book a 1:1 meeting with my financial adviser to get a free personal consultation.

Swiss Life Select_free english financial online seminar and 1 to 1 consultation with finance adviser — Disclosure: If you click this link and make a purchase, we will receive a small commission at no additional cost to you.

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. Just contact my financial adviser to get your free personalized financial advice.

Disclaimer

Please be aware that this article is intended to provide you a brief overview of health insurance in Germany. The information and tips in this article are based on personal experiences and thorough research.

This blog is not an insurance broker platform and this article does not represent professional advice. Before purchasing, you should read the fine print of the insurance policy to make sure you understand the details.

This blog is not qualified to give you any financial advice according to German law and we do not accept any form of liability resulting from reading this article. Our blog makes no guarantee as to the accuracy or timeliness of the information in this article.

If you need any more details or the latest information, please refer to the insurance companies’ websites directly. If you need personal insurance advice, please contact an independent financial adviser.

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!