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Public or Private Health Insurance in Germany [2023 English Guide]

Updated: Apr 8

Looking for health insurance in Germany? Learn the differences between public and private insurance, including premiums and benefits. And choose between public or private health insurance based on your income and long-term needs.

Public vs Private German Health Insurance System

Key Takeaways

  • You can choose statutory or public health insurance if you don't have private insurance.

  • If you choose public health insurance, your contribution amount will depend on your income. Private health insurance (Private Krankenversicherung (PKV)) premium depends on your age and health.

  • Public insurance providers continuously adjust the services they offer. However, private insurance companies cannot change your contractually agreed benefits.

  • Only civil servants and high earners with secure long-term income should choose private health insurance.


This is how you do it

  • Before deciding between public or private insurance, you should weigh the pros and cons of both healthcare systems in the long term.

  • You must pay close attention to the services, benefits, and insurance premiums while picking a health insurance policy in Germany.

  • Consult an independent health insurance broker while picking a public or private insurance plan.

  • You can compare different private health insurance tariffs* and supplementary insurance plans* on the comparison portal TarifCheck.


Table of Contents

  1. How does private and public health insurance differ in Germany?

  2. Who is private health insurance for?

  3. Who is statutory health insurance for?

  4. Why does private health insurance become more expensive as you age?

  5. Can German health insurance benefits change over time?

  6. What services do private health insurers and statutory health insurers cover?

  7. Can I switch my public or private health insurance providers?

  8. Can I move from private to public health insurance or vice versa?

  9. How do I find the right health insurance policy?

  10. Conclusion: Is public health insurance the better choice?


German health insurance system is unique. Germany is the only country in Europe where two health insurance systems exist side by side.

It's not easy to compare the benefits of public and private health insurance.

Many of the services provided by public and private health insurance systems are the same. Still, there are fundamental differences between the two healthcare systems.

For example, health insurance costs calculation, different insurance plans offered by the two, etc.


How does private and public health insurance differ in Germany?

Public vs Private Health Insurance

Private health insurance (Private Krankenversicherung (PKV) in German) offers

  • shorter waiting times for appointments with specialists,

  • treatment by highly-paid specialists,

  • and access to the latest medical techniques.

However, only expensive private insurance scheme covers the benefits mentioned above.

Cheaper private health insurance plans offer less protection and, for some treatments, pay less than public health insurance companies.

On the other hand, public health insurance companies (Gesetzlichen Kran­ken­kas­sen (GKV) in German) operate on a solidarity system. Under the solidarity system, the public health insurer treats all insured persons equally.

Everyone gets the same health insurance protection regardless of the insured person's contribution amount.

Moreover, you can add private supplementary insurance (Private Zu­satz­ver­si­che­rung­en in German) on top of your public insurance.

This way, you can access additional benefits your public health scheme doesn't cover.


 

Private health insurance

Private health insurance

Who is private health insurance for?

Private health insurance is mainly suitable for

  • civil servants,

  • self-employed individuals,

  • students,

  • and employees whose salary exceeds the annual income limit.

The annual limit is 66,600 € gross per year in 2023.

However, not everyone who is eligible for a private insurance plan should opt for it. It's a life-long decision because returning to the public system is not easy.

Thus, you should consider the implications of changing to private health insurance beforehand.

Everyone in Germany can voluntarily insure themselves with a public health insurer. So, picking private health insurance is a choice and not a mandate.


How much is the private health insurance premium in Germany?

Private health insurance cost depends on your age, health, and the insurance plan you pick. Hence, the insurance contribution amount can vary drastically for each person.

In general, the private insurance cost for a young, healthy individual with a basic tariff may cost around 300 €. And the insurance premium can go as high as 1500 € with age and additional benefits.

You can use the private health insurance cost calculators* to compare different insurance plans and their costs.


How to pick a private health insurance plan?

A good starting point is comparing the costs and services different private insurance providers offers on comparison portal like TarifCheck*.

But, finding the right private health insurance plan is time-consuming and requires professional help. Hence, you should consult an independent health insurance broker for advice.

You can find an insurance broker by searching "unabhängige beratung krankenversicherung" on Google. Many insurance brokers in Germany speak English.


Do German employers contribute to private health insurance premiums?

German employers pay half of the private health insurance premium for employees. But only up to the maximum rate of a statutory insured person, which is 404 € in 2023.


Private health insurance providers can reject your application.

Private health insurance companies can select and reject their customers, unlike public health insurers.

For example, a private health insurer can reject a customer with a pre-existing illness.


In what cases private health insurance providers must accept a customer?

There are certain cases where private health insurance providers must accept customers regardless of their health.

  • If a customer cannot enter the public health insurance system. But in this case, private health insurer offers only the basic and standard tariffs with severely restricted benefits.

  • If the customer was previously privately insured.


 

Public health insurance

Public health insurance

Who is statutory health insurance for?

Public health insurance in Germany is available to everyone, regardless of age or health. Moreover, everyone enjoys the same medical care under the public healthcare system.

Income is the only factor that determines the public health insurance premium amount.


How much is the public health insurance premium in Germany?

public health insurance premium

Public health insurance premium is 14.6 percent of your income, plus an additional contribution (Zusatzbeitrag in German).

The additional contribution (Zusatzbeitrag) amount depends on your health insurance provider.

As the public insurance premium is the percentage of your income, individuals with lower incomes pay less than those with higher incomes.

But the maximum income German public health insurance companies consider for calculating the premium is 4987.50 € per month (as of 2023).

Thus, the maximum public insurance premium you'll pay is 728 € per month.

In short, German public insurance companies divide the income into four sections and calculate the public insurance premium differently for each.

Category

Income

Public insurance premium

Minijobs

Less than 520 € per month

14.6% of 1,131.67 € = 165 € per month

Midijobs

2000 € per month

The premium percentage decreases with salary.

10.8 % is the lowest and 14.6% is the max.

Employee tariff

More than 2000 € and less than 4987.5 € per month

14.6% of your monthly income.

Maximum monthly income limit

More than 4987.5 € per month

14.6% of 4987.5 € = 728 € per month.


Public health insurance premium for students in Germany

Public health insurance premium for students

German public health insurance contribution for students is 82.99 € per month plus additional contribution (as of 2023).

The additional contribution (zusatzbeitrag in German) differs from public health insurer to insurer and is between 3.25 € and 12.99 € per month (as of 2023).

The contribution to long-term care insurance (Pflegeversicherung in German) for students older than 23 with no kids is 27.61 € per month and 24.77 € per month for all other students.


Public health insurance premiums for families

Everyone who is working must pay the public health insurance premium. However, public health insurance covers non-working members of your family for free.

Public insurance considers your spouse and children as your family members. Hence, you can insure your spouse and kids for free if they are not working.

However, you cannot insure your non-working or retired parents under your public health insurance plan.

But the insurance provider covers your non-working or retired parents for free if they move to Germany under "The right to free movement in the EU."


Do German employers contribute to the public insurance premium?

German employers pay half of the public health insurance contribution for their employees.


Why does private health insurance become more expensive as you age?

Private health insurance contributions are not based on income but on age, health, and insurance benefits.

While young and healthy people may pay lower contributions for private insurance, premiums often increase significantly as they get older.

The reason is obvious - you need more medical attention as you age. Hence, it reflects in the private insurance premium also.


Private health insurance costs for families

Private & public family health insurance costs

You must pay separate private health insurance contributions for each insured person, including your spouse and children.

On average, you pay around 600 to 800 € per month for a good private health insurance tariff for an adult.

Thus, making private health insurance for families more expensive than family insurance in the public system, especially if there is only one earner in the family.


Private health insurance costs in old age

Private insurance companies set aside part of the insured's contributions for old age.

But it only covers part of the costs that arise over the years due to higher expenditures for the insured and medical progress.

Even in retirement, when income is lower, contributions continue to rise.


Can I reduce my private health insurance premium?

Some private health insurance companies offer tariffs with a deductible to reduce the monthly insurance contribution.

In tariffs with a deductible, you pay the medical costs up to the deductible amount, and the insurance provider covers the rest.

However, you should consider the deductible amount carefully, as you can reduce it only after a new health check.

Furthermore, reducing your existing deductible is difficult if you become ill with a condition, for example, high blood pressure or back pain.

Employees also benefit less from the savings from a deductible tariff than the self-employed.

It is because employees share the monthly contributions with the employer but must pay the deductible entirely on their own.

Moreover, private health insurance plans promising an insurance premium refund if no medical invoices are submitted may not be as attractive as they appear due to tax disadvantages.

Thus, you should carefully consider your health needs and circumstances when choosing between public or private health insurance.


 

Private vs. Public health insurance

Private vs. Public health insurance

Can German health insurance benefits change over time?

Change in public health insurance benefits

The German health system constantly adjusts the list of services provided by statutory health insurance.

Thus, it's uncertain which services the public health insurance providers will cover in the future.

For example, recently, politicians abolished the reimbursement of over-the-counter medicines and reduced the subsidies on dentures.


Change in private health insurance benefits

In contrast, private health insurance companies cannot easily adjust the list of services covered by them.

Once you sign a contract with the private health insurer, you and the insurer cannot change the contractually agreed healthcare services.

So, if a new medical treatment is available but is not part of your private insurance plan, the insurer will not cover its costs.

Hence, changing the health insurance plan is the only way to opt for or change your healthcare services.

However, changing to a different tariff can come with hurdles, such as a health check and possibly higher premiums.

You can compare different private health insurance plans here*.


What services do private health insurers and statutory health insurers cover?

Comparing the coverage of private and public health insurers in Germany can be challenging due to the absence of a fixed catalog of services in the private healthcare system.

Instead, private health insurers offer various tariffs.

Each person can customize their medical coverage as per their needs, much like a modular system.

Private health insurance can sometimes cover more than statutory health insurance schemes. For example, alternative practitioner treatments, comprehensive dentures, orthodontics, and spa stays.

However, state insurance schemes may provide better protection during long periods of absence from work due to illness or parental leave.

Additionally, public health scheme often covers psychotherapy, rehabilitation, and cures better than good private health insurance plans.

Nevertheless, you can supplement your standard public health insurance plan with optional tariffs.

The optional tariffs cover the healthcare costs that are otherwise only paid for by private insurers. You can compare the optional tariffs on the comparison portal TarifCheck*.


Private vs. Public health insurance in Germany

Public health insurance

Private health insurance

DOCTOR

Selection

Only doctors with health insurance approval

Free choice of medical doctors

Invoice

The insurer settles the invoice directly.

The patient pays the invoice and then has the costs reimbursed by the insurance company.

Drugs

  • The patient pays 10% of the prescribed medicine's cost (min. €5, max. €10)

  • No reimbursement for over-the-counter drugs.

Usually, full reimbursement of all medicines, a deductible may apply.

Psychotherapy

  • The insurer covers the approved therapies costs

  • Depending on the treatment, max. 300 sessions

  • Approval required

  • Whether and to what extent costs are covered depends on the tariff

  • Usually limited to a few sessions (20 - 30 per year)

Aids / Services (wheelchairs, prostheses, etc.)

  • The insurer covers the costs of services (aids) mentioned in a directory that is revised regularly.

  • 10% additional payment (min. €5, max. €10)

  • Often limited catalog of services that are not adapted regularly

  • Often the limited scope of reimbursement

Money

Doctors receive a flat-rate fee depending on the diagnosis

Doctors can charge higher fees to privately insured patients

HOSPITAL CARE

Hospital

Admission to the nearest suitable clinic

Free choice of hospital or private clinic possible depending on the tariff

Accommodation

Usually dormitories

Mostly single or double rooms, in a few tariffs multi-bed rooms

Treatment

Doctor on duty

  • Chief physician

  • Doctor on duty in a few tariffs

Additional payment

€10 per day for a maximum of 28 days per year

No additional payment

DENTIST

Treatment

  • Full assumption of the costs of basic care (e.g., amalgam fillings)

  • Subsidy for more expensive fillings/inlays.

  • No restriction to basic service

  • Pays 50% to 100% of the costs depending on the tariff

Dentures

Pays a subsidy of 60% on the basic service (max. 75%, with a complete bonus booklet). The patient must cover the remaining costs, e.g., for inlays/implants

  • No limitation to basic care

  • Pays 50% to 100% of the costs depending on the tariff. Often with a limit on the sum

  • Few tariffs also cover the implant costs.

UNABLE TO WORK

Sick pay

  • The insurer pays 70% of your gross income or max. 90% of net income from the 43rd day of sick leave.

  • The same applies to leaves in the case of a sick child.

  • Special rules apply to voluntarily insured people.

  • When and how much the insurer will pay depends on your insurance plan.

  • The insurer doesn't pay in the case of a sick child.

Maternity Protection

  • Max. 13 €/day maternity allowance from the health insurance company

  • The employer tops the maternity allowance to bring it closer to the net salary.

  • Special rules for voluntarily insured persons.

Max. 210 € maternity benefit from the "Federal Insurance Office" depending on the tariff

Maternity leave

  • You don't have to pay insurance premiums during maternity leave.

  • Special rules for voluntarily insured persons

Usually no exemption from paying monthly insurance contributions during maternity leave.


Source: 1


 

Switching insurance providers

Can I switch my public or private health insurance providers?

Switching your public insurance providers is fairly easy. However, switching from one private health insurance company to another is more complicated.

Theoretically, privately insured people can choose another private health insurance provider. But they may lose a large part of their old-age provisions.

Moreover, privately insured people have to undergo a health check again with the new private health insurer.

Hence, choosing a private health insurance plan with good services is important right from the start.

You can always switch to a cheaper private health insurance tariff with another provider if your current private insurance has become too expensive.

However, if an insurance broker advises you to change your private health insurance company, their suggestion might be motivated by the new insurance contract commission.

So, perform your due diligence while changing private health insurance companies in Germany.


Can I move from private to public health insurance or vice versa?

Switch from private to public health insurance

Moving from public to private health insurance is straightforward if your income exceeds the annual limit (66,600 € per annum as of 2023).

However, returning from private to state health insurance is only possible in exceptional cases.

German legislators purposely made the switching from private to public insurance tough.

They want to prevent healthy high earners from choosing private health insurance when young and switching to the state health insurance system when they are older to save money.

Moreover, moving from private to public health insurance is almost impossible for people older than 55 years, even if they are unemployed.

Thus, you should carefully consider whether you can afford private insurance contributions in the long term before joining it.

We recommend you build a financial cushion to cover high healthcare costs in old age.


How do I find the right health insurance policy?

Public health insurance

All public health insurance companies offer almost the same services. Hence, it only matters a little which company you pick.

The difference lies in the additional contributions (zusatzbeitrag in German) and non-basic benefits like travel vaccinations, alternative healing methods, preventive medical check-ups, family benefits, etc.


Private health insurance

Finding the right private health insurance provider and tariff is more complicated.

Moreover, choosing the wrong private health insurance coverage can be expensive in the long run.

Understanding which medical treatments a private insurance policy covers takes time and professional advice.

Hence, refer to an independent health insurance broker while picking a private health insurance policy.

You can also compare different plans and their costs on the comparison portal TarifCheck*.


Conclusion: Is public health insurance the better choice?

Private health insurance is not always better than public health insurance. A private insurance tariff with comprehensive services also costs a lot.

Moreover, ensuring you can afford the rising private health insurance prices in the long term is essential.

In most cases, it's best to take out public health insurance and top it up with supplementary health insurance if desired.

You can compare the supplementary health insurance plans (Krankenzusatz versicherung in German) here*.

Private insurance is only worthwhile for

  • people with a permanently high and secure income.

  • Civil servants as they receive subsidies from the state.

It is highly recommended to seek the help of an independent health insurance broker while choosing between public or private health insurance.

The insurance broker can also support you in finding a suitable private health insurance scheme that covers all essential healthcare services.


 

References:

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Disclaimer

The information provided in this post is based on our own experience and in-depth research. The content of this post might be inaccurate. It should not be considered financial, tax, legal, or any kind of advice.

We are not certified brokers or consultants. Always do your own research and contact certified professionals before making any decision.

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