The health insurance system in Germany
Everyone who is resident in Germany is legally required to have sufficient health insurance coverage. The insurance coverage in Germany is based on a dual system consisting of public health insurance (also referred to as statutory health insurance) and private health insurance. German health insurance for foreigners consists of, generally, three (3) options for coverage:
- Public health insurance;
- Private health insurance; or
- Or a combination of public and private supplemental health insurance.
Regardless of type, the insurance coverage needs to meet at least the minimum requirements stipulated by law. There are also restrictions on who can be insured with private health insurance and those who need to get insured under public health insurance.
Do foreigners need health insurance in Germany?
German health insurance for foreigners is an important requirement for a residence permit. Apart from tourists and short-stay visitors, everyone else needs to get health insurance. This is the case for the following groups of persons:
- International students;
- Guest scientists and researchers;
- Foreign employees; and
- Freelancers and self-employed foreigners in Germany.
Your occupation, nationality, and salary in Germany will largely decide which type of insurance you can get.
Public health insurance in Germany
The compulsory insurance limit for 2021 is €64,350 per year or €5,362.50 per month. This means that foreigners earning less than this in Germany needs to be insured via public health insurance and cannot choose private health insurance.
Foreigners who will become employees in Germany are automatically enrolled by their employers. However there are many different public health insurance providers, and you are free to choose anyone. It is important to inform your employer about your choice.
Three of the largest providers of public health insurance in Germany are AOK, Barmer GEK and TK. While there are over 100 different providers available, the main difference between them is if they are English speaking, the additional contribution rate they charge (average for 2020 is 1.1%) and some offer special incentives.
A complete list of public health insurance providers are available here.
The minimum coverage stipulated by law all health insurance coverage in Germany has to meet includes:
- in-patient (hospital) care as a ward patient
- out-patient care from a general practitioner or medical specialist (such as a cardiologist)
- prescription drugs
- pregnancy care
- basic dental care
- employee sick note
- Statutory Sick Pay when the employer’s duty to pay it is over (up to 90 percent of your net salary)
The cost of public health insurance for foreigners
Every public health insurer charges the same basic premium of 14.6% of your gross income, in addition to an additional contribution rate. The contribution rate is dependent on the insurance provider but is an average of 1.1% in 2020. Your employer pays half of the basic premium (7.3%) in addition to half of the additional contribution rate.
The maximum you pay is determined by the maximum contribution ceiling. For 2020 the maximum contribution per month is €4,687.50. Anyone earning more will only pay the maximum amount per month.
Additionally, public health insurance provides family insurance as well. This means your spouse, children, and dependents are covered under the same insurance policy as yours at no additional cost. The only requirement is that they are registered with the same insurance provider.
Private health insurance in Germany for foreigners
While the majority of persons earn below the compulsory insurance limit and thus need to be insured with public health insurance, there are instances where this limit does not apply. Foreigners in Germany who can have private health insurance in Germany are:
- Freelancers and self-employed;
- Public servants; and
- Employees who earn above the income threshold for compulsory insurance.
The income threshold for compulsory insurance in 2021 is €64,350 per year or €5,362.50 per month. If you meet these criteria you can however also become voluntarily insured within the public health insurance and additionally get private supplementary health insurance for increased coverage.
The cost of private health insurance for foreigners
Opposed to the public health system, the cost of private health insurance is determined by your age, health, occupation the tariff chosen. Often young healthy persons will pay significantly less for much better coverage compared to those who are insured with public health insurance. There are also ways to reduce the cost by increasing your deductible for example.
Although all private health insurance must meet the minimum standard and coverage according to public health insurance, often the service, appointment times, and medical costs are covered better. Each tariff charge can vary so it is important to use a price comparison website like Check24, Krankenkassen Deutschland or PKV-Gesundheit.
It is also highly advisable to use a health insurance broker, who can guide you on the best tariff and coverage versus cost for your particular situation. Brokers do not charge you but instead get paid a commission from the insurance company, so it is well worth getting the advice of an independent insurance expert.
The main differences between public and private health insurance
German health insurance for foreigners, whether public or private, have access to health institutions for appointments and medical treatments. However, there are some key differences in the choice of facilities, coverage, and the service you receive. The main differences are:
- The cost for public health insurance is the same for everyone regardless of the state of health and coverage. Private health insurance is determined by your health condition, the coverage you choose, etc. so it is important to evaluate what the best option is for you.
- Pre-existing health conditions are generally not covered by private health insurance providers. However, public health insurance covers you regardless. It may be wise to check what additional tariff to cover pre-existing conditions costs for private (if at all possible) versus going for public health insurance is the best option.
- Private health insurance works on a refund basis. This means that prescription medicine is paid by you upfront and reimbursed by the insurance company (a deductible may be applicable). Persons with public health insurance have to pay 10% up to €10, and a minimum of €5 per prescription.
- Generally, private health insurance does not cover family members. However, if everyone is young and healthy it may still be worth going private for the entire family in order to have better coverage and benefits.
Supplementary Health Insurance I Germany
Foreigners in Germany who are insured with public health insurance can also choose to get a supplement health insurance from a private insurance provider. This means you can extend your coverage beyond what your public health insurance provider offers. Popular supplementary health insurances are dental care or treatments in private hospital facilities.
When to get German Health Insurance for Foreigners
Anyone from another EU country who moves permanently to Germany, or for a long period of time, should get their health insurance sorted upon arrival and register as a resident in Germany. If you will be employed, your employer will help you register for your health insurance. Freelancers and self-employed persons need to register themselves.
Third-country nationals (outside of the EU) need proof of valid German health insurance in order to get a residence VISA. So it is important to get your insurance before you apply for a VISA and enter the country.
Health insurance in Germany for researchers and scientists
Guest researchers and scientists can be covered by their home country health coverage if they are for short stays. Germany has social security agreements with the EU, EEA, and some other countries. This means that as long as the coverage is equivalent to the coverage provided by German statutory health insurance, it may be not necessary to get separate German health insurance. Longer stays are required to have German health insurance.
If you are from a non-EU country, or any country without a social security agreement, it is important to get the compulsory health insurance from licensed insurance companies in Germany. There are also some specific policies for guest researchers and scientists, such as EDUCARE24, IHC-COMPANY’s International Science Healthcare Plan and MAWISTA Science.
Coverage Through The European Health Insurance Card in Germany
Expat health insurance in Germany for temporary visitors from EU and EEA countries who have a European Health Insurance Card (EHIC) are covered through their home country. This is a free card that you can apply for in your home country and covers short stays for a period of up to one (1) year. You will be eligible for free access to some health treatments while visiting Germany.
It is important to note that it is not a substitute for proper German health insurance and you need to get a proper policy coverage (including long term nursing care) as soon as you take up residence or take up employment in Germany.