Home Insurances Health Insurance Health Insurance In Germany - Private and Public Insurance Options in 2020

Health Insurance In Germany – Private and Public Insurance Options in 2020

The Health Insurance System in Germany

In Germany, the health insurance system is based on the principle of social insurance. Insurance coverage is based on and operated with a dual system consisting of statutory health insurance (SHI/GKV), in German referred to as Gesetzliche Krankenversicherun, and private health insurance (PHI/PKV) referred to as Private Krankenversicherung. Since 2009, anyone taking up permanent residence in Germany is required to take up health insurance covering at least hospital and out-patient medical treatments. Health insurance is also required for short-term stays in Germany, so a VISA will not be issued unless valid health insurance is in place.

Persons can be insured under the health insurance system of their country if you are a citizen from the European Economic Area (EEA) or if your home country has a social security agreement with Germany.

Countries that have signed a social security agreement with Germany are; 

  • Bosnia-Herzegovina;
  • French overseas territories (French Guiana, Guadeloupe, Martinique, Mayotte, Reunion);
  • Israel;
  • Croatia;
  • Morocco;
  • Macedonia;
  • Montenegro;
  • Serbia;
  • Turkey, and;
  • Tunisia.

Approximately 90% of the German population is either a mandatory or a voluntary member of the public health insurance, while the remaining are insured under private health insurance. A total of over 73 million persons are insured in Germany.

“There are three options to be insured in Germany; public health insurance, private health insurance, OR a combination of public health insurance and supplemental private health insurance”

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Government Health Insurance System in Germany(GKV)

The government health insurance system is referred to in different terms. In German, its called the Gesetzliche Krankenversicherung (GKV) or also called statutory health insurance. The insurance companies are public insurers and are non-profit companies. They are also referred to as sickness funds or Krankenkassen in German.

All persons in Germany are entitled to extensive insurance benefits. The health insurance reform in 2009 also allowed public insurance companies to offer individual health protection, such as special additional benefits (option tariffs or premium refunds) and bonus programs.

Overview of public health insurance (GKV) in 2020

Statutory, or public health insurance in Germany, is based on the solidarity principle. This means insured persons pay according to their income and thus different rates regardless of age or state of health. In general, all statutory health insurers (krankenkassen) contain 95% of the same benefits regardless of the premium paid. The main difference is generally the service they provide.

Main features of public health insurance (GKV)

  • 50% contribution relive by your employer;
  • Free choice of health insurance among participating insurers (krankenkassen);
  • No health checks and less paperwork;
  • Family insurance coverage; and
  • Bonus programs.

Advantages of public health insurance (GKV)

  • Contributions are calculated and based on income (i.e. not based on age and health condition);
  • There are no major premium adjustments;
  • You don’t pay more for pre-existing health conditions;
  • Children and spouses are insured free of charge;
  • A change among other public health insurers is easily possible, so it’s easy to save money from one provider to the other; and
  • Additional services are available similar to those having private health insurance.

Disadvantages of public health insurance (GKV)

  • The health insurance is binding to standard benefits;
  • Contribution increases with your income (i.e. not based on age and health);
  • Medication is co-paid, meaning you have to pay a contribution for medication;
  • Treatment is partly performed only by contract doctors. You will often find it will take longer to get appointments and access to the best medical professionals; and
  • Not everyone can be insured through a public health insurer. They don’t legally need to cover Freelancers from a non-EU country, so many are forced to be insured privately.

How contributions are calculated under public health insurance in Germany

Public health insurance was based on gross income and the additional contribution rate was set uniformly for all health insurers. However, this was changed during a health reform from 1st January 2015. This change means that health insurance companies were no longer allowed to charge a unit amount, but instead, each fund will raise individuals’ contributions through an additional percentage. This contribution consist of two equal parts shared between the employer and employee.

The fund contributions of 7.3% for the employer and employee (total 14.6% for 2020) is the same for all public health insurance companies. The additional contribution varies from the different funds. During 2020, the average parity (additional) contribution rate is 1.1%. It currently ranges from 0.0% up to 2.7%. For employees, this contribution is also split between the policyholder and the employer, however, students, self-employed persons, and other persons without an income pay the full additional contribution themselves. 

The composition of public health insurance contribution for employees looks like this:

  • General contribution rate: 14.6%
  • Average additional contribution 2020: 1.1%
  • Employee share: 7.3% + half the additional contribution share
  • Employers contribution: 7.3% + half the additional contribution share

Tariff Options for public health insurance (GKV)

There are four main tariff options within public health insurance. These are:

Compulsory public health insurance

Since the 1st January 2009, health insurance is mandatory for all persons in Germany regardless of occupation, income or group of people. It is important to distinguish compulsory health insurance and the compulsory insurance limit.

The compulsory insurance limit of €62,550 per year or €5,212.50 per month for 2020 enables employees to switch to private health insurance. Others such as civil servants, self-employed, and some groups of students and freelancers must join private health insurance or become voluntarily a member of the public health insurance system in Germany.

Compulsory public health insurance in Germany is for anyone who does not fall within the voluntary or private health insurance options.

Voluntary public health insurance 

Voluntary public health insurance in Germany is for persons who are civil servants, self-employed, freelancers, and employees who earn above the compulsory insurance limit of €62,550 per year, or €5,212.50 per month for 2020. Students can choose between statutory health insurance and private health insurance. 

The health insurance contribution is based on a holistic gross income. The criteria for the calculation is explained further below.

Statutory Family insurance 

Family members of the person insured can be included under public health insurance for free. This includes spouses, life partners, and children up to 18 years of age. Special conditions apply to children of the age of 23 if they are not gainfully employed, or without age limit, if the cause is due to physical or mental disabilities. Children up to 25 can also be insured for free if they are still in school or vocational training.

Spouses can only be included in the members insurance if they have no income, or if monthly part-time self-employed income is below 1/7th of the member’s income (up to maximum of €434 for 2020) or has a mini-job with an income of maximum €450 for 2020.

Statutory Student public health insurance tariffs

In principle, students are equally required to have health insurance as well as long-term care. The students’ tariff is for those that cannot due to their age continue to be part of statutory health insurance anymore. It is possible for students to take out private health insurance instead of being part of public health insurance in Germany.

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Calculation criteria for compulsory insured persons under public health insurance (GKV)

The total gross income of insured persons serves as the basis for the contribution calculation. The income applicable for compulsory insured persons are:

  • Salary;
  • Holiday and Christmas bonuses;
  • Income from self-employment as a secondary income;
  • Company or direct insurance pension payments;
  • Pensions and civil servants salaries; and
  • Benefits in kind.

Calculation criteria for voluntary insured persons under public health insurance (GKV)

As explained in the composition of the health insurance contributions above, mandatory insured persons of the public health insurance are charged a percentage based on their gross income.

However, voluntary insured persons are charged based on a holistic economic performance. This means that the following criteria are part of the calculation when determining the total contribution, or cost, of their health insurance under public health insurance (GKV):

  • Gross income (including vacation pay and Christmas pay);
  • Income from self-employment;
  • Investment income (capital asserts such as interests and dividends);
  • Rental and leasing income;
  • Pension income;
  • Statutory pension income/payments (including widows and orphans pension);
  • Social Care; and
  • Alimony (maintenance) payments from a separated or divorced spouse.

Statutory health insurance contribution rates

Although there is a general contribution rate most persons will be charged, there are other rates that may apply. The rates insured persons under public health insurance (GKV) will pay are determined by their status. The following public insurance rates apply during 2020:

Contribution rateExplanation
14.6%General contribution rate which includes entitlements to sickness benefits
14.0%Reduced contribution rate without sickness benefits
7.3%Contribution rate for employees and pensioners with compulsory insurance 
10.22%Contribution rate for students with compulsory insurance
1.1% (*)The average additional contribution rate (*depending on health insurance provider).
Public health insurance contribution rates

It is important to know that freelancers and self-employed persons pay their health insurance contributions based on estimated income. If the amount differs from the actual income, you will receive a refund or need to pay more.

Reduced Contribution rate without sickness benefits

Usually, the general contribution rate of 14.6% applies and includes the right to continued payment of salaries if you get ill. This applies from day 43 (6 weeks).

However, there are special cases where insured persons pay a reduced rate without the right to sick pay. Persons who fall under these rates are:

  • “Housewifes” – if a man or woman is in private health insurance, they can voluntarily take out statutory health insurance with a public health insurance fund/provider;
  • Full-time self-employed persons insured without sickness benefit; or,
  • Students over the age of 30 (limit of 14th semester has been removed since 01/01/2020).
Calculation examples for employees, students and self-employed persons

These are example cost calculations based on the different contribution statuses and rates:

Employees (based on €2,000 income)CalculationCost
€2,000 * 7.3% contribution share€146
€2,000 * 0.55% average additional contribution share€11
Total monthly health insurance contribution €157
Public health insurance contribution for employees
Students (based on €500 monthly student/ BaföG rate)CalculationCost
€500 * 10.22% contribution rate€51.10
€500 * 1.1% average additional contribution rate€5.50
Total monthly health insurance contribution €56.50
Public health insurance contribution for students
Self-Employed with sick pay entitlements (based on €4,000 monthly income)CalculationCost
€4,000 * 14.6% contribution rate€584
€4,000 * 1.1% average additional contribution rate€44
Total monthly health insurance contribution €628
Public health insurance contribution for self-employed with sick pay
Self-Employed without sick pay entitlements (based on €4,000 monthly income)CalculationCost
€4,000 * 14.0% contribution rate€560
€4,000 * 1.1% average additional contribution rate€44
Total monthly health insurance contribution €604
Public health insurance contribution for self-employed without sick pay

What you need to consider when choosing public health insurance 

The general health insurance contribution of 14.6% (during 2020) applies across all public health insurance funds (krankenkassen). However, the additional contributions do vary so this will lead to a difference in health insurance costs between different providers. So it is recommended to review the list of public health insurance providers and their additional contribution charge to determine the total cost. Annual savings can be in the three-digit range.

Apart from cost, there are a few other criteria policyholders should consider before choosing to sign with a public health insurer:

Service and support

Good health insurance companies provide easy accessible support or sometimes even a contact person for urgent matters. Booking of appointments and advice about drugs from a medical expert is part of many health insurance companies.

Alternative treatment grants

Apart from the statutory health coverage required in Germany, many public health insurance providers also offer additional services. The cost for health insurance courses, alternatives practitioners, or professional teeth cleaning for example is often partially or fully reimbursed by the health insurance fund. It is however important to note that often only doctors and therapists who are contractual partners of the health insurance companies are available. 

Bonus Programs

The aim of bonus programs offered by health insurance providers is to promote one’s own health. The benefit of doing various preventative care and treatments is for both yourself and the health insurance company. It is also a great way to earn both cash or non-monetary rewards along the way.

Health Insurance tests

Health insurance providers are regularly tested by various institutes. The health insurance test rates the quality, services and addition l benefits of many providers. Apart from this, the company as a whole is also being checked in terms of finance, transparency and provision.

Some of the best known health insurance testers are:

  • DSFI;
  • Focus Money; and
  • Stiftung Warentest.

“Germany has many private and public health insruance companies (krankenkasse), and you are free to choose any of them”

The assessment ceiling and compulsory insurance limit

Although public health insurance is calculated on the gross income, the assessment ceiling is the maximum insurance contribution one has to pay per month. The maximum insurance contribution is €4,687.50 per month in 2020 (or €56,250 per year). The assessment ceiling is often decisive for members of the public health insurance to switch to private health insurance.

The compulsory insurance limit, on the other hand, is the income limit that enables employees to switch to private health insurance. The current limit for 2020 is €5,212.50 per month in 2020 (or €62,550 per year).

Minimum and maximum contribution for self-employed voluntary members of public health insurance

The assessment ceiling for self-employed persons who are voluntary legally insured under the public health insurance is €1,061.67 in 2020. This is a uniform fictitious minimum income that applies to all self-employed persons voluntarily insured.

Since the contributions assessment ceiling (maximum amount) is €4,687.50 per month in 2020, one can calculate the minimum and maximum health insurance contribution for full-time self-employed persons voluntarily insured.

Minimum contribution during 2020:

Self-Employed with sick pay entitlements 14.6% + additional contribution rateMinimum contribution: €155.00 + additional contribution 
Maximum contribution: €684.38 + additional contribution
Minimum and maximum contributions for public insured self-employed persons with sick pay
Self-Employed without sick pay entitlements 14.0% + additional contribution rateMinimum contribution: €148.63 + additional contribution 
Maximum contribution: €656.25 + additional contribution
Minimum and maximum contributions for public insured self-employed persons without sick pay

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Private Health Insurance in Germany (PKV)

Not everyone can be insured through private health insurance in Germany as it is on a voluntary basis for only some. Private health insurance contributions depend on your age, state of health, and the benefits included – opposed to public health insurance which is based on income.

Generally, the following persons can have a private health insurance in Germany:

  • Employees earning a gross income above the income threshold for compulsory insurance;
  • Public servants; and
  • Freelancers and self employed persons.

Employees can be insured if their gross income is above the threshold for compulsory health insurance of €62,550 per year, or €5,213 per month in 2020. In that case, they need to apply for exemption from compulsory health insurance.

There are around 9 million people in Germany who have private health insurance, and there are more than 40 private health insurance providers. The PKV offers numerous advantages and can be characterized as offering individuals services with the best and modern treatments available.

Who can get private health insurance in Germany (PKV)

Every employed person can take out private health insurance as long as the regulations for voluntary health insurance applies to them. This includes students, self-employed persons, and civil servants. Employees can also qualify under the voluntary health insurance if they earn more than the annual wage limit of €62,550 for 2020. This compulsory wage limit is recalculated each year.

Self-employed

Both self-employed and freelancers can choose private health insurance. In fact, public health insurance providers are not obligated to cover third-country nationals, thus many are forced to choose private health insurance.

Self-employed persons and freelancers cannot change to public health insurance once they are insured privately. Only by becoming an employee, one can switch to public health insurance. Unlike employees in public health insurance, the cost of private health insurance is payable in full for self-employed persons and freelancers.

Civil servants

Civil servants can be privately insured without any prerequisites and level of income. In many cases, civil servants are also entitled to assistance from their employed, the same way as employees with statutory health insurance.

Civil servants’ private health insurance cost is great because their employer covers between 50% to 80% of the cost. Additionally, spouces and children also receive a state subsidy.

Employees

The only prerequisite for employees to become eligible for private health insurance is the annual gross income limit (JAEG). This is great for high-earning employees who can benefit from non-income dependent insurance coverage while continue to have the benefit of the employer covering half of the contributions. 

Students

Students also have the option to take out private health insurance for the duration of their studies. Often the rates are very cheap because of the age and health condition of students.

Main features of private health insurance

  • Suitable for self-employed, freelancers, civil servants, and employees with an income above the threshold;
  • Contributions are dependent on age, state of health, and occupation;
  • More flexibility coverage; and
  • Treatment costs are reimbursed by private health insurance companies upon submission of an invoice.

Advantages of private health insurance

  • Shorter waiting times;
  • Faster appointments with specialists;
  • State-of-the-art medical treatments from consultants;
  • Ability to choose additional coverage; and
  • Contributions are not dependant on your income.

Disadvantages of private health insurance

  • Family members are not covered under the same insurance and need their own insurance;
  • You cannot return to Public Health Insurance when over 5 years of age; and
  • Cost coverage depends on the tariff of your health insurance.

Tariff options and cost of private health insurance in Germany

When deciding to join private health insurance, the cost is often determined mainly by the different tariff variants and classes. These all differ in terms of coverage and price. In addition to compact tariffs, one can also choose to get a modular tariff and able to customise and personalise your health insurance coverage.

Entry-level tariffs

The entry-level tariffs offer services of at least a level of public health insurance at a significantly lower price. Often there is no retirement provision but instead a higher deductible.

Comfort tariffs

Includes more extensive services than the entry-level tariff at a good performance versus price ratio. When comparing such tariffs, the price often is because of differences in the amount of deductibles or reimbursements for other services.

Premium Tariffs

This is often the most extensive coverage you can get with the best medical treatments available but is also the most expensive option.

Contribution relief Tariffs

Because private health insurance in Germany is based on age and health amongst others, the price will go up accordingly. The contribution relief tariff counteracts the increase in contributions and inflation costs. It is therefore advised to start early with private health insurance in order to have the best coverage at an old age with a lower price.

Important services from Private Health Insurance in Germany

Private health insurance options in Germany guarantee basic health protection at the same level as public health insurance. However more often than not, the care for private health insurance patients goes far beyond that. The benefits of private health insurance extend not only to coverage but access to the best specialists with shorter waiting times. Often you will also enjoy accommodation in a single or double room. The benefits of private health insurance depend on the choice of tariff mentioned above and often differ significantly from public health insurance options.

The most important health insurance services include:

Daily sickness benefit insurance

After day 43 of illness, the statuary sick pay expires. Private health insurance companies continue to provide sickness pay amounting to the net salary. Self-employed persons must cover the entire period themselves as statutory sickness pay does not apply to them.

In-patient services

Private health insurance patients who need in-patient treatment can freely choose a hospital covered by the insurance company. In most cases but maybe depending on the tariff, you have the right to care by consultant physicians and single accommodation during treatment.

Out-patient Services

Out-patient services by private health insurance include the free choice of doctor and much quicker appointments. Prescribed medication and treatments are often covered and depending on the tariff, alternative practitioners’ costs can also be reimbursed. Other benefits often include visual aids and assistants and hearing and speaking aids. Generally, doctor fees up to 3,5 times the usual rate (or more depending on the tariff) are covered.

Dentures and dental treatments

Private health insurance can include benefits for orthodontics and dentures covering up to 100% of the cost.

Psychotherapeutic services

Psychotherapy is not regulated by private health insurance conditions, but some insurance providers cover such services. The costs of these services can vary greatly.

Additional Services Offered by Private Health Instances 

Since private health insurance can be customised to your needs and wishes, there are some additional services offered by PKV providers.

Deductibles

The deductible is the share that you pay for the services you need. In order to save money on health insurance contributions, you can increase your deductible and pay more if you need medical services. Persons with chronic diseases who may require expensive treatments are not advised to add a deductible. The monthly premium savings should be more than the deductible itself for it to be worthwhile.

Alternative medicine and alternative practitioners

Alternative natural treatments can be included as an additional service when being privately insured. Public health insurance does not cover natural and alternative treatments. It is however important to note that some private health insurance companies only cover 50% to 80% of such costs – so if you would like to include alternative treatments it is important to check the amount covered.

Premium Reimbursements

If nothing is claimed and no benefits are paid throughout a year, the policyholder can receive a premium for this. Some private health insurances even offer up to 20% reimbursements of their annual contributions as a bonus.

Health Cures

Generally, health cures, such as spas, are not covered by Private Health insurance. However, this can be included by an additional tariff. There is often a maximum cost allowance and self-employed persons can even deduct these short-term tariffs from health insurance as a “provision”. 

Cost of health aids

In most cases, the cost of aids is specified – the amounts and in which time intervals they are paid. For particularly expensive aids, often a prearrangement with the health insurance company is recommended. 

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The Cost Of Private Health Insurance In Germany

Opposed to the public health insurance which is based on income, private health insurances are based on the following criteria:

  • Your age;
  • Your health status;
  • Your occupation ;
  • Additional services; and
  • The deductible.

Because of this, it is therefore advised to get several private health insurance quotes or engage with a health insurance broker who can offer you both advice and various options.

How to reduce private health insurance costs

  • Increase deductible: By increasing your own contribution for treatments and medication, you can reduce the monthly premium. Persons who have a chronic illness should consider carefully this option as it may end up being more expensive.
  • Change tariff: Private health insurance persons can change tariff and company. So you may be able to find similar coverage at a cheaper price.
  • Reduced coverage: If your private health insurance contains many additional services and benefits, it’s like more expensive. By reducing the coverage for things you may not need, you can reduce your monthly premium.

The emergency tariff

Since 2013, the emergency tariff takes over if the insured person is not able to pay the monthly premiums. It cannot be freely chosen. The private health insurance company can suspend your insurance after two (2) reminders of non-payment. It is possible to return to the insurance contract after the outstanding premiums have been paid.

The coverage only includes acute pain and illnesses except for pregnancies. You will receive all the necessary treatments and preventative examinations.

The cost of the emergency tariff is around 100 EUR per month, where 25% of the contributions are taken for the retirement provision.

Comparing Private Health Insurance Options

There are over 40 private health insurance companies members of the PKV Association. There is a large selection of tariffs and tariff options. It is therefore worthwhile to compare the options available to you. This can be very difficult and often requires the help of experienced health insurance brokers. Howe er, there are a few things you need to look out for when getting insured privately.

The health insurance companies

They should be reviewed based on the following:

  • Financial strength;
  • Balance sheet on financial market;
  • Stability of contributions; and
  • Administration costs.

Tariffs and tariff combinations 

Tariffs options, combinations and additional services should be considered on the following:

  • The price of the contributions;
  • Services covered and to what extent;
  • Terms of the contract; and
  • General price vs coverage ratio.

Test institutions and rating agencies

Another great way to get expert advice are from the following health insurance organisations:

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Terminating, Changing or Switching to Public Health Insurance

There could be various reasons for terminating or changing private health insurance. It is important to inform yourself well before making the decision as it may not be advantageous. Especially when it comes to the provisions of old age, consumers can expect losses.

Termination due to change of tariff in private health insurance 

Privately insured persons have the right to a tariff change within their insurance. If you are dissatisfied with the insurance coverage or in case of premium increases, switching to a new tariff may be advisable. 

In the cade of premium increases or the insurance provides makes a change in benefits, the extraordinary termination can also be done 2 months after the announcement of the new premium price.

Change of private health insurance provider

If for any reason one would like to change the private health insurance provider in Germany, it is possible. However, due to the pension reserve position, it may be only advantageous in some circumstances. Generally speaking, the longer your insurance period, the greater your savings would be later.

Changing From Private Health Insurance to Public Health Insurance

A change from private health insurance to public health insurance is not that easy. A re-entry into statutory health insurance is possible if privately insured persons’ annual gross income falls below the compulsory insurance limit. Another possibility to change to public health insurance is also possible if you meet the conditions of family insurance or in case of individual professional groups (these are regulated in the Social Security Code).

Reasons and deadlines for termination of Private Heath Insurance

There are mainly two (2) reasons when termination of private health insurance can occur, and the deadlines a cancellation can be made.

Ordinary Termination

At the end of the calendar year or at the end of the insurance year (depending on the start of the insurance), a private health insurance policy can be terminated with a 3-month notice period. It is important, however, to take note of the minimum contract period of your private health insurance of usually one (1) to three (3) years.

Special Termination

The extraordinary termination gives the right of termination for various reasons. These reasons include:

  • If the insured employee falls below the current compulsory insurance limit, and subsequently becomes by law required to take out compulsory insurance.
  • If the insured enters statuary family insurance;
  • If the insured person is entitled to medical care, which the right arises during the insurance period; and
  • If the private health insurance company adjusts its premium and or insurance benefits.

A special termination can also apply in the case of grossly negligent and breach of duty by the insured. This can include previous illnesses which were hidden during the health check of which the insurance policy is based on. The insurance company can in this case terminate the insurance policy within one (1) month without notice. 

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The Künstlersozialkasse (KSK)

The Artists’ Social Insurance Act (KSVG) ensures that self-employed artists and publicists have similar health protection in public health insurance as employees. Both artists and publicists are usually less protected than other self-employed persons, so with help from the Künstlersozialkasse, The German state supports and recognises the importance of this group in society as well.

The Künstlersozialkasse is not an insurance provider itself but coordinates the payment of contributions for its members to a health insurance provider together with the statutory pension and nursing care contributions. The artists’ welfare fund covers half of the insurance cost; 20% from a government grant while the remaining 30% is paid from social security contributions from companies that are involved with art and journalism.

The total payable for artists and publicists (50%) is dependant on the gross income of no more than 3,900 EUR annually. If higher, the KSK can usually not be used except for young professionals.

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Health Insurance for guest workers in Germany

Guest workers are classified a such because they have a short-term work stay. It is however still necessary to obtain health insurance in Germany for the entire stay.

Health Insurance for EU Citizens Guest Workers

Generally, guest workers from any EEA Member State together with those countries that have a Social Security Agreement with Germany, need health insurance. This applies regardless if they are employees, self-employed, or if the person is residing in another Member State or if the employer is rested in another Member State. There are two (2) exceptions to this rule.

  1. The person is working as an employee in one one Member State and as self-employed in another; or
  2. The person has health insurance abroad and the temporary work is no more the 12 months.

Health Insurance for non-EU Citizens Guest Workers

Employed persons from third-world countries are subject to compulsory insurance regardless of their length of stay. Health insurance must be applied for at a German Embassy prior to arriving in Germany and is required to obtain work and residence permits.

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Health insurance for guest scientists

The regulations for guest scientists (researchers) and their family members state that it is obligatory to have health insurance in Germany. Similar to guest workers, health insurance must be presented when applying for a residence permit.

Guest scientists and workers can be classified in one of these four (4) main origins and types of stay:

  1. Guests scientists from EEA countries and countries with Social security Agreements: Home country health insurance, such as the European Health Insurance Card, is valid.
  2. Foreign scientists residing in Germany for long stays: It is compulsory to obtain German health insurance or apply to convert existing health insurance to an entitlement tariff for the duration of the stay in Germany.
  3. Guest scientists with employment contracts in Germany: It is required to obtain health insurance in Germany either via public or private health insurance depending on which they qualify for.
  4. Guest scientists with fellowships: Only Private health insurance is possible.

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Health Insurance in Germany for students, apprentices and au pairs

Students, apprentices, and au-pairs must have valid health insurance in Germany. It is important to note that apprentices and au-pairs are only subject to compulsory health insurance if they earn more than 450 EUR per month. They can take out private health insurance in Germany specifically tailored to foreign guests and workers in Germany from EU or EEA countries.

Anyone from the EU and EEA, or those countries with a Social Security Agreement with Germany, can receive healthcare with the European Health Insurance Card. Additionally, benefits may be taken out in Germany in those cases, but the range of benefits is dependent on the agreement.

Private health insurance must be taken out for non-EU and EEA countries or any country that does not have a Social Security Agreement. The host families for au-pairs cover the cost for private health insurance and accident coverage in Germany.

Restrictions for au-pairs in Germany:

  • 18 to 27 years of age;
  • 18 to 26 years of age if applying for a visa;
  • 18 to 24 years of age coming from non-EU countries; and
  • A maximum insurance period of 12 months.

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Health Insurance For Immigrants in Germany

A German VISA is only issued with valid health insurance upon entering, so anyone who immigrates to Germany needs to take out compulsory insurance. Any person who is a citizen of an EU Member State has the right to live in Germany even if they are not working there. However, the right of residence is subject to two (2) conditions:

  1. Immigrants must have sufficient means of taking care of themselves financially; and
  2. Health insurance is taken out in the EU country.

The same regulations apply to non-EU nationals. They also require health insurance in Germany in order to apply for a VISA but require this prior to arrival. Different conditions apply if the immigrant is gainfully employed or not.

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Special regulations for asylum seekers in Germany

Asylum seekers are granted special status and are not covered by public health insurance. Instead, they are entitled to benefits under the Asylum Seekers Benefits Act. The level of benefits are dependent on the length of stay, but generally, the entitlement includes:

  • Medical treatment in case of acute illness. This includes medicines, dressings, and other benefits that aid in recovery;
  • Nursing and medical care, including medicines, dressing, and midwife assistance (even for those recently given birth); and
  • Check-ups and vaccinations.

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Assistance From Insurance Brokers

If are able to take out private health insurance, it is often advisable to seek advice. There are many things to consider. Health insurance brokers in Germany are independent companies who offer advice and resell insurance from many leading insurance providers in Germany. There is no extra cost as the insurance brokers get paid a percentage of the insurance premium you pay.

They will often know the best option for you, depending on you your age, health, occupation, income, and length of stay. Since they are independent, they can often advise you on the better option both in terms of price and coverage.

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Get connected with the right health insurance provider

We can help you choose the best health insurance in Germany for your needs whether you are employed, self-employed/freelancer or student!

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Information About Medical Assistance in Germany

If you require acute help, advice, and assistance or need medicines, the below tips and contacts may be useful:

Emergency Numbers

In case of emergencies, the following numbers should be used and are free of charge:

  • 112: Ambulance and fire brigade
  • 110: Police

Medical On-Call Service By The Association of Statutory Health Insurance 

The emergency department of the municipal hospital and local university hospital can be reached on:

  • 116117

Medicines and Pharmacies

The majority of medicines, both over the counter and prescription (prescribed by a doctor) medicines, can be obtained at any pharmacy. They are usually indicated by a large red “A” symbol. 

There are also emergency pharmacies, in Germany called “Apotheke von Dienst”, which can be found information about at any local pharmacy.

Useful Links

Organizations Website
Federal Foreign Officewww.auswaertiges-amt.de
Federal Office for Migration and Refugeeswww.bamf.de
Federal Commissioner for Foreignerswww.bundes­auslaender­beauftragte.de
The National Refugee Councilswww.fluechtlingsrat.de
German Academic Exchange Service (DAAD)www.daad.de
Association of German Student Services (DSW)www.internationale-studierende.de
List of useful links for health insurance in Germany

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Frequently Asked Questions (FAQ) About Health Insurance In Germany

How much is health insurance in Germany?

Public health insurance in Germany has a general contribution rate of 14,6% of your gross income for employees (half is covered by the employer). There are different contribution rates for self-employed and students. Private health insurance is based on age, health and occupation amongst others, so generally young and healthy persons pay less for private health insurance.

Is health care free in Germany?

Healthcare is covered by compulsory health insurance in Germany, either via public or private health insurance. Special regulations apply to asylum seekers and third-country nationals while EU citizens can use their existing European Health Insurance Card.

How does health insurance work in Germany?

Everyone in Germany is required to have compulsory insurance. Depending on your occupation and income month others, you will either have to take out public health insurance or take out private health insurance.

How can a foreigner get health insurance in Germany?

Foreigners can apply for German health insurance by contacting private health insurance providers or brokers prior to arriving in the country. Employees who fall under public health insurance are automatically admitted by the employer.

What happens if you don’t have health insurance in Germany?

Employees in public health insurance have their contributions paid each month from their salary. In the case of private health insurance where you are unable to pay your premium, an emergency tariff will apply. This will cover you only for acute illness and pain.

How many Germans have private health insurance?

Around 9 million people in Germany are covered by private health insurance. These are issued by around 40 private health insurance providers.

Do you have to pay to see a doctor in Germany?

Doctor fees are cover by public health insurance. Private health insurance policies also include private health institutions which you would otherwise need to pay for if you are cover by public health insurance.

How much does it cost to have a baby in Germany?

A pregnancy in Germany, including its associated costs, is covered by both public and private health insurance. Even the emergency tariff, that applies if you are unable to pay your private health insurance, and refugees are covered in case of pregnancies.

Who pays for health insurance in Germany?

In the case of public health insurance, family members can be insured under the same policy. Private health insurance required a separate policy for each person.

Is it illegal to not have health insurance in Germany?

Health insurance is compulsory by law in Germany and you may be requested to make back payments for the time you were not covered by valid health insurance. 

Does German health insurance cover dental?

Both public and private health insurance cover dental in principle. However, private health insurances often cover additional services such as professional cleaning either by default or with a dental supplementary insurance.

How do I get health insurance with no income?

Any person dependent with no income, or under certain rules, can be insured under the same public health insurance as the main policyholder.

Is health insurance tax deductible in Germany?

Private health insurance in Germany is tax-deductible for self-employed and freelancers.

Which insurance is best in Germany?

In general, all insurance providers, both public and private, have the basic necessary coverage. However, private health insurance often has better coverage, faster appointments, shorter waiting times, and access to the best physicians.

What is the income threshold for compulsory insurance in Germany 2020?

In Germany, health insurance is compulsory for all employees with annual income above an insurance threshold (2020: €62,550 per year, or €5,213 per month).

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