HEALTH INSURANCE
As an expat living and working or studying in Germany, you will most probably find the german dual-payer (aka two-tier) health insurance system somewhat confusing. Rather than trying to figure out the best deal for you and your family all by yourself, thereby risking to get lost in the maze the german health insurance system represents, why not trust me and the pool of independant experts I can draw from to help you make the best informed decision?
Broadly speaking, you can choose from two different health insurance options in Germany: statutory (aka public) health insurance or private health insurance. The default option is the staturory health insurance, as certain conditions have to be met in order to be able to opt for private health insurance, which not only offers the better coverage tailored to your requirements, but can also be the most cost-effective option in your particular situation. That said, when you are in the privileged position that you can choose between the two options, whether the one or the other is better suited for you really depends on your personal situation. Therefore, the pros and cons of both options, which, among other available types of health insurances, are briefly described below, should be carefully assessed before making a decision.
- Statutory Health Insurance
- Private Health Insurance
- Supplementary Health Insurance
- Travel Health Insurance and Incoming Insurance
Statutory Health Insurance
Statutory health insurance providers (gesetzliche Krankenkassen) are basically non-profit health insurance funds abiding to the so-called solidarity principle (Solidaritätsprinzip), according to which the contributions are based on the income and not on the age and health condition of and the range of coverage sought by the insured person.
The current general contribution rate is 14.6 percent of gross income. There is also an additional contribution which varies from healthcare fund to healthcare, which averages to 1.7 percent of gross income. An important advantage of statutory health insurance is that your employer pays half of the total contribution. Only in cases where statutory health insurance members are insured voluntarily (i.e. self-employed, freelancers and civil servants), the entire contribution has to be stemmed by those members themselves. Another advantage of the statutory health insurance is that, in general, any bills are directly settled with doctors and hospitals so that their members do not have to pay in advance or deal with any annoying paperwork.
The entitlement to healthcare benefits is independent of the respective contribution amount and are based on medical requirements of the insured person. The solidarity principle mentioned earlier is also reflected in the so-called family insurance (Familienversicherung), whereby your spouse and your children up until the age of 25 with no or very low income (535 € per month in 2025) are insured free of charge.
There are, you might have guessed, a couple of disadvantages that come with the statuory health insurance:
A member of a statutory health insurance fund does not have the option to customize their insurance cover and, for example, cancel some benefits in order to save on contributions. Both the amount of contribution and the range of benefits are prescribed. In contrast to a private health insurance contract, the exact scope of benefits can also change at any time, and the amount of top-up payments (Zuzahlungen) can also be adjusted. Only by switching to another health insurance company can the insured person save a little on the contributions.
In addition, the free choice of doctor is restricted, as statutory health insurance members can only be treated by doctors who have contracts with the health insurance funds (Kassenärzte). In the case of inpatient treatment, one is only entitled to standard benefits. Top-up payments, which members of statuory health insurance funds have to pay themselves, must be made for remedies and aids (e.g. physiotherapy, glasses, hearing aids). There are also only small subsidies for expensive dentures such as bridges, dental prostheses and crowns.
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Private Health Insurance
In contrast to statutory health insurance providers, which follow the solidarity principle described above, providers of private health insurance (Private Krankenversicherung) offer healthcare coverage based on the equivalence principle, characetrized by the close relationship between the premium amount and the insurance coverage. The more comprehensive the agreed insurance coverage, i.e. the higher the insurance benefits you are entitled to claim for healthcare services, the higher the premiums you will have to pay.
Moreover, every insured person pays their contribution exclusively for their own healthcare coverage. This is basically why, in the case of private health insurance, the premium does not depend on income, but on age, health condition and the chosen plan. A private health insurance policyholder can thus, to a certain extent, adjust his or her insurance cover to personal needs and therefore also influence the height of the premium. You may also reduce your monthly premium if you agree to a deductible, i.e. contribute to your treatment costs up to a fixed amount per year. Often times, private health insurance companies offer premium refunds if no benefits have been claimed during a certain period.
As a privately insured patient (Privatpatient), you typically enjoy much better medical services, get an appointment with a specialist way quicker, and are called in the waiting room sooner than statutory insured patients. You are also not required to make any top-up payments while in hospital or for prescribed medication. As contributions are not calculated according to your income, they do not increase after a salary increase. Unlike statutory health insurance, the contractually agreed benefits are guaranteed and cannot be reduced.
Though the advantages of being privately insured are plentiful, a certain number of hurdles that need to be taken into consideration before opting for a full private health insurance plan.
Though the self-employed, freelancers, civil servants and students can subscribe to a private health insurance plan without any special requirements, employees, on the other hand, can only switch to private health insurance if their gross annual income exceeds the gross annual income limit of 73.800 €uros. Note that this is the figure for 2025 and that it is typically subject to yearly increases.
Typically, anyone interested in subscribing to a health insurance contract must also fill in a form with questions relating to the health condition (Gesundheitsfragen) and may even be ‘ordered’ to undergo a thorough medical check-up, with any pre-existing conditions leading to risk surcharges on their premiums or, worse, a rejection of their application. In addition, family members cannot be insured free of charge in private health insurance. Partners and children each have to take out their own policies and pay their own premiums, which, in aggregate, may or may not exceed the premium one would pay in the statutory health insurance. Monthly premiums of private health insurance contract often rise sharply with age, though there are ways to cap the premium or at least limit the increase of the premium when reaching a certain age (typically the retirement age) by making additional contributions/provisions during the time until that age is reached. Though not impossible, switching back to a statutory health insurance fund may prove quite challenging. Some plans also offer very limited benefits that do not even keep up with those offered by statutory health insurance funds, while others have a significantly reduced coverage in some areas, such as psychotherapy.
Are you still confused about whether the statutory or the private health insurance is a better match for you and your family considering your personal situation and that of your family?
Get in touch with me so I can clear any remaining doubts and guide you to the right plan.
Supplementary Health Insurance
In case you personal situation is such that buying a full private health insurance plan is not possible for you, you still have to possibility to top-up you healthcare coverage by subscribing to a supplementary health insurance (Krankenzusatzversicherung).
With supplementary insurance, insured persons can partially cover additional costs, for example for expensive dentures. It is also possible to top-up your healthcare coverage with benefits that usually only apply to private patients – such as treatment by the head physician, single room occupancy in a hospital or treatment by a non-medical practitioner.
There are many different types of supplementary health insurance you can subscribe to, the most common types being:
. Supplementary hospital insurance (Krankenhauszusatzversicherung)
Hospital care, financed by the statutory health insurance, usually provides for patients to be treated in the nearest hospital and accommodated in a shared room. With a supplementary hospital insurance, a statutory health insurance patient can benefit from almost the same coverage as private patients. This includes the choice of hospital, treatment by the head physician and a single or double room instead of a shared room. The supplementary hospital insurance may however be limited in scope and it is therefore necessary to check the exact scope of coverage mentioned in the insurance conditions of the plan you are interested in.
. Daily hospitalization allowance insurance (Krankenhaustagegeldversicherung)
With this insurance, a daily allowance is agreed upon for the duration of your hospital stay, which insured persons can use freely to cover other costs incurred during your hospitalization. Whether you want to use the allowance to treat yourself during your stay at the hospital (e.g. for telephone, TV or magazines services) or to cover for running costs for childcare or housekeeping during your absence, is totally up to you.
. Sick pay insurance (Krankentagegeldversicherung)
Anyone who has to rely on their current income in full can consider taking out a sick pay insurance. This insurance, which is essential for the self-employed, freelancers, and high-earning employees with a salary above the so-called contribution assessment ceiling (Beitragsbemessungsgrenze), helps to bridge the gap between the sickness benefit paid out to you in the event of illness or accident and your net salary. This is because wages and salaries are generally only paid by the employer for up to six weeks in the event of illness. After that, the statutory health insurance fund basically covers 70 percent of gross income or a maximum of 90 percent of the net income, for a maximum of 72 weeks.
. Supplementary outpatient insurance (ambulante Zusatzversicherung)
This insurance covers the additional costs of outpatient treatment (which may include non-medical practitioner treatment) that arise when a statutory health insurance member opts for the level of treatment that a privately insured patient would usually receive. In order to take out supplementary outpatient insurance, insured persons must have opted for the cost reimbursement procedure (Kostenerstattungsverfahren) with their statutory health insurance, which stipulates that any treatment costs are initially paid by the insured person.
The statutory health insurance fund then only reimburses the amount to the insured person once the invoice has been received, and only according to a catalog of usual services and rates. Any amount exceeding the reimbursed amount remains to the account of the insured person.
. Supplementary dental insurance (Zahnzusatzversicherung)
Statutory health insurance funds only cover a relatively small proportion of the expenditures for dentures. To cover the remaining costs, their members have the possibility of taking out a supplemental dental insurance.
Such a supplemental dental insurance mainly relates to the restoration of your teeth with high-quality dentures (especially implants, bridges and crowns). Therefore, this product is particularly suitable if you attach importance to a high-quality restoration of your teeth as opposed to a lower-quality, standard restoration, which lies within the scope of the statutory health insurance coverage.
Before you can sign the contract for the supplementary dental insurance, you will have to truthfully answer some health questions. The key to getting insurance at all is that your dentist should not have classified any tooth as requiring treatment, as treatments that are already necessary at the time of application are usually excluded from the contract.
Since the range of products on offer is large and the differences in premium huge, it is essential not only to compare offers based on the premiums, but also and formost by comparing the extent of coverage mentioned in the insurance conditions.
Get in touch with me if you require assistance with choosing the right supplementary health insurance plan tailored to your needs.
Travel Health Insurance and Incoming Insurance
Are you planning to travel for work or go on holiday with to places outside of the geographical area of coverage of your current health insurance, but still like to remain on the safe side with regards to your healthcare coverage when abroad? Or do you require a so-called incoming insurance as a foreign visitor to the European Union as part-fulfillment of the requirements of a Schengen Visa as stipulated in article 15 of the Visa code?
Get in touch with me and I’ll figure out the best option for you and your family.
