Germany has a highly complex social security system, that offers many benefits. In this respect, such a system is very unique with its five social insurances – health insurance, care insurance, pension insurance, accident insurance and unemployment insurance. Nevertheless, there are areas in the social security system that should be evaluated properly. People coming from abroad, with a foreign language and a different cultural background, might be overloaded with new impressions and information on arriving in Germany for the first time. Did you know that there are two types of health insurances in Germany? Perhaps not. Wouldn’t life be easier if you have a competent partner on site who is able to consult you and help you understand the two systems (public and private) and get the correct information and recommendations to begin with? This is what we are here for – to assist you with any advice or consultation necessary to choose the right health insurance for your individual situation.
Public insurance – how it works
Solidarity is the fundamental principle of the public health insurance (GKV). It is expressed in the definition of the GKV as a solidarity community (§1 SGB V) and in the solidarity financing of health insurance (§3 SGB V).
Solidarity-based financing of the GKV differs substantially from the financing of private health insurance (PKV). While health risks are calculated individually in the private health insurance and financed through corresponding premiums, the benefits in public health insurance are financed through contributions that are carried by both the employee and the employer together and are based on the insured person’s income that is subject to contributions. This means that the financing is based exclusively on the economic performance of the individual and is independent of gender, age or health status. The public contribution is linked to the gross income. Each public insurance provider, known as the Krankenkasse, charges 14.6% as basic premium and a supplemental charge between 0.3% up to 1.6% of the monthly gross income. Additionally, everyone in Germany has to contribute towards public care insurance known as Pflegeversichrung. This is either 3.05% of your gross salary if you have children, or 3.30% if you don’t have children. The mentioned percentages apply to a maximum monthly income of € 4.837,50 Euros.
Example: an expat earns 5.000 Euros per month with no children and is insured by a public insurance provider with a supplement charge of 1.3%. He pays, as an employee, 384,58 Euros for the health insurance and an additional 85,87 Euros for the care insurance. This is a total of 470 Euros.
Public health insurance – what does it cover?
The minimum threshold all health insurance coverage in Germany include;
- in-patient (hospital) care as a ward patient
- out-patient care from a general practitioner or medical staff
- prescription drugs
- pregnancy care
- basic dental care
- statutory paid leave (up to 90 per cent of your net salary) when the employer no longer is obliged to pay this
In addition, all those who are unemployed or dependent (the spouse, civil partner and children up to a specific age) living in the same household in Germany will be covered in your plan at no additional cost. They would need to be registered with the same health insurance provider as the paying member.
Although medical provision provided by public healthcare insurance in Germany is fairly extensive, additional care may require additional costs. This is why it is vital to know what is included in your coverage plan. For example, while basic dental care is covered, aesthetic teeth cleaning may incur an additional charge.
At present, there are over 100 different public insurance providers in Germany. They differ mainly in either the supplemental charge or benefits covered. In this regard, we can advise you which health insurance provider best meets your individual needs and requirements.
How does private insurance work?
Private health care offers the highest level of insurance coverage, which is why, for certain individuals, this is the most cost-effective option. Entry age, health and the level of coverage determine the premium cost.
As an individual who is privately insured in heathcare, you are considered a private patient and can expect a higher level of service from the medical profession. A private patient can even request (and often get) a medical doctor who can speak their native language. The private medical insurance market is served by about 40 German insurance companies, and there are premium and benefit combinations available to suit most budgets. The cost per person for full medical insurance is based on the which benefits are chosen, as well as the age of the individual when starting out with such an insurance, as well as any pre-existing medical conditions. A major portion (up to 80%) of private medical insurance premiums has also been tax deductible from German income taxes since 2010.
You might want to switch to a private health insurance (Private Krankenversicherung or PKV) instead of the public health insurance if your gross salary exceeds 64,350 Euros per year (2021 figures). Self-employed individuals, civil servants and those who work part-time and earning less than 450 Euros per month, which is what is commonly known in Germany as a ‚mini-job‘, are also eligible.
It is important to note that while public health insurance policies also cover your family members, this isn’t always the case with private health insurance. So if you opt to go private, it is necessary to check the policy details as you may need to organise separate provision for the other family members who are dependant on you.
Private health insurance – what does it cover?
The maximum threshold all health insurance coverage in Germany includes;
- in-patient (hospital) care as a ward patient (1 or 2 bedroom and are in the hands of a specialist)
- out-patient care from a general practitioner or top medical specialist (such as a cardiologist)
- prescription drugs (not generics)
- pregnancy care
- top dental care
- alternative medicine (acupuncture, homeopathic etc)
- statutory sick pay when the employer’s duty to pay it is over (100% per cent of your net salary)
Professional advice is recommended, since conditions and benefits vary, depending on your line of work. For instance, IT consultants, engineers and physicians amongst others have more benefits when insured with the private sector. We are happy to discuss further in depth with you regarding why this is so and help you maximise and take full advantage of these benefits!
Private vs public health insurance in Germany – key differences
Supplementary private insurance
If you are insured with public health insurance, whether out of choice or you do not meet the criteria, you can secure yourself and/or your family privately by upgrading your public health insurance through a range of supplementary insurances (additional outpatient insurance, additional inpatient insurance, additional dental insurance and additional paid leave coverage). These supplementary insurances fill the gaps (both in treatment and financially) within the public healthcare. Therefore, it is possible for you to cover additional needs that suits your current situation. Through such supplements, it becomes possible to have nearly the same coverage that private health insurances offer.
What do the supplementary insurances cover?
- Check-ups and screenings are limited in form and frequency (should you wish for better or more frequent care you have to pay for it privately)
- One or two-bed (single or double) rooms for patients in hospitals
- Treatment by a specialist or doctor consultant
- Paid leave after the 6 weeks offered by your workplace is over
- Prescribed medications (since these are solely generic drugs and for this reason you also have to pay between €5 and €10 per prescription, excluding children, when insured with public health insurance)
- Alternative medicine and natural remedies
- Costs of dental treatment and prostheses that are not covered by public healthcare
- Visual aids such as glasses and contact lenses are not paid (unless you suffer from a serious eye disorder)
Do you want to know more? We are here at your disposal!