Public insurance
How does the public insurance work?
Solidarity is a fundamental principle of the public health insurance (GKV). It is expressed, among other things, in the definition of the GKV as a solidarity community (§1 SGB V) and in the solidarity financing of health insurance (§3 SGB V).
The solidarity-based financing of the GKV differs essentially from the financing of the private health insurance (PKV). While health risks are calculated individually with private health insurance and financed through corresponding premiums, the benefits in public health insurance are financed through contributions that are borne jointly by the employee and the employer 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 insurance fee is linked to the gross income. Insurance providers charge 14.6% as basic premium and as supplemental charge of 1.3% additionally of the gross income, up to a monthly income of €4,600 at maximum. The nursing care scheme cost is either 3,055 per cent or 2.8 per cent of your gross salary (with a maximum of €123 per month if you have no children), of which your employer pays a maximum of €56. Basically, both charges will be payed by the employee (7.3%) and the employer (7.3%) equally.
Public health insurance – what does it cover?
The minimum threshold all health insurance coverage in Germany has to include:
- 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
- statutory sick pay when the employer’s duty to pay it is over (up to 90 per cent of your net salary)
Public insurance also includes the compulsory long-term care insurance (Pflegepflichtversicherung).
In addition, all non-working dependents – spouse, civil partner and children (up to a specific age) – living at your address in Germany will be covered under your plan at no additional cost. They simply need to be registered with the same health insurance provider as the paying member.
Although the medical provision provided by public healthcare insurance in Germany is fairly extensive, additional care may require additional payment – so make sure you know what your coverage includes. For example, while basic dental care is covered, aesthetic teeth cleaning may incur an additional fee.
Germany currently has over 100 different public insurance providers. They differ mainly in supplemental charge and benefit coverage. In this regard, it is in our interest to advise you on choosing the best fitting health insurance provider for you and your family’s specific needs.
Private insurance
For who could the private system be of interest?
Private health care, on one hand, offers the highest level of insurance coverage. On the other hand, for certain people it can also be the most cost-effective option. Entry age, health and the level of coverage determine the premium to pay.
As a privately insured person you are considered a private patient and can expect a higher level of service from the medical profession. A private patient could also request (and will often get) doctors who speak their native language. The private medical insurance market is served by about 40 German insurance companies, and there are premium/benefit combinations available to suit most budgets. The cost of full medical insurance per person is based on the level of benefits chosen, as well as the age of the person on entry and 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 is higher than 64,350 Euros per year (2021 figures). Self-employed persons, German civil servants and those persons working part-time and earning less than 450 Euros per month (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. Therefore, if you opt to go private, check the policy details, as you may need to arrange a separate provision for your family.
Depending on which basis you work, it is of utmost necessity to acquire a tailored consulatation. Professions such as physicians, lawyers etc. have more benefits that allows them to insure oneself through the private sector. What’s the reason? We are happy to give you a more detail on this!
Private vs public health insurance in Germany – key differences
| Public health system | Private health system |
| Obligation to accept each individual | Freedom of contract & free competition of companies |
| Income related fee based on pay-as-you-go system | Risk adequate premium |
| Standardized health plan defined by law | Individual agreement of scope of services |
| Benefit in kind principle | Refund of expenses principle |
Supplementary private insurance
If you are insured with the public health insurance by choice, or do not meet the criteria to insure yourself or your family privately, you can upgrade your public health insurance through a range of supplementary insurances. The supplementary insurances fill the gaps (both in treatment and financially) within the public health care. It is therefore possible for you to cover additional needs that suits you best. Through such supplementary insurances, it becomes possible to have almost the same coverage that a private health insurance offers.
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 inpatients in hospitals
- Treatment by chief or consultant doctors
- Sick pay, after 6 weeks
- Prescribed medications are solely generic drugs and for these you also have to pay between €5 and €10 per prescription (excluding children up to a certain age) as a publicly insured individual
- Alternative medicine and natural remedies
- The costs of dental treatment and prostheses that are not covered by the public health care
- Visual aids, such as glasses and contact lenses, are not paid unless you have a serious eye condition