Health Insurance in Germany

Public or Private Health Insurance in Germany: HOW TO CHOOSE?

In Germany, health insurance is compulsory. In other words, German law mandates that you have health insurance. With most cases, however, you can decide the type of insurance you want. You can choose between private health insurance, public health insurance, or a combination of the two. About 90% of people in Germany have public health insurance, and the remaining 10% have private health insurance. This guide covers both public and private health insurance in Germany so you can choose the best option for yourself.   

Sections in this article: 

Public health insurance

Pubic health insurance in Germany is also referred to as the Government Health Insurance System (GKV) or statutory health insurance. 

Who can have public health insurance?

For both EU and non-EU expats to be eligible for public health insurance, your income cannot exceed 60,750€ per year (as of 2019). In other words, you have to apply for private health insurance if you earn more than 60,750€ per year.

How much does public health insurance cost?

The cost of German public health insurance depends on the type of coverage you have and your income.

Public health insurance is oftentimes more expensive than private health insurance for young professionals. The cost of public insurance depends on your income and private insurance depends on your age/health.

As a result, if you are young, in good health and have a decent income, public insurance might be more expensive than private insurance. On the other hand, if you are older and not in good health, public health insurance is usually a cheaper option.

Generally public health insurance costs 180€ (for lower incomes) and 800€ (for higher incomes) per month.

As of 2019, the German state healthcare contribution was 14.6%. In Germany, you and your employer split the cost. This means that you each pay 7.3% of your healthcare costs. For example, let’s imagine you make 1000€ per month. In this case, you and your employer would owe a combined total of 146€. Since you split the cost equally, your employer would pay 73€ and you would pay the other 73€. The payment is taken directly from your monthly paycheck.

Best German public health insurance for expats

From our experience and research, Techniker Krankenkasse (TK) is a great public health insurance provider for expats in Germany. TK is Germany’s largest public health insurance, and for good reason. TK offers reliable customer support in English, and the application forms are available in English.

Benefits of TK health insurance

Family insurance: You do not have make any additional payments to add your family members to your insurance plan.

Coverage abroad: TK health insurance gives you coverage in almost all of Europe. The European Health Insurance Card (EHIC) is included on the back of your TK eHealth card. You can show this card if you need to go to a hospital for medical treatment while you’re abroad.

Doctor of your choice: You are free to choose your doctor.

Private health insurance 

Private health insurance in Germany is sometimes referred to as Private Krankenversicherung (in German) or is abbreviated to PKV

Who can have private health insurance?

If you earn more than 60,750€ per year (as of 2019), you can choose to have private health insurance instead of public health insurance. You can also have private health insurance if you are self-employed, a civil servant (such as a professor), a student, or work part-time and don’t earn more than 450€ per month. 

Cost of private health insurance

Private health insurance companies will charge you based on your age and health. This means that the cost of private health insurance usually increases as you get older. It will be less expensive than public health insurance while you are young, but more expensive when you are older.

Best German private health insurance for expats

Ottonova is without a doubt the best private health insurance company in Germany for foreigners. They focus predominantly on working with expats and non-German speakers.

Furthermore, Ottonova has an English website and they offer a discounted private health insurance package specifically for expats!

Combining public & private insurance 

Your third option is to have both public and private health insurance. 

Although public health insurance covers basic needs, you can also buy add-ons from private insurers. In other words, you can purchase extra coverage from private healthcare providers. For example, you can add more coverage for access to better hospitals and doctors that speak your language.  

Coverage for non-working dependents

Public health insurance premiums usually insure both you and all your non-working dependents, such as your children. On the other hand, private insurance usually makes you pay for each individual person you want to have insured. 

Switching from private to public health insurance

This is a tough one. In most all cases, you will encounter difficulties trying to switch from private to public health insurance.

Many people mistakenly think, “Okay, the cost of public insurance depends on my income and private insurance depends on my age/health. So I’ll have private insurance when I’m young and healthy. Then when I get older and private health insurance becomes more expensive, I’ll switch over to public health insurance.” Well if that was possible, public insurance companies would go broke!  

Therefore, obstacles are in place to prevent people from selecting private health insurance only when they’re younger, and then switching to public health insurance when they’re older.

Once you go from public to private, it is very difficult to go back to public. 

There are some ways you might be able to switch from private to public:

  • If your spouse has public health insurance, you may be able to join his/her plan. This is only possible, however, if your own income is less than 425€ per month. 
  • If you are an employee, you have the possibility of switching back to the public health insurance system if your yearly income falls below 60,750€/year.
  • People that are self-employed or freelancing would need to find employment earning less than 60,750€/year.

If you are over the age of 55, however, switching from private to public health insurance is nearly impossible. Otherwise, everyone would do it! 

If you can’t decide between public and private health insurance, you have the option of selecting public health insurance, and then buying add-ons from private insurers.

Switching between public health insurance providers

As a general rule, you have to stay with your current public health insurance company for 18 months. After those 18 months, you can switch to a different public health insurance. Note that you usually need to give your health insurance provider two months notice. 

The contribution amount

How much you pay for public health insurance is called the state healthcare contribution amount. It is 14.6% of your income, and you and your employer split the cost equally. 

Each public health insurance provider also charges an additional contribution amount. It’s usually a very small percentage. The Federal Ministry of Health set the average rate for additional contributions at 0.9%. You also split this amount with your employer.

Techniker Krankenkasse (TK) has one of the lowest additional contributions of all insurance companies in Germany. The additional contribution is only 0.7%. This means that you and your employer would split the cost of 15.3% of your income (14.6% state healthcare contribution + 0.7% additional contribution). 

When do I need to get German health insurance?

Everyone living in Germany is required, by law, to have German health insurance. If you’re from a country outside the European Union (EU), it’s a good idea to start the process of getting either public or private health insurance before you arrive to Germany. There are many reasons for this. One reason is because non-EU citizens applying for a German residency permit/ visa must provide proof of valid German health insurance. 

The process is slightly different if you are from the EU, European Economic Area (EEA) or Switzerland. If you fall into one of those categories, you can start the steps of getting German health insurance when you arrive to Germany. You might have an EHIC card from your home country, but it’s important to note that the purpose of the EHIC card is for temporary travelers in Germany. That is to say, it can’t be used in place of German health insurance. You still need to get insured through the German healthcare system. 

Regardless of where you’re coming from, you must apply for German public health insurance within 3 months of becoming a resident in Germany.

Final thoughts…

In conclusion, all expats living in Germany must have some form of German health insurance. You should look at the differences between public and private insurance before you make a decision. You can save yourself a lot of money by considering factors such as your health, age, income, number of dependents, and the contribution amount. In addition, if you opt for public insurance, add-ons from private insurers can increase your quality of healthcare coverage. 

Whether you choose public, private, or a combination of both is highly dependent on your individual situation.

In short, however, here is a very simplified generalization for expats:

  • If you don’t have any dependents (e.g. children or a non-working spouse), you’re young, healthy and don’t plan on living in Germany after you reach your 50s, then private health insurance is likely a better (and cheaper) option.
  • If you have dependents, you’re older, and you plan to live in Germany after you reach your 50’s, then public health insurance is likely a better (and cheaper) option. 

Lastly, you should consider getting German legal insurance if you don’t have it already. Many Germans have legal insurance, and for good reason. Our article, “Legal Insurance In Germany: Do You Need It?” explains everything you need to know about legal protection for expats in Germany. 


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