What are insurance deductibles? Out-of-pocket costs explained.

A deductible (Selbstbehalt or Selbstbeteiligung in German) is the amount you agree to pay out-of-pocket for covered medical services before your health insurance starts covering costs. It's one of the most important factors in how much your health insurance costs — and one of the most misunderstood, especially for expats navigating the German system for the first time.

In this guide, you'll learn:

• What a deductible is and how it differs from a copayment
• The three types of deductibles in German health insurance
• How deductibles work in public, private, and expat insurance
• Whether a high or low deductible is right for your situation
• Whether your deductible payments are tax-deductible

If you're still deciding between insurance types, start with our guide to how health insurance works in Germany.

What is an insurance deductible? (Selbstbehalt)

Simply put, a deductible is a fixed amount or percentage you pay yourself before your insurance kicks in. The higher your deductible, the lower your monthly premium — and vice versa.

Here's the key principle: if you choose a plan with a €1,000 annual deductible, you cover the first €1,000 of your medical costs each year. After that, your insurance pays for everything (or nearly everything, depending on your plan). If you only spend €300 on healthcare that year, you only pay €300 — not the full €1,000.

Deductibles in Germany reset on January 1st each year. Any amount you've paid toward your deductible doesn't carry over to the next year.

Deductible vs. copayment: what's the difference?

These two terms confuse many expats. A deductible (Selbstbehalt) is a total amount you pay before insurance coverage begins. A copayment (Zuzahlung) is a small fixed fee you pay each time you use a specific service — like the €5-€10 per prescription in public insurance. With a deductible, you pay up to a threshold; with a copayment, you pay a per-visit fee regardless of how much you've spent. In Germany, copayments are common in public insurance (GKV), while deductibles are more typical in private insurance (PKV).

Not every medical service counts toward your deductible. In most plans, preventive care — checkups, vaccinations, cancer screenings — is fully covered without affecting your deductible.

Types of deductibles in German health insurance

German health insurance offers three main deductible structures, primarily in private insurance (PKV):

Fixed annual deductible (Absoluter Selbstbehalt)

You pay a set euro amount per year before insurance covers the rest. This is the most common type.

Common options range from €300 to €5,000 per year (the legal maximum under §193 VVG is €5,000). The most popular tiers are €300, €500, €1,000, and €1,500.

Example: You have a €1,000 annual deductible. In March, you visit a specialist (€150). In June, you need blood work (€80). In September, you see a dermatologist (€120). Your total so far: €350 — all paid out of pocket. In November, you need a minor procedure costing €900. You pay the remaining €650 to reach your €1,000 deductible, and insurance covers the other €250. Any further costs that year are fully covered.

Percentage-based deductible (Prozentualer Selbstbehalt)

You pay a fixed percentage of each medical bill, up to an annual cap. Standard options are 10% or 20% of each claim, typically capped between €400 and €1,500 per year.

Example (Allianz model): You choose a 10% deductible capped at €500/year. You visit a specialist and the bill is €200 — you pay €20 (10%), insurance pays €180. This continues until your co-payments for the year reach €500, after which insurance covers everything at 100%.

Modular deductible (Modularer Selbstbehalt)

The deductible applies only to specific categories of care — such as dental treatment or inpatient hospital stays — rather than all medical services. This lets you reduce premiums in areas where you're unlikely to need care while keeping full coverage elsewhere.

Example: You add a €500 dental-only deductible to your plan. You pay the first €500 of dental work each year, but GP visits, specialist appointments, and hospital stays are covered from the first euro. This pairs well with a separate dental insurance plan.

How deductibles work in private health insurance (PKV)

Private health insurance (PKV) is used by about 10% of German residents (approximately 8.7 million people). It offers more flexibility than public insurance, including the ability to customize your deductible.

PKV providers like Barmenia, ARAG, Allianz, AXA, and Gothaer each offer different deductible structures and amounts. When comparing plans — something we cover in our best private health insurance guide — the deductible is a key factor alongside premiums, coverage scope, and waiting periods.

How much can you save?

Premium savings depend on your specific tariff, age, and health profile. As a rough guide, a €1,500 annual deductible can reduce monthly premiums by approximately €150-€175 — but this varies significantly between providers.

With PKV premiums broadly increasing in 2026, deductible strategies are becoming more relevant as a cost management tool.

The employee deductible trap

Important for employees: Your employer covers approximately 50% of your PKV premium (capped at ~€509/month in 2026), but they do not contribute toward your deductible. A €1,000 deductible comes entirely out of your pocket. Since raising your deductible also reduces your employer's contribution, the net savings for employees are much smaller than for freelancers. Most insurance advisors recommend employees choose a low or zero deductible.

Freelancers and the self-employed

For freelancers and self-employed people, the calculation is different. You pay your full premium yourself, so every euro saved through a higher deductible stays in your pocket. A deductible of €500-€1,000 is commonly recommended for healthy freelancers — enough to meaningfully reduce premiums without creating unmanageable financial exposure in a bad year.

Practical tip: If you choose a deductible, set aside the full annual amount in a dedicated savings account (Tagesgeldkonto). That way, you're never caught off guard by a sudden medical expense.

Feather's approach

Feather's private health insurance comes with a €0 deductible. Instead, you receive a monthly cashback of €100 (€1,200 per year), which covers your first €1,200 in medical expenses. If your claims are lower than that, you keep the difference. And if you don't submit any claims in a calendar year, you receive a no-claims bonus starting at €343 with the standard plan — increasing every year.

No-claims bonus (Beitragsrückerstattung)

Many PKV providers refund part of your premium if you don't file claims during a calendar year. This interacts with your deductible strategy: if you have a high deductible, you're already paying small expenses out of pocket, which means you're more likely to qualify for the no-claims bonus. However, some tariffs offer reduced bonuses on high-deductible plans, so you can't always "double dip."

Read more about how this works in our health insurance bonus program guide.

How deductibles work in public health insurance (GKV)

About 90% of residents in Germany are covered by public health insurance (Gesetzliche Krankenversicherung or GKV), which is mandatory for employees earning under €77,400 per year in 2026. In most cases, GKV does not involve deductibles — you show your insurance card at the doctor and the bill is handled automatically.

However, many GKV providers offer optional tariffs called Wahltarife mit Selbstbehalt (§53 SGB V). Here's how they work: you agree to cover your own medical costs up to a set amount, and in exchange, your insurer pays you an annual bonus (Prämie) — essentially cash back for taking on more financial responsibility.

GKV deductible tariffs at major providers

The maximum annual bonus is capped at €600 per tariff (or €900 if you combine multiple Wahltarife).

What's excluded from the deductible?

Certain services are never counted against your GKV deductible, regardless of your tariff:

• Preventive care and early detection screenings
• Maternity and childbirth services
• Vaccinations
• Dental prophylaxis (like teeth cleaning)
• Services for family co-insured dependents (Familienversicherte)

The 3-year lock-in

Once you enroll in a Selbstbehalt Wahltarif, you're committed for at least three years. You cannot switch to another Krankenkasse during this period — unless your insurer raises its supplementary contribution (Zusatzbeitrag), which triggers a special cancellation right (Sonderkündigungsrecht).

Stiftung Warentest has called these tariffs a "bet on your health" (Wette auf die Gesundheit). If you develop a chronic condition in year one, you'll pay the full deductible in years two and three with no way out. Consider this carefully before signing up.

If you're thinking about switching your health insurance provider, do it before enrolling in a Wahltarif.

How deductibles work in expat health insurance

For expats in Germany who don't qualify for public or private insurance — common among non-EU citizens, new arrivals, and students — expat health insurance is often the starting point. Deductibles in expat plans work differently from both GKV and PKV.

With Feather's expat insurance plan, which has been consistently rated highly on Trustpilot, the deductible is €25 per insured event — whether inpatient or outpatient. For pre-existing conditions known in the six months before coverage began, the deductible rises to €5,000, with a €30,000 limit for the entire contract duration.

For our long-term expat insurance plan — designed for people who have been in Germany for more than five years and don't qualify for public or private insurance — you can select a deductible of up to €3,750.

Important: Expat insurance is designed as a transitional product. If you're employed and earning a regular salary, you likely qualify for public health insurance or private health insurance. Transitioning sooner rather than later protects you — conditions diagnosed while on expat insurance could count as pre-existing if you later apply for PKV.

High vs. low deductible: which should you choose?

The right deductible depends on your employment status, health, age, and financial situation. Here's a framework:

A worked example: is the premium saving worth it?

Let's say you're a self-employed freelancer choosing between two PKV plans:

• Plan A: €400/month premium, no deductible
• Plan B: €250/month premium, €1,500 annual deductible

Plan B saves you €1,800/year in premiums. If you stay healthy and spend under €300 on medical costs, you come out ahead by roughly €1,500. But if you need a surgery or treatment costing €3,000, you pay the first €1,500 out of pocket — and your net savings shrink to just €300.

Over 5 years, Plan B saves you €9,000 in premiums. If you hit the full deductible in 2 of those 5 years, you pay €3,000 extra — still saving €6,000 net. The breakeven point is roughly when you exhaust the full deductible in 3 out of 5 years.

Bottom line: High deductibles reward people who rarely use healthcare. If you're unsure, start with a moderate deductible (€500) and adjust at renewal.

Curious whether private insurance is the right fit? Read our analysis: Is private health insurance worth it in 2026?

Still unsure? Try our recommendation tool — it analyzes your lifestyle and recommends the most suitable plan.

Are health insurance deductibles tax-deductible in Germany?

This is one of the most common questions expats ask — and the answer has two parts.

1. Health insurance premiums: yes, they're tax-deductible

Your health insurance premiums qualify as Vorsorgeaufwendungen (precautionary expenses) under §10 EStG. For both GKV and PKV, the portion covering basic healthcare (Basiskrankenversicherung) is fully tax-deductible with no cap. This includes your standard contribution and any supplementary contribution (Zusatzbeitrag).

2. Out-of-pocket costs (including deductible payments): only above a threshold

Medical expenses your insurance didn't cover — including deductible payments, co-pays, and uncovered treatments — can be claimed as Außergewöhnliche Belastungen (extraordinary expenses) under §33 EStG. However, there's a catch: you can only deduct the portion that exceeds your zumutbare Eigenbelastung (reasonable personal burden threshold).

This threshold depends on your income and family situation:

Practical reality: A single expat earning €60,000 would need more than approximately €3,500 in unreimbursed medical costs before any tax benefit kicks in. For most healthy working adults, PKV deductible payments of €500-€1,500 won't reach this threshold — meaning they're effectively not tax-deductible.

If you have a chronic condition and high annual out-of-pocket costs, however, tracking every receipt could pay off at tax time.

How to save money with your deductible

A few practical strategies to make the most of your deductible:

1. Use the no-claims bonus to your advantage. In PKV, if you don't file any claims during a calendar year, many providers refund 1-3 months of premiums. If you have a moderate deductible and minor expenses, it may be worth paying small bills out of pocket to preserve this bonus. Run the numbers: compare the bonus amount against what you'd spend out of pocket.

2. Claim preventive care without worry. Preventive services — check-ups, vaccinations, screenings — are excluded from deductibles in both GKV Wahltarife and most PKV plans. Use them freely. They won't affect your deductible or your no-claims bonus eligibility.

3. Keep a dedicated emergency fund. If you choose a deductible, maintain a savings buffer (Tagesgeldkonto) equal to your annual deductible amount. In PKV, you'll need to pay medical bills upfront and wait for reimbursement — this can take weeks. Having cash on hand prevents a medical bill from becoming a financial emergency.

4. Compare the full picture. Don't just compare premiums. Calculate your potential annual costs: premium + likely out-of-pocket expenses + deductible. A €200/month plan with a €1,500 deductible could cost more than a €300/month plan with no deductible if you need regular care.

5. Review annually. Your health needs change over time. A high deductible that made sense at 28 might not work at 40. In PKV, you can typically adjust your deductible at renewal. In GKV, remember you're locked in for 3 years — so plan ahead.

Ready to compare your options? Use our health insurance comparison tool to find the best plan for your situation, or explore the differences between public and private health insurance.