In this post, you’ll learn everything you need to know about health insurance and the German healthcare system in 2024.
In fact, this is the exact advice we’ve given to more than 70,000 Feather customers. With a 4.9 rating from 1,700 reviews, you can rest assured it’s good advice.
Today, we’ll show you precisely all we know about healthcare and insurance in Germany…
And how you can pick the best option for your lifestyle.
Let’s get started.
Do You Need Health Insurance in Germany?
On April 1, 2007, Germany introduced a law requiring every resident to have health insurance.
This includes:
- Expats
- Students
- Freelancers or self-employed individuals
- Visa and Chancenkarte applicants.
By January 1, 2009, this became a firm rule for all residents, whether German citizens or individuals from other countries living there temporarily or permanently.
Why Is Health Insurance Mandatory in Germany?
You need health insurance in Germany because it ensures healthcare is fair to everyone. This system started in 1883 when the Parliament made health insurance mandatory for certain employees.
But, Why?
There are 4 reasons healthcare is mandatory in Germany:
- Fairness: residents receive treatment regardless of wealth or health condition.
- Sustainability: if everyone contributes to pay, it helps keep the system strong and growing.
- Distributing Risk: Mandatory insurance ensures people can’t just get coverage when they need expensive medical care. This helps keep healthcare steady and affordable for everyone.
- Early Intervention: Health insurance encourages people to seek care early, which improves overall health and helps the healthcare system work better.
What happens if you don’t have health insurance in Germany?
If you don’t have health insurance and don’t pay premiums, several things can happen:
- Accumulating Debts: You’ll owe money for your missed contributions.
- Legal Actions: Authorities may collect these debts by taking money directly from your bank account.
- Late Payment Fees: Insurers add extra charges for late payments.
- Limited Coverage: you’ll only receive basic medical care during emergencies or pregnancy.
If you go without insurance for a while and want coverage again, you’ll have to pay all the missed premiums.
When should you get health insurance in Germany?
In Germany, getting health insurance quickly is important, particularly if:
You’re moving from another EU country for work.
Arrange your health insurance immediately after registering for residency. There’s a short grace period after registration, so there’s no need to worry. Your employer will also help you navigate this process, as they’re liable for you if you are not insured by the time your employment contract starts.
You’re moving from a non-EU country,
You’ll need German health insurance to get a Visa or a residency permit. It’s crucial to secure insurance coverage before you arrive in Germany.
However, to apply for a Visa, you need proof of health insurance, which you can’t get without a job in Germany. The consulate refuses travel insurance, as it doesn’t meet their requirements.
However, you need a visa to obtain a job legally. This situation creates a catch-22: you need a job for insurance and insurance to get the job.
No worries, though, Feather has the perfect insurance for you:
Expat health insurance
Feather offers an expat health insurance plan with a unique confirmation letter upon request.
Here’s why this is a game-changer:
- All the required documents: When you sign up for our plan, you can download a confirmation of cover, certificate of authority, and Anlage 6 in under 3 minutes straight from your account. Make sure to submit them with your application.
- Confirmation Letter: This letter explains why Feather’s insurance meets the official criteria, helping you overcome the consulate’s pushback.
- Customer Success: Our approach has helped many customers navigate consulate requirements successfully.
- We have your back: If your local consulate doesn’t listen, we’ll personally contact them.
Plus, once you secure employment, we help you transition quickly (and digitally) to a standard public or private health insurance plan.
Is the German Healthcare System Good?
Germany’s healthcare system ranks 8th in the world in Ceoworld’s Health Care Index, compared to the United States’ 15th.
Here are some key facts from the Federal Ministry of Health that explain Germany’s ranking:
- Germany has 1,914 hospitals with 494,326 total beds installed.
- There are over 409,115 working doctors in Germany.
- There are over 18,753 public pharmacies in Germany.
- Statutory or private health insurance covers 98.6% of the German population.
How Does the German Healthcare System Work?
In Germany, every resident must have health insurance, regardless of how long you plan to stay.
You’ll need to pay for your health insurance every month.
In turn, your insurance covers (almost) all healthcare expenses you come across. It takes care of things like medical operations and medication.
You have two health insurance types in Germany:
- Public providers
- Private providers
Both options are great for patients but have different eligibility requirements, costs, and coverage.
How Does the Public Health Insurance System Work?
Public health insurance, or statutory health insurance (Gesetzliche Krankenversicherung, in German), is state-backed insurance provided by more than 100 not-for-profit public health funds (Krankenkassen).
Here’s how they work:
- Cost: It’s directly proportional to your income. You pay half and the other half by your employer. This way, you’re paying for your healthcare services and everyone else’s.
- Flexibility: You can choose your provider but might struggle to find specialists. Unless in an emergency, you must find a cabinet that accepts new patients.
- Coverage: It is mainly limited to necessary care. You’ll still get a few preemptive procedures like checkups and cancer screenings, but if you want specific treatment, you must pay for it yourself.
How Does the Private Health Insurance System Work?
Forty-two companies provide private health insurance in Germany. They are all regulated by the government, so there is no need to worry about their legitimacy.
There are two basic categories of private health insurance:
Joint-stock companies (Aktiengesellschaft — AG)
Its shareholders own these. The company’s profits are distributed to the shareholders; policyholders do not receive a share of the company’s profits.
Mutual insurance company (Versicherungsverein auf Gegenseitigkeit, VVaG)
Their members own them, and any profits made are redistributed among the members. Their purpose is to serve the policyholders’ interest.
How they compare to public insurance:
- Cost: The price depends on your age and health when you sign up. Younger, healthier individuals usually get a better price.
- Flexibility: Private insurance offers more flexibility. Doctors tend to prioritize privately insured patients.
- Coverage: You can modify your coverage with private insurance. It can offer more comprehensive coverage than public insurance if you’re willing to pay higher premiums.
Over 13% of German residents are privately insured. While many want private insurance, not everyone can be on a private health insurance plan. Eligibility depends on a few factors, including income and what type of work you do.
Private vs. Public Health Insurance
Here’s how they compare:
| Public Health Insurance | Private Health Insurance | |
|---|---|---|
| How much does it cost? | The contribution rate is ≈14.6% of gross salary. Employers pay for 50%. | It changes based on risk level: Age, health, and coverage. |
| Who is eligible? | Any person living in Germany for the long term can get public insurance. | In 2024, employees must earn at least €5,775 gross. Freelancers under 45 need must earn at least €2,500 (€3,750 for those over 45). |
| What is covered? | Essential coverage: hospital stays, doctor visits, emergency treatments, medical tests, and limited dental and vision care. | Covers more medical services and private hospitals. Does not include treatment for some pre-existing conditions. |
| Flexibility | Plans and coverage are fixed. | Your insurance plan is modular: you can adjust your coverage level. |
| Wait times | Services for not urgent needs are slower. | Quicker access to non-urgent medical services. |
| Access to specialists | Possible after your general practitioner recommends it. | Possible without a general practitioner’s recommendation. |
| Claims & Reimbursements | After you show your card, the provider will handle the billing directly with the insurance company. | You must first pay yourself. After paying, you submit a claim to your provider, who will review it and reimburse you. |
| Learn More | Guide to public health insurance. | Guide to private health insurance. |
Should you choose private or public?
You can choose between the two based on your profession and income. It’s hard to say which is better without discussing your needs and situation first.
Here are some factors you should consider to determine which insurance is better.
Duration of Stay:
- Long-term Stay (until retirement or beyond): Public health insurance may be better because older individuals tend to pay lower premiums.
- Short-term Stay (a few years): Private health insurance might save you money.
Family Considerations:
- Public Health Insurance: Covers dependents (spouse and children) for free.
- Private Health Insurance: Requires payment for each dependent.
Citizenship:
- EU citizens can access public health insurance when working or studying in Germany.
- Non-EU citizens often need to choose private health insurance.
Employment Status:
- Employees often choose public health insurance due to income-related thresholds.
- Self-employed tend to choose private health insurance for generally lower costs.
Health Status:
- Pre-existing Conditions: Public insurance provides comprehensive coverage.
- No Pre-existing Conditions: Private insurance can offer lower premiums.
Coverage Needs:
- Public Health Insurance: Many treatments are not covered but can be included with additional supplementary insurance (e.g., dental).
- Private Health Insurance: Offers customizable coverage at a higher cost.
What is the best public health insurance provider?
We recommend four public health insurance providers:
Here’s how they compare:
| Barmer | TK | DAK | AOK | |
|---|---|---|---|---|
| Your contribution | 16.79% of gross income | 15.80% of gross income | 16.30% of gross income | 16.40% of gross income |
| English Support | Easily accessible | Easily accessible | Easily accessible | Harder to access |
| Digital services | You can get medical advice by phone, chat, or message. They also have a Doctor Finder tool available. | The TK App is available to download health cards and documents. TK Coach helps with stress management, fitness, and nutrition. App TK-Doc allows you to chat virtually with doctors. | DAK App is available to submit invoices and certificates, contact, digital mailbox, view sick notes, electronic patient files, etc. Online medical video consultation is available. | It depends on the regional AOK branch, but overall, it is less developed than the others. |
| Processing speed (based on our customers’ feedback) | 5/5 | 5/5 | 5/5 | 3/5 |
| Our Highlight | Excellent customer support in English. | Great digital services and the best insurance for students. | Excellent coverage for families. | Personal support all over Germany. |
| Bonus Program: Receive rewards for health activities. | Up to €150. | Up to €400. | Up to €500. | It depends on the regional AOK branch. |
| Dental cleanings | Removal of tartar once a year. | Up to €40/year. | Up to €60/year. | Up to €50/year. |
| How to sign up | Get covered with Barmer | Get covered with TK | Get covered with DAK | Get covered with AOK |
What is the best private health insurance provider?
Germany has over many private health insurance companies, but we can only recommend one: Feather.
Here’s why we think you should sign up for private health insurance through us:
- 90% of our customers don’t need a medical checkup. If you do, we’ll cover 100% of the costs.
- We average 4.9/5 reviews, the best-rated support in Germany.
- Fully digital: manage your policy online, including updating information or claims.
- Everything in one account: Health, liability, household, and other insurance policies can all be managed in one account.
- Customized coverage: Choose between different plans to adjust your coverage to your needs
How expensive is Healthcare and Insurance in Germany?
Healthcare and insurance costs in Germany vary based on whether you have public or private coverage.
For both, most healthcare services are covered, with some requiring a small fee, like between 5 and 10 euros, for each prescription medication given to them.
Public insurance is generally more expensive, but that depends if you have a family. It consists of a fixed rate of 14.5% of your annual salary plus an additional fee, split with your employer.
Private insurance generally costs less, depending on age, health, coverage, and your chosen provider.
How can you access healthcare in Germany?
Should you need care, these are the most common options:
- Call your doctor. Even after closing hours, they will get back to you the next day with the next steps. Read this guide to learn how to find a doctor in Germany.
- Dial 116117 if you need medical help outside standard hours; they will guide you to on-call doctors or pharmacies open 24 hours a day.
- Take a taxi to the nearest hospital’s Notaufnahme (emergency room)
- Call 112 or 19222 for an ambulance.
How to Change Your Health Insurance Provider
Switching Between Public Health Providers
You can change your public health insurance provider under certain conditions:
- Change in Employment: You can switch providers if you change your employer or employment contract.
- Increase in Contribution Rates: If your provider raises the health insurance fund’s supplementary contribution rate, you may switch to another provider in the first month the new rate is applied.
- Change in Insurance Status: For instance, if you transition from being employed to self-employed or are dependent on someone’s policy, then become employed.
Signing up with a new provider within 14 days of these events is crucial. Standard cancellation periods apply if you miss the 14 days or your situation doesn’t fit these criteria.
You must have been with your current provider for at least a year to be eligible to switch. When you do switch, the cancellation period is the current month plus two additional months.
When switching between public providers, you don’t have to cancel your existing policy directly; just apply with the new provider and inform your employer, who will handle the cancellation on your behalf.
Switching from Public to Private Health Insurance
You can switch from public to private health insurance without a cancellation period if:
- Change in Employment with Higher Earnings: If you change employers and your new annual gross earnings exceed €69,300, or if you start self-employment.
- You must sign up with a new provider within 14 days of these events to avoid a cancellation period.
If you miss the 14-day window or don’t meet the criteria, the cancellation period of the current month plus two additional months will apply. The new membership starts after this period ends.
Special Case for Salary Increases: If your salary increases with the same employer and your yearly gross earnings surpass €69,300, your mandatory public insurance membership ends at the current year’s close.
For example, if you receive a salary increase on March 1, 2024, you must stay with public insurance until December 31, 2024. No cancellation period will apply if you cancel your public insurance within 14 days starting January 1, 2025. If you miss the 14-day deadline, the standard cancellation period applies.
What is supplemental health insurance?
Supplemental health insurance fills gaps in your regular health insurance. It covers expenses your primary insurance doesn’t, like disability or dentistry.
For example, if you get chronic back pain, income protection insurance provides a monthly payout until you can return to work. You can use this money for medical bills, transportation, childcare, food, or housing.
Does health insurance expire after leaving your job?
Public Health Insurance
No, it does not expire immediately.
If you have public health insurance and lose your job, your coverage will remain, but your payment method may change.
The Agentur für Arbeit (Job Center) will cover your health insurance costs if you receive unemployment benefits. If not, you must pay approximately €210 per month yourself.
You can also be covered for free under a family member’s policy or enjoy one month of free coverage automatically applied after a job loss.
Private Health Insurance
No, it does not expire but becomes more costly.
If you lose your job, you’re still covered under private health insurance but must pay the entire premium yourself. Previously, your employer would have paid for half.
If you receive unemployment benefits, you must switch to public health insurance, which the Agentur für Arbeit will pay for. If you do not receive benefits, you maintain your private insurance but bear the total cost.
Conclusion
We hope this guide helps you to better understand Germany’s insurance and healthcare systems.
Now, over to you:
What did you learn from this guide? Do you think something is missing?
Let us know now by leaving a comment!
