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Guide to Germany

Health insurance in Germany: What you need to know

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  • Ricarda Klinkow

Health insurance is mandatory in Germany: This applies to permanent residents as well as to international students or employees staying temporarily. We are here to guide you through the differences between Germany’s two distinct insurance systems, i.e., private and public health care, and to provide information on coverage and contributions as well as on how to choose or switch your individual insurance plan.

Germany's health insurance options

In Germany, you are free to choose your doctor, whether it is for the common cold requiring a prescription, a sick leave notice, or for the ongoing treatment of a chronic illness by a specialist. Health insurance is a legal requirement and is therefore mandatory for everyone in Germany, including permanent residents, immigrants, and international students.

To offset the potentially high costs associated with various treatments and medical services, two separate insurance systems are in place: statutory and private health insurance. While both systems guarantee a similar level of medical care, there are substantial differences between the two. These distinctions include eligibility criteria, costs, services covered, and more.

What is public health insurance?

The most common form of health coverage in Germany is public health insurance, or statutory health insurance. Membership in this system is mandatory and nearly everyone is automatically eligible to receive this kind of insurance. The following groups are entitled to statutory health insurance:

Public health insurance providers such as Barmer cover the costs of various essential medical services. This includes routine check-ups with general practitioners or specialists, emergency hospital treatments, basic dental care, and prescribed medications. However, certain services may only be partially covered or require full payment by the patient, such as specific vaccinations.

If you have children, they can be included in your public health care plan at no additional cost. The family coverage option is applicable until the children reach a certain age and can be extended until they turn 23 if they are still attending school or undergoing an apprenticeship. Students are covered up to the age of 25.

The solidarity principle in statutory health insurance

The solidarity principle underpinning statutory health insurance in Germany ensures that everyone has equal access to medical treatment, irrespective of their employment status or medical history. Your monthly premium is directly tied to your income, meaning that lower-income individuals pay lower contributions, while those with higher incomes contribute more.

However, higher earnings do not lead to continuously increasing contributions, as there is a capped threshold in effect. Consequently, only your gross income up to an annual amount of 62,100 euro is considered for contribution calculations.

Eine Kinderärztin mit Mutter und Kind und einem Tablet

People with statutory health insurance generally do not have to pay at the doctor. Important preventive check-ups are also completely free of charge.

How does private health insurance work in Germany?

Private health insurers are private companies that provide either basic health insurance or supplementary health insurance coverage. Unlike its statutory counterpart in Germany, private health insurance is less common as it is available to a smaller eligible population. To qualify for this system and to become a member, certain criteria must be met. An important consideration is your annual income, which must surpass a designated threshold. As of 2024, you must earn a gross income of more than 69,300 euro per year to be eligible for private insurance. Moreover, certain professions or statuses automatically qualify for private health insurance, e.g. self-employed individuals and civil servants.

Private health insurance encompasses all essential medical care services. Additionally, you must choose your own coverage options by including special treatments in your insurance plan. This can extend to specific dental care or optician’s services, which typically fall outside the coverage of the statutory health insurance. It is important to note that, unlike statutory health insurance, patients may under certain circumstances be required to pay for treatments and health care services upfront. Subsequently, the private insurer reimburses the cost after the patient submits the invoice – in cases where treatment was indeed necessary. Insurers may demand a cost estimate beforehand.

It is also important to note that it is possible to complement public health insurance with supplemental private insurance for additional services.

Calculating premiums in private health insurance

Unlike the public insurance system, private health insurance premiums are not influenced by your income. Instead, your age and medical history determine the amount you have to pay each month. Although these individual insurance plans may come with a higher premium, privately insured patients often enjoy advantages such as shorter wait times for doctor’s or specialist’s appointments.

Choosing and switching your insurance provider

Finding the most suitable health insurance for your requirements is easy within the statutory insurance system, as all public German health insurance companies cover the costs for the same essential medical treatments. If you are a Barmer member, you can also gain access to additional benefits, such as medical advice in English through the convenient Teledoktor service or the possibility of receiving a cash reward of up to 150 euro annually through the Barmer Bonus Program. These additional services and benefits can make switching from another provider worthwhile.

Find out more about the benefits of mandatory health insurance in germany

Perfect support in Germany: Barmer is one of the biggest public health insurance providers and specialized in health insurance for international students and employees.

When selecting a private insurance plan, it is recommended to compare thoroughly, as the coverage and costs may vary among companies. The premium is determined by your age and medical history. Consequently, for individuals with chronic illnesses or older patients, the cost can be considerable and, depending on your financial situation, challenging to afford. Unlike public insurance, private health insurance requires separate premiums for each family member, as there is no family health care plan available.

Switching between health insurance systems is generally an option, provided you meet the requirements for each system. However, it is important to note that switching from a private insurance plan to the statutory system can be very challenging if you are over the age of 55.

Ein junger Mann mit Laptop sitzt auf dem Boden einer WG

In Germany it is very easy to change your health insurance online. The statutory health insurance providers do not even require a health check.

Health insurance in numbers

In 2023, patients were able to choose from 96 different insurance providers for their statutory health insurance plan in Germany. More than 72 million people are registered in the public health care system, constituting almost 90 percent of the population. In contrast, a little over 9 percent of the German-speaking population, as indicated in a survey, exclusively opted for private insurance, while about 21 percent sought additional individual services.

What happens when I’m not insured?

If you lack any form of German health insurance, whether private or public, and require medical attention, you must cover the entire cost of the services. Depending on the type of treatment, this could result in a substantial invoice. 
Although the German health insurance system is mandatory and caters to all residents, whether permanent or temporary, certain groups of people may still face the risk of being uninsured. This risk could stem from administrative obstacles, challenges faced by self-employed or low-income individuals in affording insurance premiums, or other gaps in coverage.

If you were previously a member of a German health insurance plan and find yourself without coverage, you will be eligible for the type of plan that you were enrolled in before. For instance, if you were privately insured, you can only enrol with private providers. If you are uncertain about which system applies to your situation, it is advisable to contact a statutory health insurance provider.

Furthermore, it is not recommendable to delay enrollment with an insurance provider until you become ill or require medical treatment, as you will be obligated to repay accumulated premiums.