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Health Insurance in Germany

Health insurance in Germany is obligatory for all residents, including expatriates and the self-employed. International healthcare plans are not officially accepted as a substitute for a national insurance policy. Insurance coverage is also a prerequisite for residence or work permits.
In Germany, there is a range of public (Krankenkassen) and private health insurance providers (Krankenversicherungen).

You cannot take up gainful employment without having health insurance. Any German company who wants to legally employ you will ask for your medical insurance information beforehand. It is the employer’s duty to share the respective costs with the employee, as well as to deduct and forward your financial contribution automatically from the salary.

If you need a visa for coming to Germany or a residence permit for staying in the country, you usually have to show proof of healthcare coverage as well. Only if you have some sort of special status (e.g. when transferred to Germany for a limited period) is it sometimes possible to avoid signing up for health insurance in Germany. The issue of international insurance for foreign residents is a grey area: It might be tolerated, but you shouldn’t rely on that.

One typical aspect of the German healthcare system is the coexistence of private and public providers. The option available to you depends on a variety of criteria. In both cases, you have many companies to choose from; either way, employers and employees share the costs (though not always equally).

However, health insurance does not cover all related expenses. Your medical plan does not include nursing care for the aged. Contributions to nursing care and to the German social security system are subtracted separately from your salary.

Medical insurance does not cover work-related accidents and disabilities, either. Your employer looks after the former; the latter is regarded as your responsibility. If you are self-employed, insurance matters are your own responsibility anyway, and you have to pay for all expenses yourself.

Finding the Right Plan

There are up to 170 companies providing health insurance in Germany. Services and prices of public policies and private options vary considerably.

The premiums for public health insurance are fixed at a certain percentage of your income. This leads to a lot of competition for providing different services among healthcare providers. However, legal regulations ensure some basic coverage.

You can always add optional services, which makes a thorough comparison of all companies rather complex. For example, some insurers include travel insurance outside the European Union or reimbursements for alternative medicine. Other providers offer benefits and reimbursements if you participate in preventative programs and regular checkups.

One of the most important decisions is the choice between public and private healthcare plans. Several factors play a significant role:

  • your age
  • your legal status and family situation
  • your salary and occupation
  • the intended duration of your stay
  • the services and benefits you prefer

You need to consider the following questions: Who is covered? What is covered? And how much will it cost? The answers to these questions reveal significant differences between public and private health insurance.

Private vs. Public Healthcare

Most people participate in the government’s healthcare plan. Private insurance is not available to everyone. Only if your gross income from employed work exceeds 53,550€ p.a. (as of 2014) can you normally choose that type of care. (German civil servants are among the exceptions to that rule, but not many expats will find employment in the civil service.)

Under certain conditions, the maximum premium for public health insurance is higher than the fees for private providers, making the latter more attractive. This is of particular interest to adults in good health who have no kids and do not plan to stay in Germany indefinitely.

The major benefit of public health insurance is the fact that it extends to dependent family members as well. You don’t have to pay additional fees for your non-working spouse and children. The alternative requires you to get your spouse and kids insured separately.

If you plan to stay in Germany for a short while only, you may benefit from private health insurance. But for a longer stay, especially with children, the government-sponsored option is often the better choice.


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