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Healthcare in Germany

Health Insurance and the Healthcare System of Germany Explained

Whether you opt for public or private health insurance in Germany largely depends on your income, however, this guide explains other factors to consider when obtaining health insurance and gaining access to healthcare for non-residents in Germany.

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The healthcare system in Germany is extremely reliable; however, it might seem a little confusing at first. This guide explains everything you need to know, giving you an overview of the healthcare system in Germany, including your mandatory contribution towards health insurance, and what that entitles you to.

You will also find out whether you are eligible for private health insurance, which could grant you access to perks such as private hospital rooms. Furthermore, this section outlines how to find a doctor and the best hospitals, including information regarding maternity such as pregnancy and giving birth in Germany.

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How Does Healthcare Work in Germany?

Germany’s healthcare system and social security scheme have a good reputation. So, how does healthcare work in Germany? It is based on a dual public-private system.

Healthcare for non-residents and residents alike is vital in Germany. Healthcare in Germany is divided into two sectors: the gesetzliche Krankenversicherung or Gesetzliche Krankenkasse (public health insurance or statutory healthcare system as the Germans prefer to call it) and the private Krankenversicherung (private health insurance).

In Germany, it is a legal requirement to have some form of health coverage, whether public or private, and it is even a requirement when starting a job in Germany. Your German employer will typically take care of registering you with a German health insurance company but in case you want to choose your own, they 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. Your contribution amount may be pricey, based on your line of work and annual income.

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 insurance companies to choose from; either way, employers and employees share the costs (though not always equally).

Some Healthcare Facts about the German Healthcare System

  • Does Germany have free public healthcare? Yes, all Germans and legal residents of Germany are entitled to free “medically necessary” public healthcare, which is funded by social security contributions. However, citizens must still have either state or private health insurance, covering at least hospital and outpatient medical treatment and pregnancy.
  • But what exactly does the public healthcare cover? It covers treatments and services, such as immunizations, prescriptions, and dental checks. This sort of national coverage helps keep average healthcare costs in Germany to a minimum and is one of the reasons the system has a positive reputation around the world.
  • Unlike other European countries, Germany divides its citizens’ healthcare needs by income.
  • All salaried workers in Germany, whose gross monthly income is less than 5,063 EUR (2019), have to have public health insurance, also known as gesetzliche krankenversicherung (or GKV) but are not allowed private insurance. And if you are eligible for private insurance, because, for example, you get a pay rise, you can change from public to private health insurance, but you have to opt out of the statutory insurance first – you cannot have both.
  • The percentage they owe to the state-run healthcare system is taken out of their monthly pay. Germany’s healthcare contribution costs are 14.6 to 15.6%, half of which the worker pays, and half the employer. There may also be a small supplemental rate on top of this, at an average of 0.9%, which is paid solely by the employee. This supplement is a “contribution rate” charged by the state German health insurer.
  • Applying for public healthcare insurance is relatively stress-free, as you simply need to register with the German authorities at your local town hall. Once you are registered, have a social security number, and are making your contributions, you will have access to the state-run healthcare.

What are the Pros and Cons of Germany’s Healthcare System?

Pros

  • Well-developed health insurance sector.
  • Contributions are based on income.
  • Don’t need a doctor’s referral in order to see other specialists such as a chiropractor.

Cons

  • Patients who require overnight care are charged an additional fee, including for meals. This is typically not covered by many insurance companies.
  • Some expats may not be able to sign up for private insurance as some insurance providers only accept people who have been living in Germany for at least two years.
  • The higher your taxable income, the more you pay in contributions.

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An Overview of Private Health Insurance

Do You Need Private Health Insurance in Germany?

It is certainly an option as a top up or as a replacement to the public health insurance in Germany, but if you are covered by the state, then you do not need to have private health insurance. Plus, there are many restrictions for those wishing to opt out of the state-provided health insurance and choose private health insurance instead.

Moreover, you have to be earning more than 60,750 EUR per year to opt for private health insurance. It’s also available to self-employed people and German civil servants. Civil servants, such as professors, are not obligated to have insurance from the public health insurance system. If you’re a freelancer, you can have private health no matter your income.

And, the self-employed now pay less to contributions than before 2019, after public health insurance providers reduced the “hypothetical income” they expect self-employed workers to earn on average per month, from 2,284 EUR to 1,038 EUR. Previously, even if you were just earning 1,000 EUR you had to pay 420 EUR, now it’s around 190 EUR per month.

Also, if you earn less than 450 EUR per month, you might be able to use your partner’s health insurance for free, if they earn a higher salary.

The application process for private health insurance is a bit more complicated. You may be subjected to medical tests, required to answer a questionnaire concerning your medical history, and submit proof of your income.

Unlike with the public healthcare system, if you choose to go the private route or choose your own medical insurer, you will have to go through the selection and application process without your employer’s help. Private health insurance is not necessarily better than public health insurance, but you will be seen sooner. Also, you may have better access to doctors who speak your native language.

If you need a visa to come to Germany, or a residence permit to stay 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.

Private vs Public Healthcare in Germany: What is the Difference?

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

Private health insurance allows you to get medical attention faster. However, there are other things to consider: Who is covered? What exactly is covered? How much will it cost? The answers to these questions reveal significant differences between public and private health insurance.

Most people use public healthcare, that is, the government’s healthcare plan, as private insurance is not available to everyone. In most cases, you can only choose private health insurance if your gross income from employed work exceeds 60,750 EUR per year. 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. Thus, private health insurance can be of particular interest to adults in good health who have no kids and do not plan to stay in Germany indefinitely.

Also, patients with private healthcare, or a corresponding supplement to their public insurance plan, enjoy a number of other benefits as well. For example, you may stay in a single or double room instead of a small shared room with three or four beds.

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.

The Benefits of Private and Public Healthcare

Private Public
Faster service Available to all earning less than 60,750 EUR
Convenient for a short stay in Germany Extends to dependent family members
Can be less than public insurance price No extra fees for non-working spouse
Access to exclusive doctors Children included in your plan
Access to multilingual doctors Civil servants don’t have to contribute

Types of Health Insurance Plans

There are more than 100 companies providing health insurance in Germany. If you’re wondering how much health insurance can be per month, the average cost varies considerably and depends on the health insurance coverage, and whether you’re using the state system or private insurance.

The biggest public healthcare insurance providers in Germany are AOK, TK, and Barmer GEK, and the most anyone has to contribute to public health insurance is 683 EUR per month.

On the other hand, some of the best-known private health insurance companies are:

  • Allianz Private Krankenversicherung
  • AXA
  • DKV
  • Debeka
  • Deutsche Krankenversicherung
  • Signal Iduna
  • HUK-Coburg-Krankenversicherung
  • Bayerische Beamtenkrankenkasse
  • Continentale Krankenversicherung
  • Central Krankenversicherung
  • Barmenia
  • HanseMerkur

Some medical coverage offers travel insurance outside the European Union or reimbursements for alternative medicine. Other providers offer benefits and reimbursements if you participate in preventative programs and get regular checkups.

Remember that prices vary depending on the extent of the cover you buy, your health, and various other factors. So please view the prices we quote as simply a guide of what to expect. If you’re planning on getting private insurance, here are some plans you can choose:

HanseMerkur private insurance for employees has a 4.8 out of 5 rating on feedback website, eKomi. The monthly cost for HanseMerkur’s private insurance for employees is 132 EUR. These are some of the positives of its services:

Coverage of HanseMerkur private insurance for employees:

  • 500 EUR per year to care for a sick child up to 12 years old
  • Preventative medical checks
  • If you stay healthy, save 10% a month
  • Get premium refunds if you’re rarely ill
  • Vaccines
  • Treatment by a head physician
  • A single or double hospital room
  • Upgrade in the fourth, sixth, and eighth year

HUK-Coburg is another private health insurance firm in Germany. The monthly cost for their “Comfort” private insurance plan is 277.88 EUR. This is what it offers:

Coverage of HUK-Coburg “Comfort” plan private insurance:

  • Get up to 3 months’ premium refund
  • Medical treatment covered
  • Drugs covered
  • Massage, physiotherapy, and more
  • 90 to 100% cover on walking aids
  • Alternative medicine
  • Dental treatment
  • Twice-a-year teeth cleaning

DKV has a 4.5 out of 5 rating from more than 7,400 reviews. The monthly cost for their Premium private insurance plan is 253.80 EUR. This is what you get with its “Premium” plan:

Coverage of DKV “Premium” plan private insurance:

  • One-bed hospital room
  • Seen by the chief physician
  • Dental treatment
  • First 30 psychotherapy sessions
  • Laser eye surgery
  • Dentures
  • Choice of hospital
  • Coverage on hospital stay past 91 days

What if You Don’t Have Health Insurance?

Having no German health insurance means having to pay upfront for everything – unless it’s a serious emergency and if you’re an EU citizen. Most EU citizens will get reimbursed for such emergency treatments by reciprocal insurance coverage between Germany and their home countries. However, for nationals of other countries, it will depend on the insurance plan they have in their country of origin.

For these and other reasons, acquiring a German health insurance plan is recommended. Even then, there are certain details to consider: some doctors only accept patients with private insurance. If you have public health insurance, make sure to look for a Kassenarzt who treats Alle Kassen (patients with any sort of German health coverage).

Please consider that small private hospitals in Germany might not have an emergency room. When you arrive at a clinic for an emergency, you’ll normally receive treatment even if you do not carry proof of health insurance with you. However, if you do not have any health insurance at all, the treatment is going to be very expensive. If you decide against a German health insurance plan, check with your insurance company at home whether they will reimburse you for medical treatment at hospitals in Germany.

What are the Best Private and Public Hospitals in Germany?

Medical facilities are usually modern and have high standards. Staff and doctors are well-trained, and hospitals in Germany offer a great number of special treatments.

You can also find many specialized physicians outside hospitals in Germany. Therefore, you don’t have to go to a hospital if you need to see an internist or radiologist. Normally, your general practitioner (GP) will write a referral if you’re in need of special treatment, although this isn’t essential; it is also your GP (and your GP only) who can send you to one of the many hospitals in Germany.

The University Clinic Heidelberg University Hospital in Heidelberg is ranked as the best of all private and public hospitals in Germany, while Asklepios Klinikum Bad Abbach in the South-East is second, and University Hospital Hamburg Eppendorf, in Hamburg comes third.

The biggest hospital (single-building) in Germany (and Europe) is University Hospital RWTH Aachen.

Some of the best healthcare centers tend to be university hospitals, as they benefit from cutting-edge medicine, and tend to attract the best doctors due to the prestige of being associated with a major university.

Some of the best children’s hospitals and medical centers for kids in Germany are:

  • University Medical Center Freiburg
  • Klinikum Stuttgart
  • DRK Kliniken Berlin
  • Heidelberg University Hospital

Best Hospitals in Major German Cities

Berlin Stuttgart Frankfurt Munich Dusseldorf
St John’s Hospital Stuttgart Clinic Johann Wolfgang Goethe University Hospital University Clinic of Munich University Hospital, Dusseldorf
HELIOS Kliniken Marienhospital University Hospital Wurzburg University Hospital of Munich Paracelsus Clinic
Vivantes Clinics Schmeider Day Clinic Artemis Laserklinik Eye Hospital Hospital Martha Maria Augusta Hospital
Martin Luther Hospital University Clinic and Faculty of Medicine Markus Hospital Paracelsus Clinic Marienkrankenhaus Kaiserwerth
DRK Clinic Adipositas-Zentrum Stuttgart St. Marienkrankenhaus German Heart Center Marien Hospital Düsseldorf

What to do in an Emergency

Should you need urgent care outside regular office hours, you can do one of the following things:

  • Call your regular doctor. Even if they have already left the practice, the recording on their answering machine might tell you the phone number of the nearest emergency doctor.
  • Look up the section called Ärztlicher Notdienst or Ärztlicher Bereitschaftsdienst (emergency calendar) in the newspaper. It lists all physicians on stand-by for emergency duty, numbers of emergency hotlines, and pharmacies with 24-hour service.
  • Take a taxi to the emergency room (Notaufnahme) of the nearest hospital.
  • Call 112 or 19222 for an ambulance.

Admission to Hospitals in Germany

No matter which kind of insurance you have you should inquire which treatments your company covers and which charges it pays for. Usually, hospitals in Germany charge their patients a daily fee of around 10 EUR, in addition to any costs you may incur for diagnostics, surgery, etc. Depending on your personal health insurance plan, these fees may or may not be reimbursed.

Moreover, patients with private healthcare can demand to be treated by one of the hospital’s chief doctors. Apart from that, medical treatment is almost identical to those with public health insurance would receive. However, there are some private clinics that are open only to patients with private health insurance.

Even though your general practitioner admits you to a hospital, they are probably not going to treat you. Only some medical specialists offer their services to nearby hospitals; they take turns working at their own practice and as part of the hospital staff (Belegärzte).

If your doctor cannot treat you personally, don’t hesitate to ask if they can recommend you a surgeon. In case your surgery is considered less urgent (e.g. hip replacements) or requires special examinations (e.g. by magnetic resonance tomography), your average wait for treatment will likely increase, as hospitals in Germany may put you on a waiting list.

When you go to the hospital (unless it’s an emergency), you need to register at the reception with proof of health insurance and an ID card or passport. Your bed would have already been reserved by your GP.

Your Stay in a German Hospital

Despite excellent facilities, some aspects of hospitals in Germany may seem odd to foreigners:

  • There are no curtains around the beds. While receiving treatment in your room, you may be exposed to other patients.
  • Hospitals in Germany provide neither pajamas nor towels. You should also remember to bring your bathrobe, toiletries, and a pair of slippers.
  • Breakfast is rather scarce, with a cup of coffee or tea and a few slices of rye bread. Prepare for early meals. Supper might be served as early as 17:00. However, most hospitals in Germany do have a cafeteria, and unless you are on a special diet, you are allowed to have private food and drinks in your room.
  • Visiting hours may vary, and visits by small children are sometimes frowned upon.

How to Find a Doctor or Dentist

Chances that while you are in Germany, you might get sick or need treatment of some sort so you will need to know how to find a doctor and dentist. If you aren’t self-employed or a stay-at-home parent, your company requires a health insurance certificate from a doctor in Germany in case you need to take sick leave.

The first step to start looking for a general physician (GP) or family doctor in Germany (Allgemeinarzt, Hausarzt). If you suffer from a condition in need of special treatment and are wondering how to find specialists, your GP can recommend you to a specialist (Facharzt) or refer you to a hospital (KlinikKrankenhaus).

If you are wondering how to find a family doctor, or how to find a dentist, every doctor in Germany is listed in the local phone directory (Gelbe Seiten) under Ärzte. In major cities, there are a great number of physicians, with more than one doctor in most neighborhoods. If you don’t know which doctor in Germany to choose, please contact your embassy or consulate. They usually have lists with recommended doctors for most regions, especially in urban areas. However, those physicians often tend to be very busy.

Then there’s always the internet: German websites like DocInsider offer ratings and rankings by other patients. Another way of finding a trustworthy doctor is by word-of-mouth: ask people you are in contact with which doctors and specialists they recommend.

A Step-by-Step Guide to Your Doctor’s Appointment

What you should know:

  • We recommend planning ahead when making an appointment with a doctor in Germany. You may not get an appointment for weeks.
  • If your case is urgent but not an emergency, go to your general practitioner (GP). But still, be prepared to spend some time in the waiting room.
  • Most practices have office hours from Monday to Friday between 08:00 and 18:00, with two hours’ break, usually between 13:00 and 15:00.
  • Many practices close on Wednesday afternoons.
  • If you have a regular appointment with your family doctor in Germany, simply show up a few minutes in advance.
  • First, you need to talk to the doctor’s assistant or receptionist (SprechstundenhilfeArzthelfer/-in) and tell them your name. Please keep in mind that most assistants speak little or no English.
  • Hand the receptionist your health insurance ID card and, if you’re seeing a doctor for the first time, you may also have to fill out a medical history questionnaire.
  • Then it’s time to settle in the waiting room.
  • While most young doctors in Germany speak English, don’t rely on anyone knowing another language. You can ask your embassy for a list of bilingual physicians.
  • You might be asked to undress.
  • Your doctor in Germany may be rather assertive.
  • If you’d like to get more information on your condition, just ask.
  • After an examination, the receptionist will hand you any required prescriptions, referrals, or sick leave certificates, and will ask you for a follow-up appointment if necessary.
  • If your insurance doesn’t cover the appointment and other needs, or if you’re privately insured, the administrative staff will send you the bill.

Getting Dental Treatment in Germany

Dental work in Germany can be quite expensive, and you often need to present a cost estimate to your insurance provider prior to getting treatment. Also, it is not always guaranteed that your insurance company deems the work necessary, as they strictly differentiate between cosmetic work and medical treatment, and therefore might not reimburse you.

The percentage that your insurance, be it private or public, will pay depends on the type of coverage you’ve selected. Some dental work is covered in standard medical insurance; however, it varies greatly depending on the procedure and the individual.

Quite a few Germans take out additional private health insurance coverage for dental treatment. This kind of top-up insurance option is called Zahnzusatzversicherung or Zahnschutz-Zusatzversicherung.

How to get Medication in Germany?

Unlike in a few other countries, you can only pick up your medication at pharmacies (Apotheke), of which there are many to choose from in most cities. Prescription and non-prescription drugs may be obtained at pharmacies (Apotheken, marked by a large red “A”) anywhere.

Medication can be expensive, depending on the coverage you have from your insurance. However, patients enrolled in the public health insurance scheme do not have to pay the full price for prescription medicine, but only 10% of the costs. Usually, this sum amounts to five or ten euros for most prescription drugs.

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Giving Birth in Germany

If you or your spouse have state-funded German health insurance, even if you’re a non-resident, the cost of having a baby in Germany including post-natal care is covered by the insurance company. If you have private health insurance in Germany, you should check with your insurer for further details about medical care for mother and baby.

If you are having a baby in Germany as a foreigner, keep in mind that giving birth in Germany does not grant your child citizenship. Only children born to a German parent get citizenship immediately. Giving birth in Germany as a permanent resident may also grant your child citizenship if you are an expat who has lived in Germany for at least eight years and had permanent resident status for at least three years.

Giving Birth in Germany Without Health Insurance

If for whatever reason, you’re not covered by any health insurance while in Germany, for example, you only planned to stay in the country for a short time and you weren’t yet eligible for local health insurance, this is what it will cost you:

  • A regular birth could be between 1,600 and 7,500 EUR
  • A C-section could cost between 2,500 and 5,400 EUR

With insurance, a regular birth would only be between 0 and 350 EUR, while a C-section would be between 0 and 420 EUR.

The Benefits of Giving Birth in Germany

Like all other forms of healthcare in Germany, the medical standards of caring for mother and baby are usually high. However, your individual experience depends on your gynecologist, obstetrician (Geburtshelfer), midwife (Hebamme), and nurses.

Prenatal Care

In Germany, you can buy a pregnancy test (Schwangerschaftstest) at any drugstore or pharmacy. Once you get a positive result, you should make an appointment with your gynecologist (Frauenarzt). As soon as you’ve decided to have the baby, prenatal care (Schwangerschaftsvorsorge) will begin.

At your first prenatal checkup, you will be handed a little booklet called Mutterpass (literally translated to “mother’s passport”). It serves as a medical confirmation of your pregnancy, a record of your medical history (both general and pregnancy-related), and an official document for administrative purposes. You need to bring it along to every prenatal checkup so that your obstetrician, gynecologist, or midwife can record the latest exam results.

Routine prenatal care in Germany usually includes:

  • Monitoring the pregnant woman’s blood pressure and weight
  • Taking blood and urine samples at every gynecologist appointment for protein, sugar, and nitrate
  • A blood test every other month to check iron levels
  • Monitoring the fetal heartbeat
  • Regular pelvic exams

You may also have tests for:

  • Blood group and Rh factor
  • An antibody test to see if your baby has a different Rh to you
  • An optional HIV test
  • Rubella immunization

You can also get an immunization for toxoplasmosis and a test for cytomegalovirus. These are recommended but are unlikely to be available through public health insurance.

In the course of your pregnancy, you may attend ten or twelve of these examinations. In the third, sixth, and eighth month of your pregnancy, your gynecologist will also perform an ultrasound exam (Ultraschalluntersuchung).

As stated above, your health insurance provider normally covers all of these costs. Regardless of your insurance status, your employer also has to give you some time off for such mandatory medical appointments, and all employed women with state-funded health insurance can go on maternity leave (Mutterschaftsurlaub) six weeks before the due date. If you are pregnant, you should tell your employer as soon as possible.

In Germany, fathers can also apply to take parental leave, which can be a total of three years’ time, up until the child’s eighth birthday, and can be split into three separate periods. However, there is no law requiring companies to give fathers any paternity leave, though they are often given about 1-2 days.

Having a Baby in Germany: Who to Turn To

In Germany, there is a definite distinction between a gynecologist (with their own practice), an obstetrician (who actually delivers babies in a hospital), and a midwife (who may work at a hospital, a birthing clinic, or may supervise homebirths). Usually, your gynecologist is in charge of prenatal exams, but they won’t be present for the birth unless they happen to belong to the resident staff of your chosen hospital as well.

A midwife is allowed to do prenatal checkups (except for ultrasounds), offer you advice on pregnancy-related questions or aftercare, and assist you in a routine delivery without complications. If you’re looking for a midwife, you should check out Hebammensuche, a German-language search engine for officially registered midwives, allowing you to search for various parameters (such as “homebirth” or “yoga”) and bilingual midwives.

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Updated on: September 25, 2019

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