Health insurance is mandatory for everybody in Germany by law. You can freely choose among healthcare insurers (Krankenkasse) but not necessarily between public and private health insurance. Many expats may be forced to use private insurance. You pay a monthly contribution for health insurance and the health insurance pays when you go to visit a doctor.
Read our article what to expect when visiting a doctor or a hospital in Germany.
Difference between public and private insurance
Public health insurers (gesetzliche Krankenkasse) are non-profits and based on the principle of solidarity. Young and healthy members finance the costs of elderly and sick people. Almost 90% source of people living in Germany have public health insurance at one of the 105 source public Krankenkassen. The biggest public health insurers by members are Techniker Krankenkasse, Barmer and AOK source. You are free to choose any public insurer independent of pre-existing conditions if you are eligible for public insurance.
Private health insurers are companies which offer healthcare plans. The private health insurance (private Krankenkenversicherung or PKV) is not based on laws but on the contract between insurer and insured. Some private health insurance plans are additions to a public insurance, for example additional dental plans, others are full health insurance plans. The biggest private insurers in Germany are Debeka, Axa and Deutsche Krankenversicherung source.
Not everybody has the same options
- Employees and unemployed are covered by public health insurance the moment they start working or in case they are receving unemployment compensation after loosing a job. Employees can opt for private health insurance only if they earn more than 64.350.- Euro per year otherwise public health insurance is mandatory. Health insurance is not tied to an employer. You do not lose your health insurance if you lose your job.
- Under public health insurance, children and unemployed spouses can be covered for a slightly increased monthly fee by the main family earners plan.
- Self-employed, students, people with less than 450.- Euro per month on basis of a Minijob contract and everybody making more than 64.350 Euro per year can freely choose between public and private health insurance. They must have health insurance but acceptance at public health insurers is not guaranteed. In that case they must be privately insured.
Public health insurance costs
Public health insurance for self-employed and employees
The costs for self-employed and employees are roughly 15% of your income plus extra fees. The fees for public health insurance are based on your income: the more you earn, the more you pay. Compare public health insurers with the Check24 Krankenkassenvergleich.
Employers cover half the costs of employees health insurance plans while self-employed have to pay the entire fee themselves. Public health insurance fee is capped at more or less 850.- Euro per month: you do not pay more than 850.- per month even if you have a higher income than 56.250 Euro per year.
Self-employed with low income pay at least around 180.- per month.
The Techniker Krankenkasse is the biggest public health insurer. You can calculate their monthly fee on the their website:
Example costs calculation
- An employee who earns 3000.- Euro gross salary per month would pay 275.- Euro per month to the health insurer.
- A self-employed with a monthly net profit of 2500.- Euro would pay 443.- Euro per month.
Public health insurance costs for students
- Students younger than 25 years pay more or less 105.- Euro per month source. You can use your EHIC insurance card if you are a EU citizen. You can use your parents health insurance if you are earning less than 450.- per month source.
- Students between 25 and 30 years pay more or less 105.- Euro per month source. You can use your EHIC insurance card if you are a EU citizen.
- Students older than 30 years pay more or less 180.- Euro per month source.
Differences between public health insurers
All public healthcare providers offer more or less the same services and cost more or less the same. 95% of the services are the same for all public health insurers source but some cover free teeth cleaning, non convential medecine or offer a bonus if you regularly go for preventive checkups.
Private health insurance costs
Private insurance costs are based on your age and your health.
- A healthy 25 year old employee could get private health insurance for as little as 175.- Euro per month (only possible if she earns more than 64.350.- Euro per month otherwise public health insurance is compulsory).
- A healthy self employed 25 year old could get private health insurance for 350.- Euro per month which is much cheaper for high incomes than public health insurance.
Note that private health insurance becomes more expensive the older you are so you might end up having to pay as much as 1500.- Euro per month. At the same time your income goes down and you cannot change back into public health insurance. There are more and more cases where people become bankrupt because they can't pay the private health insurance source.
Is public or private health insurance better for me?
If you are a student or self-employed who is also a EU citizen you can use your EHIC insurance card from the home country for most visits to doctors or hospitals at the beginning of the stay in Germany. This does however not in all cases guarantee free treatment source. Some people use this option ever after staying for many years in Germany but citizens permanently living in Germany have to get German health insurance by law. Note that the public health insurance is quite efficient at collecting fees, also retroactively.
In my opinion you should try to get into the public health insurance in most cases.
Exceptions are young self-employed without pre-conditions who know for sure that their stay in Germany is limited to a couple of years only. In this case a private insurance might be much cheaper. Compare prices for private plans with the Check24 Private Krankenversicherung Vergleich.
You have to know however that quite likely you might not be able to change into public health insurance if you change your mind some years later.
Public versus private health insurance in Germany
Public health insurance
- The most important conditions are binding by law. Public insurers are non-profits
- Doesn't become more expensive with age
- Cheaper for students under 30 years
- Unemployed spouses and children also get health insurance for free
- Matches your income
- Pre-existing conditions do not increase the costs
- Less paperwork required, the bills are send directly to the insurer
- Expensive for young professionals, especially young self-employed
- You might have to wait for specialists appointments
- You have to pay an extra for some dentist or eye care treatments
- Not available for everyone
Private health insurance
- Cheap when you are young
- You can choose what you need
- Less expensive if you don't go to the doctor often
- Easier to get specialists appointments and better treatment
- Private health insurance can become very expensive when you are old
- Expensive if you have pre-existing conditions
- Does not include family members
- You have to negotiate the contract yourself
- You pay first and then have to get the money back from the insurance
Our health insurance plans review 2021 compares services and prices and has some recommendations for choosing your health insurance plan in Germany.