How to get the best healthcare in Germany with private health insurance: options and pitfalls.

What to pay attention for when applying for private health insurance in Germany.

In this article, I am going to present various aspects, advantages and potential pitfalls of the German private health insurance system, the so-called Private Krankenversicherung (PKV). Switching from public to private health insurance in Germany makes sense if you want to get access to the best healthcare. There is a review of the best health insurance plans in this article.

I think the motivation to sign up for private health insurance should always be better medical treatment and never a seemingly cheaper price. Some consider public health insurance in Germany to be a shortcut to saving on monthly contributions because some plans are advertised to be money savers. Private health insurance can have good services for a reasonable price but healthcare in Germany never comes for cheap and you should know about potential hidden costs. Health insurance is mandatory in Germany. You cannot drop out of health insurance if you live in Germany.

Who can apply for private health insurance in Germany?

Rule of thumb: self-employed earning less than 45.000.- Euro and students are better off with public health insurance. In this case, I recommend the biggest public health insurer Techniker Krankenkasse. You can *sign up with Techniker Krankenkasse using this English form.

As an employee, private health insurance is only eligible if you earn more than 69.300.- Euro per year. Employees who earn less have mandatory public health insurance but can choose among public health insurers.

Is private health insurance right for me?

Applying for private health insurance in Germany can be a good choice if you are:

a civil servant
or an employee earning more than 69.300.- Euro per year
a self-employed person earning more than 45.000.- Euro per year
younger than 40
healthy
if you know that you will only stay in Germany for a limited amount of time.

Private health insurance might be your only choice if you just arrived in Germany.

How to change back from private to public health insurance

Public health insurance is based on your income and the principle of solidarity: high earners contribute more than low earners and the young and healthy pay with their contributions for the old or sick who need more medical treatments. This is why you cannot choose a cheap private health insurance plan when you are young and then easily return to public health insurance once your income goes down as a pensioner or after your career has peaked.

There are options to return from private to public:

starting a job as an employee automatically insures you with a public health insurer of your choice if you earn less than 69.300.- Euro.
employees earning above the threshold can reduce their salary with a sabbatical or by working fewer hours.
Becoming unemployed while having voluntarily contributed to unemployment insurance as a self-employed. In this case, the Arbeitsagentur pays the monthly contributions to public health insurance from the moment you are unemployed.

A return to public health insurance can be impossible if you are older than 55 years.

Private health insurance plans on the other hand collect individual aging provisions, so-called Altersrückstellungen, to cap contributions for older members ^source. Those payments are lost when you quit your private health insurance company.

The benefits of private health insurance in Germany in a nutshell

Faster appointments: the reason why appointment booking websites like Doctolib ask if you are privately or publicly insured is that doctors earn more from clients with private health insurance.
Original medicine instead of generic medicine. “A generic medicine is a medicine that is developed to be the same as a medicine that has already been authorized” ^source. Generic medicine can have more side effects than the original medicine.
Only pick what you need. Not into naturopathy? Simply exclude it from your insurance plan whereas with public health insurance the catalog of services is defined by law.
Tooth crowns are not covered by public health insurance but you can include them in your private insurance plan.
Glasses are mostly not covered by public health insurance but you can include them in your private insurance plan.
The doctor decides what treatment is best whereas with public health insurance the doctor has to default to the necessary and most economic treatment.
Public health insurance rates are raised over time and steadily becomes more expensive. At the same time, the amount and quality of public health insurance services has been shrinking for years to save money.

Private health insurance pitfalls

Public health insurance can be a better choice if you earn less than 45.000.- Euro per year as a self-employed.
Public health insurance is better for students.
Private health insurance is not a good choice if you cannot save for retirement and just make ends meet.
Don't decide by price. I can't stress this enough: always look at the costs of private health insurance over your lifespan. Cheap now does not mean cheap later.
Do you have kids or plan to have kids? You have to pay separately for children with private health insurance whereas public health insurance has family plans for no or little additional costs if the parent with the highest income has public insurance.
Private health insurance prices are based on existing conditions. Don't hide existing conditions when applying for private health insurance as these conditions might surface later and can make your insurance coverage void.
Disability insurance is recommended and will add additional costs

Disability insurance and care insurance

Private health insurance is a decision for life as a return to public health insurance might be impossible later on. You need to be prepared for comparatively high monthly contributions when your income decreases, in case of a job loss, when orders drop or when health issues make it impossible to work. This is why it is recommended to combine private health insurance with disability insurance or Berufsunfähigkeitsversicherung. *A good broker will consult you about the best combination of disability and private health insurance. *Feather disability insurance starts at 50.- Euro per month.

Care insurance (Pflegeversicherung) is mandatory in Germany. People in need of care can freely choose whether they want to get professional help or pay family members for these services. Care insurance costs are added to health insurance costs. You have to get private care insurance if you have private health insurance. The performance of private care insurance is equal to public healthcare insurance ^source.

Does private health insurance become more expensive when I get older?

Private health insurance costs are based on a contract and therefore do not necessarily match your income. This can become an issue if you suddenly have much less disposable income as is naturally the case if orders drop for business people or once you retire. You have less disposable money if your income goes down while your monthly private health contributions don't decrease.

You need to consider that contributions to private health insurance are lower when you are young but increase the older you get. Please note that on the other hand contributions to public health insurance costs also increase.

There are several options to make sure contributions don't increase too much:

check your insurance policy for a contribution relief clause (Beitragsentlastung). This means that monthly contributions go down at an agreed retirement age, usually around 65 to 67 years, due to extra contributions you paid at a younger age ^source.
Sick pay (Krankentagegeld) contributions are often dropped once you retire.
The pension fund can contribute up to 8% of the monthly private health insurance contributions once you retire and based on whether you paid into the pension fund for at least consequent 5 years. You have to apply for this.
Contributions are lowered by up to 10% when you retire because the so-called Zehn-Prozent-Zuschlag is dropped ^source.
Change into a different and more basic plan with the same insurer.
Make sure you add disability insurance (*f.e. Feather disability) that covers private health insurance contributions if you are unable to work.

Recommended private health insurance brokers in Germany

Important: an independent broker like *Feather or *Alexander Kühne (direct link to his calendar) is highly recommended if you want to sign up for private health insurance. Both brokers offer their services in the English language. *Feather uses an online questionnaire to pick the best plan. My favorite broker *Alexander has many years of experience in the insurance business and will consult you for a customized solution.

A good broker helps you analyze the sum of health insurance contributions over a lifespan and pick the features that are important to you. Independent health insurance brokers do not work for one company only. A competent broker knows all the pitfalls and includes the right clauses in your contract so that you can avoid too steep payments after retirement.

Private health insurance calculators and comparison websites

You can compare private health insurance plans and costs with comparison websites. *Tarifcheck sends you offers by e-mail. Tarifcheck is on German language only.

Health insurance plans are only comparable if they include the same services. I recommend making a list of medical services that are important to you before comparing health insurance plans. Inpatient psychotherapy or home care, for example, are standard services in public health insurance but are often not covered by private health insurance in Germany ^source. Also, consider if you want to include better dental and eye care in your plan.

In my opinion comparison tools are great to get a list of private health insurance companies in Germany but cannot replace the help of an independent broker.

Summary

Go with private health insurance if you want better medical treatment and likely will have a steady income that matches monthly payments.
Secure yourself against possible pitfalls with a good contract.
Use the help of an independent insurance broker like *Feather or *Alexander Kühne.