Public vs private health insurance in Germany - which one is best for me

Health insurance is mandatory for everybody in Germany by law. You can freely choose among healthcare insurers called Krankenkassen 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 my article on what to expect when visiting a doctor or a hospital in Germany.

Difference between public and private insurance

• Public health insurers or _gesetzliche Krankenkassen are non-profits** 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 if you are eligible for public insurance. Public health insurance covers pre-existing conditions.

• Private health insurers are companies that offer healthcare plans. Private health insurance (private Krankenkenversicherung or PKV) is not based on laws but on a contract between an insurer and an insured. Some private health insurance plans are additions to public insurance, for example, additional dental plans, while others are full health insurance plans. The biggest private insurers in Germany are Debeka, Axa and Deutsche Krankenversicherung ^source. The price of private health insurance is based on your age and pre-existing conditions.

Private insurance costs are based on your contract. Private insurance does not become cheaper if you earn less. Public health insurance is always a percentage of your income.

Am I eligible for public health insurance?

Not everybody has the same options:

• Employees and the unemployed are covered by public health insurance the moment they start working or in case they are receiving unemployment compensation after losing a job. Employees can opt for private health insurance only if they earn more than 69.300.- 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. Kids cannot be included for free in public insurance in some cases, like when one of the parents is privately insured.
• Self-employed, students, people with less than 520.- Euro per month on basis of a Minijob contract and everybody making more than 69.300 Euro per year can freely choose between public and private health insurance. They must have health insurance but acceptance by 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 of public health insurance for self-employed is 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 *Tarifcheck Krankenkassenvergleich.

Employers cover half the costs of employees' health insurance plans while self-employed have to pay the entire fee themselves. Public health insurance fees are capped at more or less 927.- Euro per month: you do not pay more than 927.- per month even if you have a higher income than 59.850 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 their website:

• Fee calculator for employees
• Fee calculator for self-employed

Example costs calculation

• An employee who earns 3000.- Euro gross salary per month would pay around 293.- Euro per month to the health insurer.
• A self-employed with a monthly net profit of 2500.- Euro would pay around 465.- Euro per month.

Public health insurance costs for students

• Students younger than 30 years pay more or less 120.- Euro per month ^source. You can use your EHIC insurance card if you are an EU citizen. You can use your parents' health insurance if you are earning less than 520.- per month and are under 25 years old.
• Students older than 30 years pay more or less 210.- 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, and non-conventional medicine 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.

Examples of private health insurance fees

• 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 69.300.- 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.

The price of private health insurance is dependent on pre-existing conditions, age and the services guaranteed by the contract. Note that private health insurance can become more expensive the older you are. At the same time, your income goes down and it can be impossible to change back into public health insurance. Make sure to bring this topic up with your broker when negotiating the contract as good brokers know ways around this.

Is public or private health insurance better for me?

If you are a student or self-employed who is also an EU citizen you can use your EHIC insurance card from the home country for most visits to doctors or hospitals at the beginning of your stay in Germany. This does however not in all cases guarantee a free treatment ^source. Some people use this option even after staying for many years in Germany but citizens permanently living in Germany have to get German health insurance by law. Note that public health insurance is quite efficient at collecting fees retroactively.

In my opinion, you should try to get into public health insurance if you earn less than 45.000.- Euro per year as a self-employed.

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, private insurance might be much cheaper. Compare prices for private plans with *Tarifcheck.

I think you should choose private health insurance if you want better treatment, have a broker you can trust and are not afraid to look into the contract details. There are many clauses in private health insurance contracts your broker can use to your advantage so that you get the best combination of quality vs. price.

I do not recommend signing up for very cheap private health insurance plans. The motivation to get into private health insurance should be higher quality treatment, not price. Initial cheap plans might backfire with unexpected costs in case of emergencies.

You must be aware that public health insurance only covers necessary and economic treatments. More expensive and better treatments and medicine are not necessarily covered by public health insurance.

I recommend *signing up with Techniker Krankenkasse (English form) if you want public health insurance in Germany.

Use an independent broker like *Feather or Alexander Kühne if you want to sign up for private health insurance.

Public versus private health insurance in Germany

Public health insurance

Private health insurance

my health insurance plan review compares services and prices and has some recommendations for choosing your health insurance plan in Germany.