Germans tend to be overly cautious, and healthcare in Germany reflects this fact. Generally, locals and expats report that this central European nation offers good primary health care, good hospitals, and capable dentists.
Medical professionals commonly speak English, though different levels of proficiency exist.
Health insurance in Germany
Since 2009, Germany has operated a compulsory health insurance system, which includes statutory nursing care insurance.
Expats who have a residence permit or a fix-term permit for more than twelve months come under this law. In light of the law, you have to sign up instantly for health insurance, either through a private health insurance provider or through the statutory health insurance system (state-provided).
Health insurance in Germany consists of three segments: Outpatient, in-patient and dental.
Expats from both EU nations and non-EU nations can take advantage of the state insurance plan, if a formal company employs them.
However, if you are self-employed or are a freelancer, you are legally obliged to take out private insurance, if you are not eligible for statutory insurance (which most are not). That said, most private insurance providers will only grant coverage to expats with a residence or a work permit, a document that many self-employed or freelancing expats do not have.
Furthermore, to get a residence or work permit, expats must have health insurance that meets German standards (thus, a Catch-22 occurs).
Expats in the situation above should request help from an experienced consultant to deal with the situation.
Statutory health insurance vs. private insurance
In Germany, you have two main systems for health insurance, but not every person is free to choose between the two.
For most professionals the following guidance applies:
An employee has to be insured in the statutory system, unless his or her revenue exceeds a specific amount. By reaching a particular yearly gross income, expats can decide whether to stay in statutory insurance or to sign up for a private health insurance scheme.
Employers share the burden of health insurance costs with their employees, usually paying half of the insurance, though employer contribution does have a ceiling.
A self-employed person or a freelancer can select either a statutory or a private scheme, regardless of their annual gross income. Though, only those self-employed individuals formerly registered with statutory insurance (as a student, with a company, as a child) can engage in this option once self-employed. If you want to check your situation, the best way is to ask your consultant for a status check.
Self-employed individuals must also be aware of the laws surrounding their status (i.e. having an employee changes your status).
Differences between statutory and private insurance
| Statutory Insurance | Private Insurance | |
| Costs | Contributions related to your income but capped (solidarity principle) (in 2024: 14.6% of the gross salary) | Contributions related to plan and risk of individual (cost-of-service principle) |
| Benefit | Standard benefit (suitable, necessary and economical) | Customers choice (medically necessary but higher standards and according to the customers’ requests) |
| Legal Basis | Social security statutes part 5 | General business terms and particular treaty |
| Institution | Statutory health insurance | Insurance companies |
Statutory insurance
Expats insured with statutory insurance will receive the standard benefits. A big advantage of statutory insurance is that your family (non-working husband/wife and your children up to a certain age) is covered for free.
Private health insurance schemes generally require that extra paid protection is taken out for children.
Do note that if both parents are working, children are insured under the same plan as the parent with the higher income.
Benefits of statutory insurance
Outpatient
- Free to choose your doctor if he/she is working with the statutory insurance (you have to pay a small practice fee for a medical round each quarter and doctor; you can avoid paying for the second doctor in a quarter by getting a referral from the initial doctor)
- Regular check-ups
- Medication (not free to choose, and you may have to make out-of-pocket payment)
- Standard immunisation
- Therapy of protracted illness and results of an accident (including after-care)
- Med clinical substance (physiotherapy) with an excess fee per receipt charge (for patients older than 18 years).
- Therapeutic appliances, simple design and cost limits
Inpatient:
- Multi-bed rooms
- Regular doctors
- Patients older than 18 years have to pay an extra fee per day for a maximum of 28 days a year.
Dental:
- 100 percent dental treatment but using simple materials
- 50 percent artificial teeth (percentage can be raised up to 80% by proving a check-up once a year) but also using ordinary materials
A person insured with statutory insurance might increase the level of coverage by establishing some extra protection coverage with a private company.
Private health insurance
The benefits of private health insurance depend on the plan you choose. Different coverage schemes allow you to decide the quality of the professional from which you will receive treatment, and the quality of the materials being used (for example: in-patient-treatment from a senior consultant having a room on your own, premium restoration and implants if it comes to dental treatment, valuable medication and therapies in out-patient-care).
Costs also vary depending on the plan you select. There are no minimum or maximum premiums – it varies based on the company you select. Besides the extended coverage, the most important advantage to being insured privately is that you will have access to more privileges in a hospital or from a doctor/dentist.
What is the statutory nursing care insurance?
This insurance covers the eventuality of becoming dependent on care. It is also compulsory and is associated with the health insurance. When signing up for a health insurance, you are automatically insured with the nursing care insurance.
It doesn't matter if you have statutory or private insurance – the benefits from statutory nursing care insurance are the same in both cases.
If you become dependent on care, the nursing service classifies your assistance grade. There are four levels, from 0 (assistance isn't needed regularly) up to four (a minimum of five hours of assistance a day and other criteria). Payments depend on the grade and whether you'll be treated inpatient or at home.
As is the case with the statutory health insurance, it is suggested to have some additive private cover to extend your protection.
