The German health care system
The German health care system has the reputation of being one of the best in the
world. There is an extensive network of hospitals and doctors covering even the
remotest areas of Germany.
Waiting lists for treatments are rare. Medical facilities are equipped with the
latest technology and the statutory health insurance scheme provides nearly full
cover for most medical treatments and medicines. Almost everybody in Germany has
access to this system, irrespective of income or social status.
The downside is that medical costs are high. Health care costs - for doctors,
hospital stays and even medicines - are among the most expensive in the world.
There is no such thing as "free" treatment in Germany, not even in state
hospitals. All care, including emergencies, has to be paid for by you or your
When coming to Germany, it is therefore extremely important to have a full
health care insurance, as a serious illness could cause a financial disaster. In
most cases, you will even be obliged to prove you have adequate cover.
How to cover your medical expenses in Germany
Your first priority when coming to Germany should be health insurance.
Medication, doctors and hospitals are extremely expensive, so you must make sure
that you are covered for sickness and emergencies.
In addition, you will usually not get a residency permit without proof of
adequate insurance. Health insurance is also mandatory for all employees and
students in Germany, so you will not be able to start working or studying
In 2007, there were some 200.000 persons living in Germany without health
insurance coverage. With the health insurance reform of 2007, the German
government has now implemented a new insurance law which makes insurance
mandatory for everybody living in Germany. When living in Germany, this law will
also apply to you.
There is an EU agreement which guarantees free medical treatment for EU citizens
in Germany. Since the 1st June 2004, European citizens who are travelling within
the European Economic Area are given a European Health Insurance Card, which
simplifies the procedure when receiving medical assistance during their stay in
a Member State. The European Health Insurance Card replaces forms E111 and
E111B, E110, E128 and E119. However, if you wish to take up long-term residence
in Germany you must exchange the card for a local health insurance scheme.
Health insurance contributions are split 50-50 between employers and employees,
independent on whether you opt for a statutory or private insurance schemes.
Students are offered special student insurance schemes with favourable rates.
Note that health insurance in Germany is part of the social security system.
Statutory and private health insurance
In Germany, there are two parallel health insurance systems:
(a) State health insurance is run by German government. Most foreigners (and
Germans as well) are obliged to take out state health insurance.
(b) Private health insurance can be chosen in some specific cases. It generally
offers more extensive cover, but is not automatically an advantage for all
Almost everyone can join the state insurance scheme, but only a few people are
allowed to leave this system for a private insurance. To work out which
insurance scheme fits is best for you, follow these steps:
(a) Find out whether you can choose between private and public insurance. If
you're obliged to join the state system, it is irrelevant to compare it with
private insurance. To find out whether the state system is mandatory for you,
have look at our information below.
(b) IF you are allowed to take a private health insurance, you should compare
the advantages and disadvantages of both systems before making a final decision.
Although this is complicated, take the time to analyze your situation in order
to make the right decision. Our health insurance guide will lead you step by
step through this decision process.
When is state health insurance mandatory?
As of 2007, state health insurance was compulsory for the following groups:
- Employees whose regular income before deductions does exceeds 400 per month and
remains below a set annual limit. In 2006, the general annual gross income limit
for mandatory state insurance was 47.250.
- Students at state and state-approved universities.
- People on work experience (internships) or in secondary education
- Old-age pensioners who have been in a statutory health insurance scheme or
insured as a family member for most of the latter half of their working life.
- Unemployed people receiving benefits from Federal Employment Services (with some
You can within a period of three months join a state health insurance scheme
voluntarily if you:
- Have been a compulsory member, your membership is terminated and you have
certain qualifying insurance periods
- Are an employee and your income in your first job exceeds the limit, as long as
you apply for membership within three months of starting work
- Are severely disabled (subject to certain other requirements)
- Have been insured through a family member for a specific minimum period and this
insurance has expired
Students from countries with which Germany has concluded a social security
agreement which includes an insurance clause can continue to be covered by their
home insurance company while they are in Germany. For information, enquire at
your institution's International Office. In such cases, you will be required to
present proof of insurance cover to the health insurance company in Germany.
The Federal Ministry for Health and Social Security offers detailed information
on statutory insurance in different languages at
Who can opt for private health insurance?
In theory, everybody not in the categories above can choose a private insurance
scheme. However, once you've opted out of the state insurance scheme, it can be
very difficult to go back. Before you make this decision, you should therefore
carefully compare the advantages and disadvantages of the two systems.
If you opt out of statutory health insurance and cannot go back, the private
insurance companies will be forced to offer you a basic tariff with the same
fees as the statutory insurance from 2009.
What are the advantages/disadvantages of the two systems?
There is no simple answer to this question, as it depends heavily on your
personal circumstances. To help, we have listed below some of the advantages and
Contributions: To understand the main differences between the two systems, you
should bear in mind that state and private insurance work on completely
different contribution models:
- State health insurance contributions are based on your
gross income (around 14%
with an income cap). If you have a high income, it might therefore be cheaper to
opt for a private insurance policy. Students can use a special insurance scheme
that offers favourable rates.
- Private health insurance contributions are based on your
risk profile, not on
your income. For example, women and older people generally pay higher
contributions than young men. This is due to a calculation of the average cost
for medical treatment for different groups. The older you are, the less
attractive it thus becomes to opt for a private insurance.
Note that contributions are always equally split between employer and employee,
independent of whether you are in a private or public scheme.
Payment of medicines and treatments: If you're insured through the state system,
you only pay a nominal fee for treatments and medicines as these are directly
paid for by your insurance company. If privately insured, you pay doctor's fees
and medicine costs and send receipts to your insurance company for
reimbursement. Although this makes no difference in the long run, it might be
important if you're short on cash.
Private health insurances: Private health insurance schemes provide more
extensive cover, including the option of private/semi-private hospitals,
alternative therapies such as acupuncture and herbal treatments, glasses and
contact lenses and other treatment that may not be available under the state
scheme. In recent years, some statutory insurance companies have also extended
their coverage of alternative treatments, but its still not as wide as the
coverage of private insurances.
At the doctor, you will often be treated preferentially compared to state
insured patients, as you are generally more profitable. Some doctors even
restrict their practices only to private patients. Another advantage is that
private insurances don't expect you to pay any additional co-payments (
Zusatzzahlungen) for medicines and treatment as in the state scheme (see below
for more information).
However, some private insurance policies offer you the option of a (
Selbstbehalt), which means that for each case of illness part of the cost is
paid by you up to a certain amount per year. On the upside, the insurance
company will lower your contributions if you go for this option.
Statutory insurance: Despite the constant complaints of Germans, the state
health insurance scheme also offers some advantage compared to private schemes.
The biggest one is that it also insures your family at no extra charge! YYour
spouse or civil partner and, up to a certain age, your children are covered by
your insurance, provided among other things that their collective income does
not exceed 345 a month and they do not have their own insurance (figures for
However, you should bear in mind that the state insurance system has come under
serious pressure during the last decade. As the government tries to cut the cost
of health care, co-payment (i.e. the portion of costs the patient has to pay
himself) has been increasing for all kinds of medical treatment and medicines
and is likely to increase even further in the future. In areas such as
dental/orthodontic treatment and glasses, state health insurance only covers a
fraction of the cost.
The state health insurance system
Statutory health insurance is provided by a network of non-profit making
companies working with the state to administer the national health program (
Gesetzliche Krankenkassen). Some of the most popular ones include the TK, AOK
and BEK. Since 1996, anyone is free to choose the fund they wish to be insured
with. Even though benefits are similar across all companies, it is often worth
comparing contributions since these can vary significantly.
Your insurance company will issue you a health insurance card, which you have to
take with you whenever you visit a doctor, dentist or specialist.
Note that benefits of statutory health insurance change often. Some of the
treatments covered are (as of 2007):
- Medical and dental treatment, with free choice of doctors and dentists
- Hospital treatment
- Drugs, dressings, complementary treatment, and aids such as hearing aids and
- Sickness benefit (Krankengeld): Normally, your employer will continue to pay
your wage or salary for six weeks if you are unable to work. After that your
health insurance would pay 70 per cent of your regular wage or salary before
deductions for a maximum of 78 weeks
- Measures for the prevention and early detection of certain diseases
- Preventive dentistry and in particular individual and group prophylactic
- Preventive inoculations, excluding inoculations for non-work-related foreign
- Orthodontic treatment, normally only up to the age of 18.
- Medically necessary dentures and crowns
If you have children, you can claim a range of additional benefits. The Federal
Ministry for Health and Social Security offers detailed and up-to-date
information on benefits at www.bmgs.bund.de
In the following cases, you will have to an additional contribution to
treatments and medicines (as of 2007):
- The cost of dentures (50% of medically required treatment).
- A share in the cost of in-patient preventive treatment and rehabilitation,
out-patient rehabilitation, and in-patient hospital care (10/day for a maximum
of 28 days)
- 10% of the cost of prescription drugs and dressings, minimum 5 and maximum 10.
- If your income is below a certain level, you can be exempted from these
For all questions regarding Insurance coverage please contact www.rau-assekuranz.de