Finding Your Place in the Health Insurance System

Health insurance is compulsory in Germany: Anyone living in Germany must have health insurance. There are two different forms of coverage. 74.4 million people are members of statutory health insurance funds, while 9 million have private health insurance. The level of medical care is good in both systems. 

Statutory health insurance
Employees earning less than 5775.00 euros per month and students under 30 years old must take out statutory health insurance. Those making more can choose between statutory or private insurance if they are working in Germany for the first time. To join, one chooses a statutory health insurance fund and applies. Coverage starts on the first day of work or the first day of study. Those who enter the country before that time need guest insurance for the interim period. Special rules apply to EU citizens.

The system of statutory health insurance in Germany is a little strange. Around 80 health insurance funds provide statutory health insurance in Germany. There are historical reasons for this: "Ersatzkassen" were health insurance funds for white-collar workers, "Innungskrankenkassen (IKK)" insured craftsmen, and "Allgemeine Ortskrankenkassen (AOK)" insured blue-collar workers. Company health insurance funds (Betriebskrankenkassen, BKK) looked after the employees of individual companies.

Most statutory health insurance funds are now open to everyone. The health insurance funds in Germany are public institutions. Both contributions and benefits are highly regulated by law. A high level of services at doctors’ practices and hospitals is always guaranteed. Contributions are calculated according to the level of income: high income, high contributions – low income, low contributions.

You can't go very wrong when joining a statutory health insurance fund. Ninety-five percent of benefits are mandated by law, and the differences in premiums are not very large. But: Having the choice means having to choose. Our comparison pages should help with this.

Private health insurance
Those who are not compulsorily insured through the statutory health insurance system choose private health insurance. This group is composed of mainly self-employed persons, civil servants, well-paid employees, and students over 30 years old. People who come from abroad and are not working also take out private health insurance. Private health insurance for expats with limited residence permits is cheaper – with the same benefits.

For private health insurance, insurance companies enter into a contract with the insured person. The scope and quality of insurance coverage are defined individually by each contract. Each private health insurance company offers several tariffs. Contributions and benefits vary much more than with statutory health insurance.

Legislator have therefore set strict rules for consumer protection. Before a person can take out private health insurance, a specially trained insurance expert must inquire about and analyze the customer's needs, suggest suitable health insurance policies, and justify the proposal. The expert must document the entire consultation process.

Differences between private and statutory health insurance
Whether you are statutorily or privately insured, medical care is usually provided by the same doctors and in the same hospitals. In terms of service, privately insured patients are better off: they receive appointments with specialists more quickly, and are placed in single or double rooms in hospitals. The reason for this is that doctors and hospitals receive much higher fees for treating privately insured patients than for treating people with statutory health insurance.

Family insurance is one of the big advantages of statutory health insurance in Germany. Children and spouses are insured free of charge if they have no income of their own.

Privately insured patients initially pay the costs of medical care themselves and are then reimbursed by their health insurance provider. Statutorily insured patients do not pay themselves. The doctor settles directly with the health insurance fund. Private health insurance premiums are calculated according to risk: those who are young and healthy pay lower premiums. Statutory health insurance funds calculate contributions according to a person’s income: those who earn more pay more, and those who earn less pay less.

These days, more and more people, especially the elderly, depend on nursing care. Long-term care insurance covers this risk. Long-term care insurance is mandatory for all statutorily and privately insured persons in Germany.

The right health insurance for everyone
Employees choose a statutory health insurance fund before their first day of work. Employers need this information because they must pay all social contributions to their employee's health insurance fund. When employees start working in Germany for the first time, their chosen health insurance fund also applies for their social security number. Find out more on health insurance for employees.

Students take out insurance with a statutory health insurance fund. Enrolment at a German university is not possible without health insurance. Exception: students over 30 years of age must take out private health insurance. It is sufficient for students from other EU countries to present the European Health Insurance Card (EHIC). Find out more on health insurance for students.

Self-employed persons must take our private health insurance. Offers differ greatly – depending on income and level of ambition. Private health insurance premiums are based on actual risk as determined by entry age and state of health – and the scope of benefits of the selected tariff. Find out more on health insurance for self-employed.

Vacationers, business travelers, and guests from outside the EU must provide proof of sufficient insurance coverage upon entry into Germany. Those who need a visa to enter the country must provide evidence of adequate health insurance at the consulate. Travel insurance and guest insurance are the right options. Find out more...

Au pairs are a valuable help to their host families in their daily lives. For limited stays, there are low-price offers for private health insurance. In Germany, the host family must take out insurance for their au pair. This insurance must be valid for the entire duration of the au pair's stay. Find out more...

Seeing a doctor in Germany
An extensive network of general practitioners and specialists is a feature of health care in Germany. Self-employed physicians provide the majority of medical care in Germany. They treat statutorily insured patients and bill their services directly to the health insurance funds.

When visiting a doctor, people with statutory health insurance should make sure that the doctor is allowed to bill statutory health insurance funds. It should say “Alle Krankenkassen” on the sign for the doctor’s office. Beware: "Private physicians", who the statutory health insurance funds do not cover, will bill people with statutory health insurance directly for their treatment.

Anyone not a member of a statutory health insurance fund is treated as a "private patient". They initially pay for the treatment themselves and is then reimbursed by their private health insurance provider. Doctors receive a higher fee when treating private patients.