Expat health insurance in Germany: How does it work?
Health insurance is mandatory in Germany. However, you can choose between the public system and a private one. If you are among those who are able to take out private health insurance, an expat health insurance, when combined with contingency coverage, will fulfill this obligation while allowing you to remain covered in France and maintain the level of coverage you are used to. Just make sure you take out a local pension/retirement/long-term care insurance to complete your coverage.
| Health care expenditure per capita | €4000.00 |
| Annual indexing of health care expenses | 2.5% |
| CFE hospitalization reimbursement rate | 42% |
| Number of insurance companies providing services | 15 |
| Cost of hospital coverage for people 30 years old/year | €789 |
| Cost of hospital coverage for people 50 years old/year | €1260 |
Two health care systems exist in Germany: the statutory (public) health insurance system and private health insurance. The entire population is required to belong to of the two health systems (since 2009). The system you join is largely determined by your status.
If you are an employee with a gross annual income of less than €62,550, a student, a farmer, an artist, a journalist, retired or disabled (according to certain criteria), or have qualified for unemployment insurance, you must join the statutory public health insurance system, known as the GKV (Pflichtmitgliedschaft).
If you are an employee with a gross annual income of more than €62,550 (or less than €450/month), or if you are a freelancer or self-employed, you can choose between the statutory public health insurance system and private health insurance (known as PKV).
If you fall into the category of those who can choose which health care system to join, it’s important to understand that it is extremely difficult (if not impossible) to go back to public insurance once you’ve chosen private. Expats generally make their choice based on their state of health and medical needs, how long they plan to stay in Germany, and their plans in terms of their families.
Those who earn more than the specified maximum salary and choose to join the public system must request it as an insured person or beneficiary within a few months of the termination of their compulsory insurance.
Both health plans can be supplemented with additional private insurance, particularly to obtain better coverage of preventive health care, hospital fees and dental/vision expenses.
The reputation of the German health care system is well established. It is one of the best in Europe, providing easy, nearly immediate access to health care for the entire population. It features a broad network of physicians and hospitals, with an abundance of state-of-the-art technological equipment (for example, resuscitation units were widely-available during the COVID 19 period).
However, this reputation comes at a price: medical care is expensive, even under the current public health care system.
The quality of care is very similar in the public and private networks. the benefits of joining the private network are simply: shorter wait times, appointments with/treatment by the most experienced doctors, a private or semi-private room in case of hospitalization, better dental coverage, and coverage for vision expenses and alternative medicine, among others.
Cleanliness is generally impeccable in all care facilities, and medical technologies are advanced. Germany is also known for having the shortest surgical wait times in Europe.
In the public health care system, you can choose any physician or practitioner who is registered “Alle Kassen,” and payment will be made for you in advance. Please note that that some practitioners only accept "Privat Patienten," so be sure to check before you go.
If you choose private health insurance (either local or expatriate), you can consult the doctor of your choice. You will receive the bill by mail a few days later (or you can pay at time of consultation), and can then request reimbursement from your insurance company.*
There isn’t really a fixed rate for medical consultations in Germany, but they usually cost around €75. The charges will depend on what the physician does for you during the consultation:
- In the public system, your first consultation each quarter will cost you €10, payable at time of consultation. Show your insurance card, and the remainder will be paid directly by your health insurance.
- If you have private insurance, the physician’s rate will be multiplied by a set factor. In general, the fee will be 2 to 3 times higher than the amount charged to those with public health insurance, but you will be given priority.
If you choose expat insurance, you will need to request a detailed invoice, listing every procedure performed and the associated fee, in order to be reimbursed correctly. Remember that you’ll usually have to get a referral from a general practitioner in order to consult a specialist or another practitioner (except gynecologists, dermatologists and dentists).
For prescription drugs dispensed at a pharmacy, your insurance company should be able to pay directly, but a set copay of €5 to €10 is automatically charged to the insured (based on the price of the medication; corresponds to 10% of the price). Some medications have a set price, and if that price is exceeded, the insured will also be charged the difference between the set price and the amount paid. Private insurance provides better coverage of prescription drug costs than public insurance.
In terms of hospitalization, you will need orders from a physician in order to be admitted (except for emergencies). The cost of hospitalization in a shared room (not a private room) is covered by health insurance in approved establishments A set copay of €10 per day (a maximum of 28 days/year) must be paid by the insured. If privacy is important to you, you’ll have to cover the added cost for a private room yourself.
The cost of a private room in a private hospital can be particularly high. Find out the exact cost, and how much will be covered by your private insurance company, before choosing a hospital.
Vision expenses (excluding frames) are only covered for children under 18 years of age and people with serious conditions. In terms of dental expenses, 50% of the cost of dentures can be covered (even up to 60% or 65%) within regulatory price limitations. Only approved dentists are covered in the public sector (direct reimbursement possible). Orthodontic services are covered for children under 18 years old. An 8-month waiting period applies to dental expenses.
It should be noted that dental health is seen as very important in Germany. There is a point system that rewards people who see the dentist for regular check-ups with better coverage. Also, while routine prophylactic and protective procedures are regulated in terms of pricing, exceptionally expensive or innovative procedures, as well as aesthetic procedures (inlay/onlay or ceramic crown), are covered according to a private classification system, resulting in out-of-pocket expenses for the patient. Private insurance provides better coverage for these types of expenses.
Maternity costs are covered in Germany. With public insurance, traditional childbirth costs between €0 and €350, while cesarean birth (C-section) costs around €420. Without insurance, childbirth can cost anywhere from €1,600 to €7,500.
Global health insurance provides coverage for two of the main shortfalls of the public system: vision/dental coverage and hospital fees (in addition to health care coverage outside of the EU and daily sick leave allowances for over 6 weeks).
There are 5 branches of German social security insurance (plus family benefits): sickness/maternity insurance, long-term care insurance, workplace injury insurance, pension insurance (disability, old age and survivors) and unemployment insurance. Additional information is available on each of these branches, particularly on the CLEISS website.
The two main branches are health and long-term care insurance. They are managed by health insurance funds and their affiliated long term care insurance funds. There are a total of around 100 health insurance funds, divided into 6 types.
The German health care system is divided into three main areas: outpatient care, inpatient care (the hospital sector) and recovery services.
If your employer is not signing you up for health insurance, you’ll have to find the “city hall” (Einwohnermeldeamt) in your area and register yourself as a resident. Once you’ve registered as a resident you will receive a social security number (Sozialversicherungsnummer). Then, once you are in a position to pay your taxes, you can register for health care insurance.
Since the process of becoming a resident requires proof of health care insurance, expats often use private insurance to complete their applications.
Your right to statutory health/maternity insurance coverage is immediate, there is no waiting period. Non-working spouses and children are covered at no additional charge under family insurance.
German public health care insurance is financed by member contributions, which are split equally between employers and employees. It provides full (or partial) coverage for the following health expenses: medical care, dental care, prescription drugs, prostheses, examinations and screenings, and hospital care.
The Health Financing Fund (Gseundheitsfonds) distributes a lump sum to health care insurance funds for each person they insure. These amounts are increased according to the age and risk of the insured person.
Currently, statutory health care insurance contributions are 7.3% from the employer and employee (total 14.6%), with a salary limit of €4,687.50/month Employees earning less than €450/month who are already covered through their family or another business activity are exempt (without the right to a daily sick leave allowance). Employees earning between €450 and €1,300 per month receive a discount based on their income level. Lastly, insured persons with no right to a daily sick leave allowance receive a slight discount on their contributions (14% instead of 14.6%). The maximum monthly contribution for statutory health care insurance is set at €630/month.
In addition, health insurance funds can apply a supplementary individual contribution (Zusatzbeitrag). In 2020, the average supplementary contribution amounted to 1.1%. For employees, the employer also pays half.
All public health insurance funds offer the same rates. They sometimes differ in the preventive and informational services they provide for the insured. You can earn points that can be exchanged for gifts by participating in these prevention programs. These funds are Techniker Krankenkasse, AOK, TK, Barmer GEK, etc.
Advantages of the public system: Your medical history is not taken into account when you join the public system, and dependents are free of charge if they do not earn over €450/month.
Disadvantages: The higher your salary, the higher your contribution. Hospital coverage is limited to 28 days, and private rooms are&espace¬ covered. Paid sick leave is limited to 6 weeks. Vision care is not covered for adults, and neither is preventive or alternative medicine.
For people with German private health insurance, the amount of the premiums is determined by the individual risk of the insured. It depends, among other things, on the age of the insured and their state of health (not on their income). In addition to providing health care coverage, which tends to be more extensive and therefore more expensive than public health insurance, private insurance companies must also offer a minimum coverage package at the basic rate (Basistarif). Expatriate insurance works in the same way.
Private health coverage is often less expensive than public health coverage for young people who have very few health problems. Premiums are based on the health status and age of the insured and the extent of the coverage purchased. Under the public plan, premiums are based on income level.
Some local private insurers are now reimbursing the premiums of policyholders who don’t file any claims, to encourage responsible behavior.
Please note that if you are new to the country, some private insurance companies require a minimum period of permanent residence before you can subscribe (sometimes up to 2 years). You will have to prove that you have been living there for the required period of time. Moreover, once you choose an insurance you cannot change it for 18 months.
Expat insurance can be taken out at any time, whether you’ll be moving in 3 months, you’ve just arrived or you’ve been a resident for several years. The policy will let you choose the kind of coverage that’s most important to you, and will allow you to fill in any coverage gaps in the public health insurance.
Advantages of private insurance: a good level of reimbursement, complete coverage for all types of health care expenses including vision and dental, good coverage of hospital fees and private room costs, and access to the best care.
Disadvantages: you will pay more for additional family members, more complete coverage, and if you have a history of health problems. Going back to the public system is extremely complicated.
f your status allows you to choose private health care insurance, expat health insurance will provide services and expertise that meet the standards you are used to in France in terms of your safety, your budget and full understanding of your health coverage.
International insurance options are often modular, allowing you to choose only the services that interest you. Coverage is similar to what you are used to, which avoids confusion over to how reimbursements work locally. In terms of cost, global health insurance is more budget-friendly than some of the German private health care insurance plans.
Your expatriate insurance policy has the following 4 advantages: It covers you in your home country as well as in Germany, unlike local private insurance. It provides access to any health care facility, without the limitations of accreditation or an imposed network. It also ensures that you’ll have international emergency health care coverage for your occasional personal or business trips. Lastly, it provides coverage for vision/dental expenses, which are poorly reimbursed and very expensive in Germany.
If you choose to subscribe to the CFE, expat insurance can also function as a supplement. With the CFE’s health care coverage as the initial basis for reimbursement, plus a supplemental expatriate insurance, your reimbursement rates will be similar to the rates that apply in your host country.
Apply at least 30 days before your departure, since the procedure for taking out expatriate coverage is more complicated than for traditional insurance.
You will have to complete a health questionnaire. Depending on your medical history, communication with the medical service may require a certain amount of time. You may need to obtain additional documentation, consider specific proposals, etc.
Use our website to compare coverage and get price quotes online.
Afterwards, an advisor will be available to fine-tune the offers, help you make a final choice and help you with the application process.
Your advisor will also be able to verify that your chosen plan is accepted/recognized by the administration.
When it comes to local health insurance requirements, you will need to have coverage for hospitalization and routine medical care (and maternity coverage, if applicable).
Try to choose a plan that includes a private room.
Choose a plan with an annual coverage limit of at least 500,000 EUR, since hospitalization costs can be high.
If you have a larger health care budget and regular medical needs, choose a plan that also covers vision/dental expenses, since the cost of health care is particularly high in Germany.
A life/disability insurance policy is also essential to cover the risk of disability or death, a daily sick leave allowance and workplace injuries.
Given the high quality of care and facilities in Germany, you shouldn’t need to be repatriated for health reasons. However, repatriation assistance can be useful abroad in case of accident or illness during a vacation or a business trip (depending on how often you travel and for how long).
It also provides services that can be qualified as “for your comfort" but are very welcome in case of a serious event: paying for a relative’s trip so they can come to your bedside, organizing child care or transportation, access to medical advice and guidance, a ticket home in the event of the death of a parent, etc.
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