Finding German Health Insurance for Foreigners
The German health insurance system is distinct. It is private and public at the same time. It covers everyone and everything – but of course, there are exceptions. Coming to Germany as an expatriate or international student, navigating the country’s healthcare system can be challenging. How to find the cheapest health insurance company with the best coverage as a student, freelancer, expat, employee, or with a job-seeker visa?
Having proper health insurance is essential and even legally required. This article explains how the German healthcare system works and how you can pick the right coverage at a private or statutory health insurance provider in Germany.
Legal Requirements and Health Insurance Options
In Germany, health insurance is not just a personal choice but a legal requirement for all residents, both German citizens and expatriates alike. Hence, proof of health insurance coverage is required to start a job or enroll at a university. Thus, we advise you to organize appropriate coverage before you hire a service for removals to Germany. Not having health insurance can mean you must pay missed contributions later or cover treatment costs yourself.
Germany operates under a dual health insurance system, mandating individuals to opt between so-called statutory or public health insurance (“Gesetzliche Krankenversicherung” or GKV) and private health insurance (“Private Krankenversicherung” or PKV). But what are the differences? And what are the alternatives if you just come for a restricted time?
Coverage of Public Health Insurance in Germany
Of 84 million residents, 74 million were insured with a statutory health insurance provider. Public health insurance is open to anyone. Nobody can be rejected, no matter their pre-conditions. The large majority of Germans are satisfied with their health insurance system. The coverage is good, with little or no co-payments except in specific areas such as dental prostheses, where people frequently get private supplementary dental insurance.
People with statutory health insurance are not required to advance treatment costs. The providers bill the health insurance companies directly. Every citizen is free to choose their doctor. The only prerequisite for treatment by the statutory health insurance (GKV) is that the doctor in question has authorization (“Kassenzulassung”). As members also receive a European Health Insurance Card (EHIC), care is provided all over the European Union following the guidelines according to the public systems of the respective countries. Optional private travel insurance can cover excess costs for private doctors or worldwide care for a low yearly contribution of between 10 and 20 Euros.
In total, there are 95 statutory health insurance companies in Germany. To a large extent, all statutory health insurance funds have the same legally prescribed insurance coverage, clearly defining approximately 96% of the services. It means that every insured person is entitled to adequate treatment in line with current medical standards.
Moreover, health insurance companies can offer voluntary additional benefits. Some insurance companies subsidize professional dental cleaning, travel vaccinations, preventive cancer exams, or alternative healing methods such as homeopathy or osteopathy.
Many statutory health insurance companies have bonus programs to reward their policyholders for health-conscious behavior. For certain activities – such as regular visits to the dentist – you receive bonus points that can be redeemed for a cash or non-cash reward.
Finally, statutory health insurance funds differentiate themselves through their customer services: Some have highly digitalized services, others offer customer service in various languages, and some maintain a network of physical service centers.
TIP
Compare statutory health insurance providers here
Check the overview differences in coverage, bonus programs, perks, English-support for the most significant health insurance providers BARMER, TK, DAK, and AOK.
Compulsory Membership with a Statutory Health Insurance Provider
German residents must contribute to the German public system if their gross income falls below a certain threshold, making it mandatory for a significant portion of the population. There are options to apply for being exempted from statutory health insurance to get private health insurance. However, this should be well considered as a return to the statutory health insurance system is not always possible or difficult. In general, the following rules apply to different target groups:
- Employed individuals: If you are an employee with a gross income below a certain threshold (known as the mandatory insurance limit or “Versicherungspflichtgrenze”), you are generally required to be a member of the statutory health insurance system. In 2024, this limit is 69,300 Euros gross per year.
- Self-employed individuals: Self-employed and freelancers are not required but can join the public health insurance system voluntarily.
- Family members: Family members, such as spouses and children, can be covered without additional cost by the statutory health insurance of the primary insured person, given that their incomes do not exceed certain limits.
- Students and interns: Students and interns are usually members of a statutory health insurance company and enjoy low contributions. However, there is also the option to get private insurance.
- Pensioners: Retired people are covered by the public health insurance scheme provided they have been insured there for a long enough time and do not apply for exemption at the beginning of their pension.
Cost of Cheapest Public Health Insurance
The individual cost of public health insurance is dependent on the income of the insured person or family. A general legally set contribution rate is the same across all statutory health insurance providers. Moreover, individual insurance companies charge a supplement. The lower this additional contribution, the cheaper the health insurance is.
General Contribution Rate for Health Insurance
The 2024 general health insurance contribution is 14.6% of the gross income. It is capped at an income of 69,300 Euros. Hence, you do not pay more for health insurance if you earn more:
- For employed individuals, this amount is shared equally with the employer (7.3% each)
- Self-employed people must cover the entire 14.6% (and not less than the minimum contribution for voluntarily insured individuals) by themselves. However, a reduced contribution of 14% is possible if they opt out of sick payments.
- The minimum contribution for voluntarily insured individuals is 164.92 Euros per month when opting out for sick payments or 171.99 Euros including sick payments.
- Contributions for students who are not eligible to be covered by family insurance are calculated according to 70% of the current BAfÖG maximum allowance (812 Euros in 2024), equaling a general contribution of 82.99 Euros per month.
General Contribution to Long-Term Care Insurance
The obligation for health insurance also includes nursing insurance. The selected public health insurance provider also covers it. In 2024, the contribution rate is 3.4%.
- For employees, this contribution is shared equally with the employer (except in Saxonia, where the employer only covers 1.2%).
- There is a supplement of 0.6% for individuals age 23 or older without children and reductions for people with two or more children.
Cheapest Health Insurance with Low Additional Contribution
Each health insurance fund charges an individual supplementary contribution. The amount of this contribution depends on the financial situation of the respective health insurance fund. Like the general contribution rate, employees must pay half the additional contribution. The employer pays the other half of the additional contribution.
Therefore, switching from a health insurance fund with a high supplementary contribution to a cheaper one will decrease the cost of your health insurance. Hence, the additional contribution is, together with the extra benefits offered by a health insurance fund, the most decisive factor when choosing public health insurance.
In 2024, among the four largest statutory health funds, TK health insurance (“Techniker Krankenkasse”) charges the lowest supplement with 1.2%. AOK charges between 1.3 and 2.7% depending on the regional entity, DAK 1.7%, and BARMER 2.19%.
Best Public Health Insurance Providers
There are different factors for identifying the best statutory health insurance company:
- Popularity: In terms of members, the most popular public health insurance providers by number of members are AOK, TK (“Techniker Krankenkasse”, BARMER, and DAK.
- Cost: In terms of lowest additional contribution, the cheapest nationwide available statutory health insurance providers are BKK firmus with 0.9%, hkk with 0.98%, Audi BKK with 1%, and TK (“Techniker Krankenkasse”) with 1.2%.
- Ratings: Different ratings analyze the included coverage, customer service, and financial stability of the companies
- According to the Handelsblatt ranking from November 2023, TK (“Techniker Krankenkasse”), HEK, and HKK rank best.
- According to the Finanztip ranking from January 2024, HKK, TK (“Techniker Krankenkasse”), and Audi BKK occupy the top spots.
Application Process to Get Statutory Health Insurance
Applying for statutory health insurance is straightforward. You select the desired health insurance provider based on your preferences. These can be the additional contribution rate, voluntary benefits, bonus programs, or customer service. You then easily sign-up online.
If you are already insured, changing your statutory health insurance provider after 12 months of membership is possible. In some cases, an earlier change is possible:
- If your health insurance fund increases the supplementary contribution
- When taking up a new job subject to compulsory insurance, the member can choose a new health insurance fund up to a maximum of 14 days after the start of employment.
- Suppose the insurance status changes from compulsory to voluntary (e.g., because of a raise in salary or the start of freelancer activity). In that case, a member has three months to make the change. If the status changes from voluntary to compulsory, a period of 14 days applies.
Those wishing to switch fill out a new application for enrollment with the health insurance company of their choice. The new fund will give notice of termination to your previous health insurance fund.
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Easiest sign-up for public health insurance in English
Feather Insurance is probably the easiest way to sign up with statutory health insurance as an expat in Germany. This independent insurance broker cannot only answer all your questions. They also provide a complete digital and English sign-up process.
Private Coverage in German Health System
German private health insurance (“Private Krankenversicherung”) is often associated with many advantages. This may be shorter waiting times for an appointment with a specialist, use of the latest medical techniques, single or twin hospital rooms, or treatment by the head physician.
However, these benefits are usually only part of more expensive plans. In contrast to statutory health insurance, there is no general service catalog. In private health insurance, customers look for a plan that includes benefits that are important to them and that they can afford. When visiting a doctor, the patients pay the bill themselves and get the full or part of the cost reimbursed according to the contract terms. Patients have a free choice of doctor. As with public health insurance, coverage is available throughout Europe. Moreover, a lot of plans include worldwide coverage for limited stays abroad.
As it is not a public welfare but a profit-oriented system, everyone has to cover the risks of falling ill with their contributions. Private health insurers can choose their customers and might reject them, for example, due to a pre-existing condition. The only exceptions are basic and standard tariffs with limited benefits. Here, private insurers must accept anyone who is not subject to statutory health insurance or has already been privately insured.
Membership in a Private Health Insurance in Germany
Only some people are entitled to switch to public or private insurance companies. Most German citizens do not fulfill the requirements to select private health insurance. Only in a limited number of cases, individuals can opt for private German health insurance:
- Employed individuals: If your income exceeds the mandatory insurance limit (“Versichungsplichtgrenze”), you have the option to choose private health insurance. You must return to the public scheme when your income falls below this threshold. However, you can also apply to remain with your private health insurance in certain cases, for example, if you voluntarily reduce your working time due to parental leave or caring for a family member.
- Self-employed individuals: Self-employed and freelancers can choose to join private health insurance regardless of their income.
- Students and interns: Only at the beginning of the study program can students choose to get exempted from statutory health insurance. However, this may also make it difficult to get back to public health insurance after graduation. Also, student plans of statutory health insurance providers have very favorable rates.
- Pensioners: Retired people usually remain in the private system if they were in it before. Others can also get exempted and change to private health insurance at the beginning of their retirement. However, this is usually not reasonable from a financial point of view.
- Public officials: Civil servants are eligible to choose private health insurance.
Even if you are mandatorily insured in public health insurance, you still might opt against private health insurance. In contrast to private insurers, statutory health insurance also covers family members and guarantees stable or even lower contributions as a pensioner. Once you subscribe to private health insurance, changing back to the statutory system is only feasible in a few cases (e.g., you fulfill the conditions for mandatory public health insurance) and becomes almost impossible at the age of 55 or older. Hence, this step should be well considered and should depend not only on your current situation but also on your future situation (e.g., family planning).
Finding the Cheapest Private Health Insurance in Germany
Contributions to private insurance policies do not depend on the income. Private insurers define the cost of the policy based on factors like the covered treatments, the age of the individual patient, and their pre-conditions. As a family, every person needs to be insured individually. There is no family coverage like in the public system or sick payments during a child’s illness.
It is suitable for you as long as you are single, young, and healthy. If the risk of illness is low, the premiums are low – often, private health insurance is cheaper than statutory health insurance. However, you will probably pay a higher insurance premium with age. Therefore, finding a plan that remains affordable in the long run is crucial.
Nevertheless, just looking for the cheapest private health insurance is not wise. Mainly, cheap tariffs often offer little protection. For some treatments, they even pay less than the statutory health insurance companies. In the event of illness, this can become a cost trap if you have to pay for essential services out of your pocket. Upgrading from a cheap entry-level plan to increased coverage usually comes with extra charges.
In statutory health insurance, it is straightforward to switch providers; with private health insurance, it is more complicated. It is theoretically possible, but members would lose a large part of the reserves that the insurer has accrued for the future. Also, they would have to pass another health check with the new insurer. It is, therefore, wise to choose a plan with good benefits right from the start.
Best Private Health Insurance Companies in Germany
The search for private health insurance is much more complicated, and choosing the wrong plan can be expensive in the long run. Entry-level options, as well as other offers, sometimes lack important benefits. Hence, it requires time and profound consultation to choose private health insurance.
An insurance broker such as Feather Insurance can support you with consultation insurance broker such as Feather Insurance can support you with consultation. They also publish prices for different plans on their website for better understanding.
If this is not worthwhile for you, or you are in doubt, the safe choice is to pick statutory health insurance.
Alternative Option: Expat Insurance in Germany
If you have just moved to Germany, you might hesitate to sign up with a costly statutory or private health insurance plan. Perhaps…
- You have not settled and decided if you want to stay in Germany?
- You come here to improve your German at a language school for a set period?
- You are a digital nomad or just visiting Germany for some months and looking for coverage?
- You are a job-seeker with a German Visa requiring coverage during the initial period?
Suppose you do not have a legal status that obliges you to have permanent private or public insurance (e.g., through employment or studies at a public university). In that case, expat health insurance or “incoming insurance” is a great option. It can cover you for the first months or even two years after arriving in Germany. It is usually flexible, meaning you can easily extend it if you decide to stay longer or cancel in case you leave earlier. Insurance premiums are affordable.
Incoming insurance is mainly dedicated to covering you in case of illnesses or emergencies. This means existing pre-conditions, check-ups, or check-ups are not covered.
Conclusion: Public or Private Health Insurance Scheme?
Health insurance is not only reasonable but also obligatory in Germany. Finding the best private or public insurance can be tricky:
- Statutory health insurance is by far the most selected option. It covers everyone, no matter the existing pre-conditions. All treatments in line with current medical standards are included with a free choice of doctors. Premiums are dependent on income. Also, public health insurance covers non-working family members like partners and children for free.
- There are a total of 95 statutory health insurance funds. They differentiate themselves through their fees regarding additional contributions, voluntary coverages, bonus programs, and customer service. You can easily apply online.
- Only a limited group of people is eligible to select private health insurance alternatively (e.g., freelancers and employees with a yearly salary >69,300 Euros). Once they do so, the options to go back to public insurance are very limited.
- There is a wide range of private insurance plans. Some but not all of them offer better coverage than statutory health insurance, and usually, premiums increase with age. Moreover, private health insurance only makes sense if you are healthy. Private insurance can reject you because of pre-existing conditions.
- Most people who are in doubt about whether private health insurance is worth it for them in the long run, e.g., as they might join a family later or expect lower earnings, go with statutory health insurance. Additionally, improving coverage with additional private insurance, such as dental insurance, is common but not mandatory.
- Alternatively, expat insurance is a viable, flexible, short-term option for expats who have only recently arrived and need time to settle or are unsure how long they will stay.
