THE GERMAN HEALTHCARE SYSTEM IS PROBABLY ONE OF THE BEST WORLDWIDE.
Since health insurance is obligatory, almost everyone is insured. On top of that, a very comprehensive coverage is available at relatively low rates.
And while you have to arrange insurance yourself, the German Healthcare System is very good at reminding you to do it. Key fact to remember: you need to have health insurance the moment you start working as an employee. Your employer will ask you for the details well before you start (your employer can't do the final payroll accounting if he has not registered you with an insurance company).
If you are unemployed, you are either covered by the insurance of your spouse or, the coverage is paid for out of the social funds automatically. Only very, very few citizens fall through this social web, freelancers for example who simply forgot to make arrangements.
Public Healthcare costs the almost the same at every insurance company, and the monthly fee is dependent on the level of salary. But independent of the monthly fee everybody gets the same coverage.
Read more about the system and details below...
Learn about how the German healthcare system developed, and on which principles it relies.
You should know this to understand the scope of services you are contracting with your insurance of choice.
Origin & Players
- Benefits in kind: Beneficiaries receive immediate treatment, they do not have to pay upfront
- Financing from employers and employees
- Plurality: Patients can choose amongst hospitals and private providers
Principles & Obligations
- Subsidiarity = the smallest and most local institution addresses a problem
- Health insurance companies are self-administrated
- State only provides framework and supervision
- Principle of decentralization
- The “Enzyklika Quadragesimo” of the Catholic Church (1931) defines subsidiarity
- The state grants autonomous regulation of a defined part of the society via associations
- The state is not involved in negotiations but has a supervisory role
- Inpatient care is regulated via contracts between the Association of SHI Physicians and the regional health insurance associations
- The main actors in the German system, therefore, are the associations, not the insurance companies or the physicians themselves
- Shifting responsibilities to professional associations
- Participation of organized interests in formulating and executing political decisions
- The state is a negotiating party
Current Reforms and Discussions
- universal SHI (encompassing all citizens) and health premium (standard premium per head, subsidies based on income)
- prioritization of special medical services
- the role of the European Union in healthcare regulation
- competition between statutory and private health insurance
- introducing innovative care and stronger competition
PHYSICIANS & HOSPITALS
All in all the distribution of physicians or hospitals is good all over Germany, however, you'll find the biggest population of both in the big cities.
Find an English speaking physician in your neighborhood.
About 350.000 physicians are practicing in Germany resulting in a proportion of around 3.4 per 1,000 inhabitants. The ratio, however, differs significantly between countryside and urban centers.
A physician running a practice needs to register with the Statutory Health Insurance Physicians (SHI - Kassenärztliche Vereinigung) unless he decides to take on private patients only. This institution has developed an enormous catalog of all possible medical services and assigned a value for each. Based on this catalog the physician invoices to the SHI directly. This also allows to analyze big data and recalculate the values per services. The physician can and will always try to attract private patients, too, because a similar catalog has been developed for private services - basically the same, but with higher value.
Educational background of German doctors
The education to become a doctor in Germany is still one of the hardest. Because of the high-income prospects, it was also the first choice for young students until recently. The possible income was significantly cut down by recent reforms, however, the profession of a doctor, especially if you had an own practice or were able to nail a Chefarzt position in a renowned hospital, is still one of the best-paying in Germany.
Prerequisites to become a doctor in Germany
- 6 years at a university, including the so-called practical year
- emergency aid knowledge
- work as a medical caretaker for 3 months
- complete a clinical traineeship of 4 months
- graduate in 3 state exams
How to find a good physician
In Germany, it is a custom that you choose a so-called "home doctor" (Hausarzt) - a general practitioner whom you'd be contacting first whenever you feel ill. If he believes you need to be looked at by a specialist, he will fill a so-called transversal note (Überweisung). Some practitioners have very good connections to various specialized doctors, and it is, in fact, time-saving to consult your home doctor first because that may decrease the waiting time at the specialist. Others don't. If you know you'd need a certain specialized doctor once in a while, it is wise to go there directly (i.e. gynecologist, urologist, oculist or the like). The two other doctors you would choose independently would be the dentist and, if applicable, the pediatrician.
Finding a good doctor is not so difficult. Apart from the fact that it is really a very personal perception of which criteria are essential for you, the medical university studies are of a very high quality in Germany, and you can usually trust any doctor.
Like with any serious issue it is sometimes recommended to get a second opinion, but other than that, doctors can be trusted.
Doctors usually speak some decent English so that they can make themselves comprehensible to you. It is, however, worthwhile to give their practice a call and verify. With the practice personnel, it is often difficult to communicate because their English may lack. If you don't get anywhere talking to them, don't give up but simply write them an email.
There are a couple of good websites which list doctors in the neighborhood and partly offer a rating. Google itself often already has some references based on Quipe.
Hospitals in Germany are grouped into three main types:
- Public hospitals (Öffentliche Krankenhäuser) are run by local state authorities, towns and the states
- Voluntary, non-profit making hospitals (Freie gemeinnützige Krankenhäuser) run by churches or non-profit organizations, such as the German Red Cross
- Private hospitals (Privatkrankenhäuser) run as free commercial enterprises
All of them have a very good reputation and are considered being amongst the world's best hospitals. They are modern and use the latest technology and provide high-quality medical care. See here to find a ranking of German hospitals.
Most hospitals cover a range of treatments, but not all. Once you have chosen your new home address, you may spend some time to review the scope of treatment offered by the two closest hospitals. If you need special treatment, your physician will recommend a hospital, but you are not bound to follow it. You may check here for the hospitals offering your demanded treatment.
While English-speaking nurses are rare, most doctors do speak good English.
Cost of Treatment
If you are regularly insured in Germany the cost of hospital treatment in public hospitals (on referral by a doctor, or in emergencies) is covered by the public health authorities, except for a small daily charge from the start of hospital treatment up to a maximum of 14 days.
Private insurance is recommended for specialist medical treatment outside the German National Health Service, which can be expensive.
In case you are not regularly insured in Germany but are an EU citizen, the current rules for the coordination of social security-systems in Europa stipulate, that the German physician or hospital bills the treatment-costs for emergency cases to the respective foreign health insurance of the treated patient.
German specifics of hospital treatments
Patients are usually put into 3-bedrooms with no separation between the beds. You may buy additional private insurance to cover for a single room, but that may still not always be granted if the hospital has problems with its bed capacity at that specific point in time. Usually, it is possible. You can also book a "family room" in case you need to accompany your child, or your wife giving birth. Again, this depends on the availability of beds.
Every morning, doctors will do their visits and decide whether you are ready to go home or stay a day longer. Usually, you won't be released on a Sunday.
You will be given hospital gowns in case you have an operation and need to be treated with infusion or the like. Once you feel better, you may ask the nurses, whether you can put on your own clothes. The check-ups sometimes require your undressing, and it is expected that you just do as told. There will be no cover for parts of the body that don't need inspection, however, usually, your stripping down is limited to those that need examination. The hospital gowns are open on the back, and it can be very embarrassing to ie., use the toilet and be spotted by your co-patient. So bring a gown or pyjama and have it put in easy reach. Also to bring: towels, slippers, soap, toilet articles, and a washcloth.
Meals and mealtimes at hospitals conform to what's usual in Germany: breakfast and dinner will be bread, lunch some hot meal. You can often choose out of two options. And in some cases, there may be patient fridges, and you can bring your own food and put it there (if labeled).
PUBLIC HEALTHCARE INSURANCE
The public healthcare insurance in Germany is one of the world's best.
Up to a certain level of net income, you have no choice but to register with one of the more than 150 public health insurers. Read about the income levels and general scope of services for public healthcare insurance and specific offers for expatriates.
Some insurers cover all Germany; others have a regional set-up.
If your annual gross income is below the threshold of €57.600 ("Jahresarbeitsentgeltgrenze" - as per 2017), you will need to register with one of the public health funds ("Pflichtmitgliedschaft"), unless you had been insured privately in Germany sometime in the past. Decisive is what you earn as an individual, the family income is not relevant. You can choose your own public health fund among a wide range of approved providers. The contribution will be deducted from your monthly salary. For some special care (eye and dental care), public health funds do not provide optimal protection. You can then take out supplementary private health insurance to get full coverage.
Scope of Services
Public Health Care insurance companies offer the same scope of coverage to a degree of 98%. The remaining services are used to distinguish one company over the other. Their scope of services generally cover all medical treatments your doctors decide you need to have. Some limits are individually regulated via the service catalog and regularly comprise treatments which contain an additional benefit to you (i.e. ceramic dental filling), and you'll have to pay on your own if you wanted those treatments. Usually, these payments are affordable. Mostly, these will occur with dental treatment.
They do not pay for treatments which are not yet proven to be helpful. Especially for rare illnesses, this may cause problems. But then private healthcare insurers pay a little more but neither do they pay for treatments with unproven efficiency.
- Medical and dental treatment, with free choice of doctor or dentist
- hospital treatment
- Medicines, bandages, corresponding treatments, and tools such as hearing aids and wheelchairs
- Sickness allowance: your employer pays your salary for up to 6 weeks sickness induced absence. After that, the health insurance pays 70% of your salary for up to 78 weeks
- Preventive Check-Ups
- Vaccinations, except for vaccinations for foreign travel
- Orthodontic treatments, usually up to the age of 18 years
- Medically necessary dental fillings and crowns
Generally speaking, public health insurance cost you between 14,6% plus 2,55 % (plus 0,25% for childless members - the so-called "Pflegepflichtversicherung" or longterm care insurance) of your gross salary. Most insurers set their premiums to 15,60%. Your employer will pay 50% of the premium, i.e. 7,3% of your gross salary. The maximum monthly fee is the above share on 57.600 EUR (the so-called "Beitragsbemessungsgrenze").
However, the insurers can now determine a small portion of the amount of the monthly premiums themselves. They are allowed to charge additional premiums for additional services - and many do so. The range of premiums is currently between 14.6 to 15.9 percent (the employer does NOT contribute to the exceeding part of the premium, his share remains at 7,3%). These can be special services around vaccination, pregnancy, special healing methods, dental care or financial bonus programs.
You can always cancel your membership with a public insurer at any time. The notice period is 2 months to the end of the month. After having changed to a new insurer, you are bound to this choice for at least 18 months.
If your current health insurance demands an additional premium, you have an extraordinary cancellation right that is valid for 2 months after the new premium became effective.
If you have contracted an additional service, i.e. a special tariff, you are bound to it for 3 years.
And if you want to change over to private healthcare, the cancellation period is 2 months and the 18 months period from above does not apply.
One of the most critical differences to private healthcare is the possibility to insure direct family members for free. This can make the financial advantage of the private healthcare obsolete. The family insurance covers spouses and children with no own income. They will always fall under the insurance of the spouse who has the higher income.
- both, husband and spouse, need to be insured with public healthcare.
- the spouse does not earn more than 4.575 EUR a month
- the spouse is not self-employed, respectively the average monthly income does not exceed 450 EUR
- the spouse is not insured with a different public health insurance
The latter is more theoretical as your spouse would cancel his/her membership with that other insurer and become a member of yours.
The big players
In Germany, there are 118 public health insurance. 32 of them are eligible only for members of certain companies. The biggest public insurers are the Techniker Krankenkasse, Barmer Ersatzkasse, and the diverse regional AOKs. One of the best websites offering a comparison of services and premiums is the Gesetzliche Krankenkassen.de.
Distinct offers for Expatriates
There are a couple of Insurers which offer English speaking customer services:
- Techniker Krankenkasse (TKK)
They are the biggest public insurer in Germany and offer an online appointment system which includes specialist doctors (in German only). This reduces waiting time with many specialists which can be very helpful. The TKK will consider our clients VIP and they will have access to a 1-year support in English.
- Siemens Betriebskrankenkasse (SBK)
A team of experts, which specially serves our foreign clients, knows your particular needs and advises you regarding all questions relating to health, health insurance cover and social insurance. They have put together a little explanation/welcome video.
The BKK is organized regionally and is also one of the biggest insurers. They offer a so-called health account which is worth 160 EUR per year and can be used for a defined set of service not normally covered. They also have a medical hotline available 24-hours.
- Barmer GEK
The Barmer GEK is also a very big insurer. They do offer an online doctor-finder (in German only) and a waiting time management service which is available in English. They offer a similar health account as the BKK.
Read here to understand your requested yearly income to seek private healthcare insurance, what it costs and what it provides for.
We have listed the top 10 private insurance companies and present a few expatriate programs available.
If your gross annual income is above €57,600 (as per 2017), or if you are self-employed or unemployed, you may opt for a private health fund. The freedom of choice for a private (or public) health insurer is limited also by your historical contracts. If you've ever been a member of a private insurance fund and you earn more than the said €57,600, you have no choice but to stay private.
Like public insurance companies, private insurance companies are obliged to contract with any person applying for coverage. To deal with this relatively new requirement all private healthcare insurers have come up with a "Basistarif" offering similar benefits to the government system.
In other words, if you have a serious pre-existing medical condition and won't be accepted into regular private health insurance tariffs, you can purchase this tariff as a last resort.
Scope of Services
Benefits are almost similar to that of the public system with a more comprehensive coverage of dental and eye care. Note that with a private health fund, you can adjust your level of coverage and your monthly contributions based on your own healthcare needs (if you are young, if you do not suffer from chronic diseases, etc.).
The "Basistarif", which means the minimum services tariff, equals the services of a public insurance company in scope and pricing. The belief that private healthcare may be too expensive in old age is not true. You are always free to downgrade to the Basistarif.
The premiums vary significantly and are based on your medical condition and personal risk profile as well as your own choice of services. Private health insurance, at first sight, seems to be much cheaper, however, in a family situation every family member has to be individually insured, while in public insurances the one covering the breadwinner automatically covers all remaining family members.
If you are employed, your employer will pay 50% of the premium, but maximum the same amount as if you were a member of a public insurance fund, i.e. 7,3% of your gross monthly salary with the limits to be considered (see Public Healthcare Insurance above).
The premiums can be reduced by accepting a deductible.
In contrast to public healthcare premiums, the premiums for private healthcare are not limited. If medical cost increase, the private insurers are entitled to increase your premiums. And indeed, although no statistics are available, the premiums for the same service were increased more than in the public insurance.
Depending on the start of the insurance private health insurance can be canceled at the end of the calendar year or the insurance year. The cancellation period is three months ahead. Often, however, a minimum membership period between one and three years must be respected.
A cancellation will only take effect once a new insurance coverage can be demonstrated within the notice period.
If someone wishes to contract with public insurance, then the cancellation rules of the public insurers are valid (i.e. 2 months to month's end). This is only possible if the yearly income drops below the income limits for the public healthcare insurance, or if he registers as unemployed.
The member can also cancel in case of premium increases or changes in the scope of services. He must then do so within 2 months of the change.
The big players
About 40 German insurance companies serve the private medical insurance market. And almost none of them offers special service for expatriates. The website www.krankenkassenzentrale.de enables a rough comparison of premiums and services, but it is highly recommended to consult our insurance experts. The choice of a private insurance coverage is one that you most likely won't be able to cancel thus professional advice is important.