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German Insurance: Costs & Coverage

Health insurance in Germany is obligatory for all residents, including expatriates and the self-employed. International healthcare plans are not officially accepted as a substitute for a national insurance policy. Insurance coverage is also a prerequisite for residence or work permits.
Your German public health insurance card typically includes the blue European Health Insurance Card (EHIC), which is valid throughout the EU.

Who Obtains Private Health Insurance?

You may switch from public to private health insurance if…

  • you live in Germany
  • you already participate in the public healthcare system
  • your gross annual income has exceeded 53,550 € for the past year.

Your employer, who forwards your contributions to the insurance company, has to inform you whenever a switch is possible. He or she is likely to have an interest in this option as well: It may result in lower costs for the company, too.

However, once you turn your back on public health insurance, you may not be admitted back in. This regulation intends to prevent people from switching back and forth whenever their income drops, premiums are raised, or when they have kids.

Unfortunately, private health insurance is not always a voluntary option. Some conditions may also deny you admission to public healthcare.

You may be legally required to obtain private health insurance if

  • your gross income has exceeded the yearly limit of 53,550€ for the past three years (and will continue to do so)
  • and if you have not participated in any EU member state’s public health insurance plan for at least three years out of the last five years.

If these two conditions apply, private insurance is normally obligatory. Moreover, non-EU nationals who are neither gainfully employed nor attend a university in Germany might be obliged to take out private health insurance.

You can still choose your private insurance company freely. In principle, you cannot be denied membership, although not every private insurer will accept foreign applicants.

Irrespective of preexisting health conditions, the company has to offer you an option with a pay rate capped at the maximum level of public healthcare contributions – i.e. about 630€ per month.

Registration and Costs

Getting a private insurance policy requires health checks and interviews. Age, occupation, and pre-existing conditions all influence your premium.

Moreover, a private insurance company may refuse to treat your preexisting conditions altogether. But if you don’t report your preexisting conditions at the time you sign the contract, the insurance can cancel it.

Make sure to mention any illness, especially if it’s serious, reoccurring, or rare. Despite raising your premiums, this will protect your coverage when treatment becomes necessary.

In private insurance, your contributions are based on your personal risk profile; in public insurance, they are based on your income. Both you and your employer have to each pay 15.5% of your gross income every month. The maximum premium amounts to circa 630€.

But the contributions to a private health insurance plan may be considerably lower than that. Sometimes, you can negotiate no-claims bonuses or excess options: The former reward you if you don’t see a doctor for a certain period of time; the latter require you to make higher co-payments for hospitalization.

Some advantages of private care can be bought as "add-ons" to public health insurance. We will look at this possibility below.

Signing up with a public health insurance company is relatively easy. You don’t need a health check, and preexisting conditions never form an obstacle. If the private insurance option is not compulsory for you, all public insurers have to admit you.

What Is Covered?

All insurance companies, whether public or private, have to provide basic coverage. This includes medical treatment, basic dental care, hospitalization, rehabilitation, and prescription drugs.

However, the public healthcare plan requires the patient to make co-payments for these benefits: You have to pay for all vision products (glasses, contacts) yourself; you need to pay up to 10€ for most meds, and hospitalization costs around 10€ a day.

Private insurance companies usually offer lower co-payments, as well as extra benefits, such as:

  • higher reimbursements for dental care
  • hospital treatment by one of the chief physicians
  • a single or double room in hospital
  • alternative medicine
  • (partial) reimbursements for glasses, etc.

You can purchase similar "add-ons" from private policies while still participating in the public healthcare plan.

Also take into consideration that you have to keep paying contributions to your private insurer, even when you are temporarily out of work or taking a break due to illness. Moreover, premiums on the private health insurance market tend to rise as you get older.

The coverage of any German health insurance plan, both public and private, automatically extends to emergency care during short-term trips to other EU member states.


We do our best to keep this article up to date. However, we cannot guarantee that the information provided is always current or complete.