Health insurance in Germany

Generally speaking, all employees whose annual income doesn't exceed a specific amount (Versicherungspflichtgrenze) must have statutory health insurance. Freelance artists and journalists, students, unemployed and retired people can have statutory health insurance too. Spouses and children are also insured at no additional cost, as long as they don't earn any money, or earn too little. Children are covered up to a certain age, which will depend on whether they are still in education or vocational training. Children who aren't able to care for themselves due to a disability can always be insured through their parents, no matter how old they are.

You can get more information on income limits and age restrictions for children from the individual insurers.

You are free to choose among the statutory health insurance companies. All of the statutory insurers basically offer the same comprehensive catalogue of standard medical treatments and health care services. These standard benefits are known as Regelleistungen. But some insurers also cover the costs of additional things like travel vaccinations or sports and exercise programs. Others offer repayments or bonus programs if you, for example, take part in a prevention course or have the recommended vaccinations done. Voluntary benefits that insurers aren't legally required to provide are referred to as Satzungsleistungen.

It can also be worth comparing the different insurer’s additional fees because these can vary. For people who are chronically ill or disabled, it may be especially important to know which service providers have been contracted by the specific insurer to provide their care.

You can switch insurers at any time with two months’ notice. You would then typically have to wait at least 18 months before switching to a different insurer again, though. But if your insurance premium is increased during those 18 months, you're allowed to leave sooner, as long as you give the required two months’ notice.

Most of the statutory health insurance benefits are standard services and compulsory for all of the insurance providers. The services covered include practice-based treatment by family doctors, specialists and psychotherapists, hospital-based treatment and – under certain circumstances – treatment in rehabilitation facilities. These standard benefits also include screening tests, necessary vaccinations (not travel vaccinations) and medical care related to pregnancy and birth.

Prescription drugs are nearly always covered. Treatments like physiotherapy or speech therapy and medical aids like prosthetic devices or hearing aids are also covered by statutory health insurances, as long as they are medically necessary and have been prescribed by a doctor. People have to pay a certain amount out of their own pocket for these things, though. This amount is fixed by law. The out-of-pocket costs for prescribed drugs range between five and ten euros, depending on their price. Children and teenagers under 18 do not have to pay these additional costs.

The standard benefits also include dental check-ups, dental treatment, gum treatment, and orthodontic treatment. When it comes to dental prosthetics, statutory health insurers pay a fixed amount. Before any dental work involving prosthetics is started, your dentist makes a treatment and cost plan which must be submitted to your insurer. The insurer then decides what costs it will cover, giving you a better idea of how much you will need to pay yourself.

If you have special requests – such as a private room in hospital, treatment by a senior consultant or certain dental treatments – you have to pay for them yourself. Private health insurance companies offer separate policies for some of these.

Because reimbursements for some services may vary from insurer to insurer, it can be worth contacting your insurer beforehand.

With the exception of out-of-pocket costs, all costs for services that are covered are paid by the insurer directly to the care provider – this means that you do not need to be involved in the transaction.

About 11% of people living in Germany have private health insurance ("private Krankenversicherung", PKV). Only people who fulfill certain criteria can have private health insurance. For example, your gross income must be above a certain threshold for at least one year. This threshold is regularly adjusted – for 2018 it has been set at 59,400 euros per year. Self-employed people can have private health insurance too. If you would prefer not to have private health insurance, you can opt for statutory health insurance instead.

Private health insurance premiums aren't based on income, but on age, general health and the requested health care services.

These services may include treatment by a senior consultant, a private hospital room, and special medical, dental or naturopathic treatments. The insurance benefits that are included are stipulated in the individual policy.

People with pre-existing medical conditions usually pay more than healthy people do, and older people usually pay more than younger people do. As you get older, your premium may increase quite a lot too. Family members aren't automatically covered, and have to be insured separately. You generally have to pay for diagnostic procedures, treatments and medication yourself at first. You then send the receipt or bill to your insurer, and the costs are reimbursed.

All private health insurers offer standard basic insurance policy that can be purchased if specific requirements are met. It's possible to switch to the basic policy under certain circumstances. The premium for the basic policy may not exceed the highest statutory health insurance premium. The basic policy must include the compulsory standard medical services covered by statutory health insurers.