Overview
Germany has a reputation for having one of the best and most comprehensive health care systems in the world, providing its residents with health, sick pay and long-term nursing care insurance coverage. Approximately 90% of the population is a mandatory or a voluntary member of the public health scheme while the rest have private health insurance. The health insurance reform of 2007 requires everyone living in Germany to be insured for at least hospital and out-patient medical treatment. There is a heavy penalty to be paid in case you have any gaps in coverage.
The costs of the German public health care scheme are immense and constantly rising due to demographic structure as well as medical cost inflation and of course the large bureaucracy which continues to expand with each reform. The expected loss for the public health system in 2021 is over 7 billion Euros. Financing is through payments made by the members of the German public health scheme and their employers along with ever higher tax subsidies. The tax subsidy for 2022 is double that of last year and is now 28.5 billion Euros. The previous health minister pushed through 20 new laws in 2018/2019 which went into effect in 2020, all of which will cost the system more money than before. The goal was to improve benefits and to digitalize the health system (which is still very old-fashioned and paper-driven). Some planned changes will be that you will be able to access a doctor online, call a special phone number to get an appointment with a specialist, use new apps provided by your doctor for specific diseases (for instance diabetes), and starting on March 1, 2020, it was obligatory to have your children vaccinated against measles. Women over the age of 19 can access screening for cervical cancer. This, among other improvements, will cost the system more as the years go by. Reforms can also go in the opposite direction, reducing benefits and rationing them. The German public health scheme is a social health system and offers no contractual security going forward. The effects of the Covid-19 pandemic have also affected hospital, vaccination and hygiene costs and will likely take a very large toll on the mental health of children who have been unable to go to school and socialize with their peers as well as adults, causing a rising need for psychiatric care.
You have three options for health insurance while living in Germany: the government-regulated public health insurance scheme (gesetzliche Krankenversicherung - GKV), private health insurance from a German or international insurance company (PKV) or a combination of GKV and supplemental PKV. You can opt for a full private health insurance plan if your income as an employee is above the threshold amount of 64,350 Euros gross annual salary (in 2022), if you are self-employed, not employed (a mini job does not count) or you are over 55 years of age and not employed. Finding the best service provider for public health insurance or finding the most suitable coverage from a private health insurer while still at a competitive rate is not always easy but is well worth the effort.
As people have different requirements or expectations from health insurance, it is important to understand the system in order to filter out the most suitable plan while living in Germany. It is important to mention that you cannot simply switch between the public health scheme and private health insurance at will as certain prerequisites exist. Independent advice from experienced insurance brokers who understand the pros and cons of both systems as well as considering your individual circumstances is strongly to be advised.
Health insurance is not a commodity to be bought at the cheapest price but rather is a vital financial support in times of illness or after an accident.
Government Health Insurance System (GKV)
Most German residents (approx. 73 million people) are members of the government health system. If your gross salary is less than 64,350 Euros per year, or 5,362 Euros per month in 2022 then membership in the GKV is mandatory. The government health insurance scheme is administered by 97 Krankenkassen and they charge the same basic rate of 14.6 % plus a possible average supplemental rate of 1.3 % of your eligible gross salary with a cap set at a maximum monthly income of 4,837 Euros (2022 figures). If you earn more than this income threshold which is set each year, you do not pay a higher insurance premium. Assuming a maximum monthly health insurance premium of 770 Euros as an employee earning at or above the income threshold you are therefore a voluntary member and your own contribution will be approximately 385 Euros with your employer paying the other 385 Euros. The general minimum period of membership with any Krankenkasse is presently 12 months. You can switch government health fund providers by giving two months’ notice after 12 months membership or if a supplemental premium is increased. As a voluntary member of the GKV you can opt out at any time with a 2-month cancellation notice if you prefer a private health plan and have been accepted by the insurance company of your choice.
The medical benefits offered in the GKV include in-patient (hospital) care as a ward patient with the doctor on duty at your nearest hospital, out-patient care with registered doctors (Kassenaerzte) and basic dental care. Please note that there is no coverage for private doctors or surgeons, a semi-private or private room in hospital, alternative/homeopathic medical care, dental subsidies beyond the very basics, and vision products for adults or any medical benefits outside of Europe. Your nonworking dependents living at your address in Germany are presently insured at no additional cost and simply need to be registered with the same Krankenkasse as yourself as the paying member.
If you choose to join the German government system, you can register with any of the 97 Krankenkassen which are non-profit associations administrating the government health scheme. Some (for instance AOK, TK, SBK, BARMER, DAK) are very large and have millions of members while others (often called BKKs) might have just a few thousand members. This does not mean that the benefits are very different, as all health insurance funds must adhere to the government regulations on the benefits they offer. The premiums may also vary somewhat due to changing regulations and it would also be optimal to research which voluntary supplemental programs the Krankenkasse offers in order to be able to participate in, for instance, a no-claims bonus, free checkups or discounts on supplemental health plans. Tip: Make sure you ask about the possibility of communicating in the English language to make your life easier, though only a limited number of Kassen actually offer this service and have English speaking staff.
You and your dependents must also become members of the government long-term nursing care scheme (Pflegepflichtversicherung). This covers a portion of the cost of meeting personal nursing needs, such as the feeding and bathing of those who become substantially disabled. Due to major reforms of the nursing care system in 2017/2019 there has been a further increase in the cost. This cost is 3.05% (or 3.4% if you have no children) of your gross salary (maximum approximately 165 Euros per month) of which your employer pays only up to 74 Euros.
THIS MAKES A MAXIMUM TOTAL FOR HEALTH AND NURSING CARE INSURANCE OF APPROXIMATELY 930 Euros per month if you are earning 4,837 Euros or more as an employee. Your employer contributes approximately 459 Euros. Your dependent spouse and children residing in Germany are included in your membership at no additional cost if you register them.
If you would like additional insurance coverage to supplement the government system benefits, you can purchase a policy from any private health insurance company, German or international; for instance, if you would like access to a private doctor and a private room in hospital, homeopathy and other alternative treatment or higher dental reimbursements. Emergency evacuation from places outside Germany, for instance from ski resorts, which are included with a private travel insurance policy should also be considered as these are not paid for by the state health insurance scheme and it would be very costly to have to pay for such benefits out of pocket.
Public health insurance funds sometimes offer supplemental insurance plans from a particular provider, offering a group rebate. Such tied plans are not always ideal as you would normally have a wider choice of benefits on the private health insurance market and you may be required to stick with your Krankenkasse longer than you would like to.
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