The German healthcare system

Germany is among the biggest spenders on healthcare in the European Union. Its universal, multi-payer healthcare system includes a mix of public and private health insurance. Here's everything you need to know to find your way through the German health care system and the right health insurance for you.

Medizinisch geprüft - Siegel
Reviewed content by our insurance experts

German healthcare system overview

Structure of the health care system in Germany

The Federal Ministry of Health shapes health policy at the federal level. Its responsibilities include preparing legislation and drafting administrative regulations for self-governance in the health care system. Under the Federal Ministry are a number of agencies and institutions that deal with health issues assigned to them. Examples of such institutions include the Federal Institute for Drugs and Medical Devices (BfArM) and the Paul Ehrlich Institute (PEI). The former is responsible for the approval of medicinal products. The PEI has the task of approving vaccines.

For the statutory health insurance funds, the Federal Joint Committee (G-BA) is the highest decision-making body of the joint self-administration of health insurance funds, physicians, dentists, psychotherapists and hospitals. In the form of guidelines, it determines the benefits catalog of the statutory health insurance (SHI) or German gesetzliche Krankenversicherung (GKV) for about 70 million insured persons. It is also responsible for quality assurance measures in healthcare.

What social insurances do I need?

Some insurance in Germany is compulsory. These insurances do you need or pay automatically if you live and work in Germany.

  1. The health insurance

    Health insurance has existed in Germany since 1883. There are two systems - the public health insurance and the private health insurance. The legal basis is based on the SGB V and the RVO. It is financed by contributions from insured persons (and their employers).

  2. The nursing care insurance

    This has existed since 1995 and is based on the legal foundation of the SGB XI. Like health insurance, public long-term care insurance is financed by equal contributions from employees and employers (1.525% each). Childless persons pay an additional contribution. But there is also the possibility to have private long-term care insurance.

  3. The accident insurance

    Accident insurance has been in existence since 1884 and is based on the legal foundation of SGB VII. Accident insurance is financed on a pay-as-you-go basis by the employer.

  4. The pension insurance

    Pension insurance has existed in Germany since 1889. The legal basis is the SGB VI. The pension insurance is financed on a pay-as-you-go basis by the employee and employer in equal shares (9.95% each). Further income is provided by the federal subsidy.

  5. Unemployment insurance

    This has been in existence since 1927 and is legally based on SGB III. Unemployment insurance is financed by contributions from employees and employers and, where applicable, subsidies. The contributions of the employees depend on their income.

What are the healthcare providers, associations and facilities?

In Germany, there is a framework for the organization of medical care. However, the organization and financing of the individual health services is administered by representatives of doctors, therapists, hospitals as well as health insurance companies. The supreme body here is the joint federal committee.

Is healthcare free in Germany?

In Germany most people pay into the public German health care system. This system provides free medically necessary services for every German citizen, international tourist, and expats. This system of public health is funded by employee contributions, employer contributions, and government subsidies on a scale determined by income level. If your income is higher than 69,300 euros per year you have the option to choose private health insurance.

It is legally required that every person pays into some kind of health insurance system whether it is statutory health insurance or private health insurance.

Who can access healthcare in Germany?

The German healthcare system is accessible to everyone through public health insurance. It depends on the length of residence and what kind of insurance you need. Tourists and expats need private insurance if they live long-term or work in Germany. For people with a higher salary, there is the possibility to get into the private health insurance system.

How can I access healthcare in Germany?

In Germany everybody needs to have health insurance if they live or work here long-term. So you need to register with the German authorities in your town. There you get a German social insurance number which you need for the German healthcare system. The next step for access is to register for a health insurance fund.

Depending on your job status and income you can either choose between private and public health insurance or have to be compulsorily insured with a public health insurance.

Public vs. private German health insurance

Public and private health insurance are quite different when it comes to premiums or coverage. See the differences between private and public health insurance at a glance and read what type of health insurance you are eligible for.

Public health insurance

Private health insurance


14,6% of your income

individually calculated (age, health status, coverage)


one tariff for everyone

choose the tariff that suits you


for almost everyone

well-earning employees, self- employed, civil servants, students

Family members

children and partners with no or little income are covered

everyone has his/her contract


shared room, doctor on duty

single or double room, chief physician


standard treatments

special treatments

Visual aids

only in exceptional cases

Worldwide coverage

Co-payment for meds

Comparison of premium increases in private and statutory health insurance

What are the advantages of private health insurance?

Public health insurance in Germany

All those insured by the public health insurance system jointly bear the risk of costs arising from illness. This is a cornerstone of statutory health insurance (SHI). Everyone has the same entitlement to medical care, regardless of the amount of their income and the contributions paid in with it. The respective contribution amount depends on the respective income.

What does the public German healthcare system cover?

The public German healthcare system covers the medically necessary treatments at your general practitioner, in-hospital treatment, out-patient treatments, medications (+ co-payment) and basic dental care.

So your basic medical needs are covered but if you want other needs like visual aids insured, better dental care, a chief physician treatment at the hospital or your private doctor's bills covered you would have to get private health insurance or a top-up insurance in addition.

What does public German health care cost?

In the case of the public health insurance, the members finance the expenses of the insurance with their contributions. Part of the expenditure is financed by the health fund and other sources. Thus, the amount of contributions to be paid is based on the average needs of the health insurance funds.

Publicly insured persons have to pay 14,6% of their income for public health insurance plus an additional individual premium. This additional contribution varies from public health insurance and is 1,6% on average.

As an employee you only have to pay half of it because you get a employers contribution. Self-employed persons have to pay the whole premium themselves. Civil servants also have to pay the whole amount in public health insurance themselves because they are only eligible for a employers contribution of the state if they are insured with private health insurance in most cases.

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Private health insurance in Germany

Private health insurance is an important pillar for the demographic change that is taking place in Germany. For every growing proportion of older people, there are few young people to shoulder the costs of society - not least in an item such as health insurance.

Privately insured persons, on the other hand, provide for themselves with their contributions and build up reserves for old age. Thus, in 2019, those insured in private health insurance had formed reserves in health and long-term care insurance amounting to 271.89 billion euros. A security that is indispensable for the German healthcare system. Contributions in the public health insurance system would otherwise rise immeasurably.

Who is eligible for private health insurance?

A growing number of people are opting for private health insurance. But not everyone is eligible for private health insurance. These people can get private health insurance:

What benefits do I get with private health insurance?

By choosing a private health insurance policy, you can benefit from a wide range of health insurance coverage:

There are numerous factors to consider before making your choice. To help you decide, we’ve put together a guide to different insurance types plus an explainer of the benefits of private health insurance.

What does private healthcare cost?

In private health insurance, the funded principle applies. The insurance companies calculate the premiums in advance for each individual insured person and build up reserves to keep premiums constant throughout the entire term. There is no premium increase due to illness during the insurance period.

The cost of private insurance depends on different factors. It considers your age, the coverage you want, and the conditions you already had before private insurance. So if you are young and healthy there is a higher chance to have fewer costs then older people with pre-conditions.

Can I combine public and private health insurance in Germany

If you are insured with public health insurance in Germany you can take out a private supplementary health insurance in order to get better health coverage.

There are health insurance plans for top-up-dental coverage for example or for top-up-clinic-insurance.

Outpatient & inpatient care in Germany

In Germany, medical care is divided into two areas: Outpatient and inpatient care.


Outpatient care includes all care services that are not provided by hospitals or clinics. Outpatient care is provided by all practicing and self-employed physicians, dentists and psychotherapists. Part of outpatient care are medicines, aids such as visual aids and hearing aids and the provision of remedies such as physiotherapy and occupational therapy.


Inpatient care is when a (longer) hospital stay is necessary. Patients with statutory health insurance must also pay a co-payment for room and board. A patient is treated as an inpatient in a hospital if the treatment objective cannot be achieved by other means. Admission to hospital for inpatient treatment is usually preceded by a referral from a general practitioner or an emergency referral. If full inpatient treatment is required, those with statutory health insurance have a direct legal entitlement to full inpatient treatment in an approved hospital.

What are pros and cons of the German healthcare system?

Germany has the highest spendings on health care in Europe and one of the best health care systems in the world. So there are many pros but also some cons.

  • Health care is accessible for everyone
  • You will get high-quality treatments in general
  • You can combine public and private health care through top-up insurances
  • You can choose your health care provider
  • You often have to pay for prescripted medication or medical aids in public health insurance in Germany
  • You only get the basic dental treatments and no coverage for visual aids with public health insurance
  • Not everyone can get private health insurance
  • Some pre-existing conditions can't be covered by private health insurance

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In Germany, the private health insurance income threshold for employees working in Germany is set by the Federal Ministry of Labour and Social Affairs (BMAS).

Unfortunately, we're not able to offer you private full-comprehensive health insurance, due to the information provided.

If you live in Germany and work remotely for a foreign employer, please contact us.

If you are insured in the public system in Germany, we can offer you our excellent top-up dental insurance - to cover the gaps in your public health insurance.

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FAQs about the German healthcare system

If you are eligible for private health insurance and you are in Germany on a visa or a limited permit, we can offer you the Expat Tariff up to five years.

The payment is different than in the public system. With private health insurance you pay the full tariff to us at the beginning of the month. If you are employed your employer will contribute their part to your health insurance through your salary.

ottonova is fully regulated by the BaFin and therefore fulfilling the requirements (§ 257 7Abs. 2a Satz 1 SGB V and the § 61 Abs. 5 SGB XI) for you to be able to apply for a visa with your ottonova insurance, which also includes our Expat tariff of course.

Marie-Theres Rüttiger
HIER SCHREIBT Marie-Theres Rüttiger

Marie-Theres is online editor for health and insurance topics at ottonova. She researches and writes mainly about private health insurance, (e-)health and digital innovation that make life better.

ottonova sales experts
HIER SCHREIBT ottonova sales experts

Our ottonova team of experts has over 40 years of experience in private health insurance and answers questions about it every day. What are old-age provisions and for whom does private health insurance make sense? What is the actuarial interest rate and which tariff is right for you? They know!

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