Public or private healthcare in Germany - what is the right fit?

As an expatriate moving to Germany, one of the crucial decisions you'll face is choosing between private and public health insurance. This decision can significantly impact both your healthcare access and financial situation. In this article, we'll explore the advantages and disadvantages of each option to assist you in making an informed choice.

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  • There are two kinds of health insurance in Germany - public or private
  • If you are employed and your salary is under the annual pay threshold of €69,300, you will automatically be registered for public health insurance
  • To enter the private insurance system as an employee you have to earn at least 69,300 per year
  • If you are self-employed, you are also eligible for private insurance
  • Health insurance for expatriates represents a form of private medical coverage. It serves as an interim measure for individuals relocating to Germany, offering superior protection compared to travel insurance
Learn more about the expat tariff

All residents of Germany must have health insurance. There are two kinds of health insurance – public or private, known as the gesetzliche Krankenversicherung, and private, known as private Krankenversicherung. In short, these two are referred to as “GKV” and “PKV.” There are advantages and disadvantages related to each, so you’ll have to do a little research to find out what makes the most sense for you and your situation. Read on for advice on how to select the right healthcare for you.

First, you should consider if you’d like to be insured publicly or privately. Not everyone is always eligible for private insurance, so before setting your heart on the PKV, you should find out whether you’re a good fit. There are a few questions to consider when deciding if you’d like to be insured by a private insurer or a public insurer.

Public Or Private Insurance All residents of Germany must have health insurance

Public health insurance coverage

The public health insurance system – also known as statutory health insurance or gesetzliche Krankenversicherung (GKV) in German – offers a basic, universal standard of healthcare to everyone resident in Germany.

If you are employed and your salary is under the annual pay threshold (Jahresarbeitsentgeltgrenze) of €69,300 per year, you will automatically be registered for public health insurance. The higher your salary, the higher your premiums – but your coverage will remain unchanged.

There are downsides to the public system. For one, the scope of coverage is basically fixed. Although some public insurance providers (of which there are 95 in 2024) offer slightly different coverage, the treatments covered generally follow the minimum requirements of the German Social Code. Lawmakers can also amend this at any time, so your level of cover is not guaranteed to last forever.

The public system also covers fewer treatments, especially when it comes to dental care.
To have more coverage for dental treatment, it may be worthwhile to purchase a supplemental dental insurance.

Private health insurance providers – Of the 42 ordinary member companies, 36 offer comprehensive health insurance – have far greater scope to tailor their coverage and offer premium treatments and services.

If you are in good health and have no family history of serious illness, or if you are simply looking for a more affordable option, you can choose a more basic level of coverage.

On the other hand, you can also choose a full-coverage policy to cover all eventualities. Such policies are naturally pricier but offer peace of mind, leaving you safe in the knowledge you have done everything possible to safeguard your health.

Plus, private health insurance coverage is guaranteed by contractual agreement: Your provider can never curtail or change this coverage.

ottonova offers a range of comprehensive health insurance policies tailored to different needs – including a special rate for expats.

What's included in private health insurance?

In private health insurance should be included in any case reimburse all costs that include medically necessary treatment, but certainly, go beyond that. That means there should be no problem getting reimbursements for dental prostheses or visual aids such as glasses and contact lenses. But also the basic billing of the doctor at least at 3.5 times the fee schedule rate, as well as the assumption of alternative healing methods such as alternative practitioners, treatment by a chief physician or a single or double room in the hospital.

What are the advantages of private compared to public health insurance?

By the way, you can join private health insurance despite illness - your contribution will then be individualized according to the risk (risk surcharge). Depending on the diagnosis, private health insurance also has the right to refuse membership.

More information about Private health insurance in Germany

What's included?

Do you qualify for private health insurance?

To enter the private insurance system, the German government decides on a minimum Jahresarbeitentgeltgrenze (JAEG) – an annual income threshold – 69,300. This is adjusted for inflation every year, which means you need to check the current JAEG before signing up for private insurance. If you earn less than this amount, you do not qualify for private insurance and must choose a public insurance provider.
If you are married to your partner or if your relationship is recognized as a domestic partnership, your provider can also cover your partner, as long as they do not earn income or earn below a certain threshold.

Are you successfully self-employed?

If you are self-employed, you are also eligible for private insurance.

In addition, there are special types of plans for different jobs or life situations. For example, most Beamte, or civil servants, are privately insured. As a result, most private insurance companies have a special rate just for them. Students also receive a discounted rate with most private plans or, if you’re self-employed, there might be a special price offered by private insurance providers. It’s important to understand what you’re eligible for before choosing private or public health insurance.

What do I pay in public health insurance?

In the statutory health insurance, your contribution depends on your salary and is calculated as a percentage of it. The amount of your statutory health insurance contribution is determined by the legislator with the general contribution rate – currently this is 14,6 %. The reduced contribution rate is 14%, but then you don't have a daily sickness benefit.

In addition, there is the additional contribution, which each health insurance fund determines itself. This is the only difference between public health insurance providers.

This is 1.70% on average. Thus, legally insured persons in Germany pay an average statutory health insurance contribution of 16,2%.

The general contribution rate of 14,6% is applied up to the contribution assessment ceiling. Once this salary limit is reached, insured persons pay the maximum contribution (including the respective supplementary contributions of the health insurance fund) and the contributions no longer increase with increasing salary. This limit is €62,100 per year in 2023.

The contribution ceiling is not to be confused with the annual earrings ceiling. This is the limit from where employees can take out private health insurance.

For those earning above the contribution limit for statutory health insurance (62,100 Euro per year), your insurance costs will be at the maximum rate possible. On average this is €1,050.53 without children and €1,019.48with children. (For employees the employer pays the half of the contribution.)

If you earn above the annual earrings ceiling and are single with no dependents, this isn’t the most financially advantageous choice.

What do I pay in private health insurance?

On the other hand, the private system is designed to ensure that your monthly payments cover only your medical costs. Your monthly rates in the private system are primarily based on your age at the time that you sign the contract. Then, any pre-existing conditions may result in a small surcharge. For example, all 33-year-olds would pay the same base rate, but a health condition like asthma might result in a small percentage increase.

An 32 years old employee would pay €295 in our Business Class tariff, a self-employed person €604 in the same tariff as they don't have an employer that pays the half of the contribution.

For expats that stay only for a maximum of 5 years in Germany, we have created a special expat tariff. Check out our ottonova expat tariff with special expat rates!

Is private health insurance an option for you?

We are happy to advise you regarding your tariff options and the possibilities to save costs.

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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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Which tariff options do you have with ottonova?

Discover our special expat tariff

How long do you plan on staying in Germany?

Young, healthy well-earning professionals pay into the public insurance system, where funds are collected and used to finance the rest of the insured persons. While this system is designed to benefit the majority of Germans, those who won’t be in Germany for a long time will most likely see no real return on their investment.
If you are planning on a short-term stay in Germany, selecting a private plan will save you money while offering you better coverage.

What matters to you in an insurance provider?

In the public system, insurance coverage is very similar between the providers. The price will be the same for each company and coverage is mandated according to government regulations, so the differences are very small. But in the private system, the providers are able to offer different prices, perks and coverage. So consider what aspects are the most important for you. For example, is vision a main concern?
Public insurance offers no additional coverage or payments toward glasses, contacts or visual aids, while private insurance providers have various levels of coverage, depending on the company and their available plans.Most dental treatments are also not included in public insurance and other exceptions apply as well.
Or if digital services are important to you and your lifestyle, research the available options. Some insurance providers offer an app for your smartphone to help you manage your health documents or other digital services, like telemedicine, which can make your life easier.

Do you have children? Do you plan on having children?

Historically speaking, health insurance for children costs more in the private health insurance system. Public insurance premiums are only paid by working parents, so if you’re working, but your partner is at home raising your four children, you’ll only pay one premium to cover your family of six. In the private system, all insured persons must pay a premium, including children.
However, for the cost of your healthcare, privately insured persons may also receive better coverage and preferential treatment by most physicians. Everyone’s priorities are different, so consider carefully when choosing.
Additionally, public insurance providers generally do not cover the costs for extra treatments associated with raising children like in-vitro fertilization, childbirth classes, and others. But many private insurance companies may offer premium coverage options for these situations.

If you’d like to get a sense for which option would work better for you, use our special tool, the Life Calculator. When deciding on a health insurance company, consider factors like your current income, your relationship status and children, or planned children, and what kind of coverage is most important to you.

Are there other options than private or public health insurance?

Insurance from other EU countries

If you are from a different EU country you have the option to use your European Health Insurance Card (EHIC) in Germany. That means even when you get health insurance in Germany, your insurance in the other EU Country will pay for it.

Attention this only works when:

you stay in Germany temporarily, your EHIC covers you then. Extra health insurance is not necessary.

If you are an Erasmus student from another EU country, then your EHIC also covers you for your entire degree. 

When you start working in Germany, your  EHIC does not cover you anymore. If your payment is more than 520€ you need to get a german health insurance

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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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