Depending on their status and income level, German nationals and residents can choose between the public or the private health insurance system. How contributions are calculated and what type of care is covered will vary based on the option.
Health Insurance in Germany
How does the healthcare system work in Germany?
The German healthcare system is based on a hybrid model. In principle, enrolment in the system is mandatory except for certain categories of workers:
Employees whose annual gross income is above a threshold defined each year (€64,350 in 2022, or US$73,475)
The latter have the choice of voluntarily joining the public health insurance system (Gesetzliche Krankenversicherung or GKV) or opting for a fully private health insurance plan (Private Krankenversicherung or PKV).
In the first case, they enjoy the guarantees and the care benefits provided by the public health system, specifically:
GP consultations with the physician chosen by each insured person from among the GKV's approved doctors (Vertragsärzte)
Consultations with a specialist, again listed under the system
Hospitalisation on physician's referral (except for emergencies) in all approved public establishments, excluding comfort costs (double or single room)
Dental care (prosthetic care is only covered at 50-60% of the reference rate for those over 18)
The option of private health insurance generally allows the insured to benefit from more extensive coverage, from care provided by private-system doctors (Privatarzt)―in private practice or in hospital―from additional dental care, or even from care excluded by the GKV (vision, alternative medicine, etc.).
How to choose health insurance in Germany: local or international?
As contributions to the public insurance system are proportional to income, the choice of private insurance is often more competitive above a certain income threshold.
The choice of a private insurer is then completely free: it can be a German insurance company as well as an international health insurer, whose guarantees and services are generally more comprehensive and adapted to the needs of expats.
> Good to know:
The private insurance option is binding, meaning that the possibility of returning to the public insurance system is then very limited.
In the event of enrolling in the public healthcare system, it may be advisable to take out additional private insurance, possibly international.