Health Insurance

There are over 100 different health insurance companies in Germany. Some of them are statutory health insurance, and others are private. These two main types of insurance differ in terms of accessibility, amount of personal contributions and benefits. In principle, you can choose your health insurance company freely - there are some limitations, but only in the case of private health insurance: Private health insurance schemes admit only certain occupational groups (civil servants, self-employed professionals, students) and high-income workers. The statutory health insurance schemes, however, accept everyone regardless of their profession and income level.

In a statutory health insurance scheme, your health insurance contributions depend on your salary, i.e. the more substantial your income, the higher your monthly dues. That means the low-income members of statutory health insurance schemes pay less. The idea behind the difference in contributions is that all the members of society bear the costs of health insurance collectively. A significant advantage of statutory health insurance is that, under certain circumstances, you can also include your spouse and children in your health insurance scheme. To learn more about the topic, read the section "Family Insurance".

In private health insurance schemes, the amount of your health insurance contributions does not depend on your income, but on your insurance risk. Every individual's insurance risk is calculated based on age, gender, pre-existing conditions and, to some extent, type of lifestyle. However, it is safe to say that in the case of private health insurance, the contributions are usually higher than in statutory health insurance schemes. That is why private patients are often treated preferentially, and, e.g. can book a doctor’s appointment quicker than others. Furthermore, privately insured individuals are usually entitled to more benefits than statutory insured individuals. However, as a member of a private health insurance scheme, initially, you must pay all the costs of doctors' visits and medications in person - your health insurance company then compensates you afterwards.

If you work in art- or media-related professions, you can apply for admission to the German Artists' Social Security Fund ("Künstlersozialkasse", a.k.a. KSK). If admitted, you pay only half of the designated insurance contributions, and the "Künstlersozialkasse" covers the remainder.

Most people in Germany are members of statutory health insurance schemes. If you are unsure which health insurance company is right for you, consult the Consumer Protection Centre ("Verbraucherzentrale"). You can also compare the different insurance policies and their benefits or shortcomings at www.krankenkassen.de. Every insurance company -whether private or statutory– offers various insurance schemes. Some of these schemes, for instance, cover the costs of glasses or alternative medicines, but others do not.

Please note: Switching from a private health insurance scheme to a statutory one is often very difficult, even impossible. Before joining a private insurance scheme, you should carefully examine if this is the right choice for you. 

You can register at a health insurance company as soon as you have decided which one to join. In principle, you can initially sign up online - the membership applications are available on the websites of different health insurance companies. You can also find a branch of your chosen health insurance company nearby and register there personally. To join a health insurance scheme, you usually need to submit a passport photo, your registration certificate and your proof of income (or a certificate of assistance from the Jobcenter or the social welfare office). After successful registration, your health insurance card will be sent to you via post. You always have to carry the card with you when you visit a doctor or a hospital.

If you are a member of a statutory health insurance scheme, under certain circumstances, you can also include your spouse and children in your health insurance without any extra fees. Including your family members in your health insurance scheme is known as family insurance ("Familienversicherung"). However, family insurance is only available as an option when your spouse and children have little or no income. Ask your health insurance company how much you can earn at the most to be able to benefit from family insurance. Try to communicate in writing so that all agreements are documented. If any problem occurs later, you will be able to introduce some proof for your possible claims.

In the case of children, furthermore, age plays a crucial role: Until the 18th birthday, children are always to be covered by their parents' statutory health insurance scheme. The coverage will be extended until the 23rd birthday if the children do not work. Young individuals may also remain insured via family insurance until their 25th birthday, when they:

• go to school,
• take part in a vocational training programme and do not earn money,
• study, or
• work voluntarily for one year (the so-called Voluntary Social Year).

The children who have a disability are covered by their parents' statutory health insurance for life.

Monthly contributions by members cover health insurance expenses. If you receive unemployment benefits or social assistance, the Employment Agency, the Jobcentre or the Social Welfare Office will take over the health insurance costs for you. If you work in a job which is subject to the deduction of social insurance contributions, your health insurance contributions will be transferred by your employer to the health insurance company directly. Half of these monthly payments are deducted from your salary, and your employer pays the other half. Usually, your job is considered to be subject to the deduction of social insurance contributions when you earn more than €538 per month. If you have a mini-job, are self-employed or study, you have to cover the costs of your health insurance personally and transfer the designated amount to your health insurance's bank account every month.

Please note: You cannot save any money by going without health insurance coverage for a period. If you do not pay your monthly dues for a while, you will have to pay the whole amount later.

Statutory health insurance companies do not pay for cosmetic surgeries, vaccinations for private overseas trips or medical superintendent treatments. In principle, dentures are only partially covered, so it is worthwhile to have a bonus booklet ("Bonusheft"). In a bonus booklet, your dentist confirms that you come by for regular check-ups (every six to twelve months). If you collect these confirmations in your bonus booklet over the years, your health insurance company will cover a more significant part of your expenses if you eventually need a denture. You can directly obtain a bonus booklet from your dentist.

When you stay in a hospital, you will be charged €10 per day, and your health insurance scheme covers the remainder of your medical expenses. 

Good to know: To avoid having to bear the costs of certain treatments yourself, you can take out supplementary insurance. Supplementary insurance is voluntary insurance that you can take out alongside your statutory health insurance. It helps to cover costs that are not covered by statutory insurance. For example, it can be helpful for better dental care, new glasses or a single room in a hospital. You choose supplementary insurance according to your needs and what matters to you so that you can have additional cover and more benefits if you require them. 

You can take out supplementary insurance with private health insurers, specialised insurance companies, or sometimes also with your statutory health insurance provider. Be sure to seek advice before taking out supplementary insurance. On Krankenkassen.de, you also have the opportunity to compare different health insurance companies and make the right choice for you.

In principle, patients have to personally pick up the medicines they have been prescribed by a doctor from a pharmacy. You can search for a pharmacy nearby online. Whether you have to pay for the medication yourself depends on several factors:

• If you are privately insured, you initially have to pay for your medications at the pharmacy. Then, as soon as you send the prescription and the receipt to your health insurance company, you must, in principle, receive a full refund.

• If you are a member of a statutory health insurance scheme, the amount of payment depends on whether the medicine in question is a prescription medicine. Prescription medicines are those that you can only obtain if a doctor prescribes them for you, i.e., you cannot buy them without a prescription. There used to be a pink prescription paper for prescription medicines. The e-prescription has been available since July 2023, and all pink prescriptions have been replaced by the e-prescription since January 2024, which has been announced as mandatory. With the e-prescription, it has become easier to apply for a follow-up prescription, as you no longer have to go to the doctor's surgery. The e-prescription can be redeemed either with the electronic health card (eGK), the app or a paper printout. You can find more information about the e-prescription and the app on www.das-e-rezept-fuer-deutschland.de. 

  For non-prescription medications, you will be handed a green paper. In principle, you have to personally pay the full costs of any non-prescription medication you require. In the case of prescription medications, you have to contribute partly, which means you must pay a small part of the price to the pharmacy. But your share of the costs must not be higher than €10 per medicine. Prescribed medicines for children and adolescents are usually fully covered, i.e. you do not have to pay anything at the pharmacy.

Please note: There is a limit to personal contributions when it comes to medication costs. If you have already spent more than 2% of your annual gross income on medication and in-patient treatments, you will be exempted from further charges for the remainder of the year. If you are chronically ill and in need of multiple medications, you will be exempted from personal contributions once you spend 1% of your annual gross income on medications. 

Once you reach the limit (1% or 2% of your annual gross income), you can submit an application to your health insurance company to demand exemption from any additional payments for medications for the rest of the year. To do this, you must send the health insurance company all the relevant payment receipts and your proof of income. After reviewing the documents, your health insurance company will send you an exemption certificate. By showing this certificate to pharmacy staff, you will be released from the obligation to contribute personally. The respective exemption is valid for the remainder of the current year.

In principle, health insurance companies also cover psychiatric treatment costs. Members of a statutory health insurance scheme, however, can only choose therapists who are approved by the statutory health insurance ("Kassenzugelassene Therapeuten"). When looking for a suitable therapy, pay attention to the keyword "Kassenzulassung ("health insurance admission"). In order to be able to start therapy, a doctor or a psychotherapist must first make a so-called "suspected diagnosis". This diagnosis will then be sent to your health insurance company, which, after evaluation, will accept or reject the therapy application.

Important: If you are unable to find a therapy service with a therapist authorised by the health insurance funds in Germany, there still may be a way to get help, i.e. the so-called ‘cost reimbursement procedure’ (“Kostenerstattungsverfahren”). In this procedure, you look for a therapist yourself, regardless of whether they are authorised by your health insurance provider or not. You must first pay for the treatment yourself, but you can then submit the invoice to your health insurance provider and apply for reimbursement. The procedure, however, can be somewhat complicated as you have to submit certain documents and evidence. It is, therefore, vital to get well-informed beforehand.

Good to know: Psychiatric treatment means that you will receive medication from a specialised psychiatrist. This medication can help to alleviate psychological symptoms such as depression or anxiety disorders. Psychotherapeutic treatment, on the other hand, consists of regular counselling sessions with a therapist. In these sessions, you learn to better understand your thoughts and feelings and to deal better with difficult situations. Sometimes, it makes sense to combine both treatments in order to receive the best possible support. You can find more information on mental health in our chapter ‘Mental health’.

Your health insurance will reimburse various therapeutic treatments prescribed by a doctor. These include, e.g. physiotherapy, occupational therapy, and speech therapy. Specific foot treatments and physical therapies can also be reimbursed. For the costs to be covered, the doctor must prescribe the relevant treatment, and the prescription must be authorised by the health insurance company. In some cases, you will have to pay a small part of the costs yourself. Please note, therefore, that you should keep your bill and other proof of payment. You can find out more about the reimbursement of costs for therapeutic products and treatments on the Federal Ministry of Health and Verbraucherzentrale.de.

Health insurance covers the costs of a range of medically necessary aids. These include:

• Glasses and contact lenses: For certain visual defects and from a certain age, or for certain medical conditions.
• Hearing aids: For proven and medically confirmed hearing loss.
• Wheelchairs and walking aids: For people who are dependent on assistance when walking due to illness or disability.
• Prostheses and orthoses: Replacement of body parts or aids to support limbs.
• Incontinence products: Nappies and other products for the treatment of incontinence.
• Oxygen equipment: For patients with respiratory problems who require additional oxygen.
• Hospital and care beds: If required at home or in a care home.

In order for the costs to be covered, doctors must confirm the need for the aid and issue a prescription. This must then be authorised by the health insurance company. In some cases, you will have to bear part of the costs yourself. You should, therefore, keep your bills and other proof of payment. You can find more information about the reimbursement of medical aids on the Federal Ministry of Health and Verbraucherzentrale.de.

Since January 2021, it has become much easier to switch to another health insurance company. All you have to do is choose a new health insurance company and register there. You do not need to terminate your old health insurance contract first. However, this only applies if you switch from one statutory health insurance to another. If you want to switch to private insurance or move abroad, you have to cancel your old health insurance.

In principle, you can only change your health insurance company after 12 months of membership. If you start a job with a new employer, however, you can also switch your health insurance company even if your current health insurance company has covered you for less than 12 months.

If your health insurance company suddenly demands more money from you, you are entitled to a so-called "special right of termination" ("Sonderkündigungsrecht"), which means you can cancel your contract before 12 months of membership and find a new health insurance scheme.

It is possible to switch from private health insurance (PKV) to statutory health insurance (GKV), but the details depend on your situation. If you are younger than 55 and work as an employee, you can switch to statutory health insurance if your income falls below the compulsory insurance threshold of €66,600 gross per year (as of 2024). 

You can also switch via family insurance if your partner is insured in the statutory health insurance scheme or if you are unemployed and receive Unemployment Benefit I. After the age of 55, switching is only possible in exceptional cases. Make sure you are well informed before making a decision. Further information on switching from private to statutory health insurance can be found on Verbraucherzentrale.

When you have statutory health insurance in Germany, it means, in principle, that you are insured in Germany. However, insurance coverage is often also available abroad, for instance, in EU countries, the European Economic Area (EEA) and Switzerland. If you are travelling outside the EU, you should check whether you need additional international health insurance. If you have any questions about insurance coverage abroad, it is best to contact your health insurance company directly.

Good to know: There are special agreements with countries such as Turkey that regulate your insurance coverage. These agreements ensure that you receive similar benefits as in Germany in specific countries. You can find more information on the German-Turkish social security agreements here.

When a health insurance company rejects your membership application or refuses to pay for a doctor's visit or medications, you can contact the Independent Patient Counselling (“Unabhängige Patientenberatung”) to complain. You will not be charged for the call or the counselling service. The staff can provide you with advice in German, Arabic, Turkish and Russian. If you are a member of a statutory insurance scheme, you can also file your complaint with the Regulatory authorities of statutory health insurance.