The German health care system is split into two systems: Public and Private. About 90% of the population is insured in public health care with the remaining 10% in the private system. Whether you choose to be insured in the public or private system depends on a number of factors and is a very personal decision.

Public Health Care

The Public Health System is operated by the government who decides what benefits will be covered and how much those insured in the system will pay for it. It is a social system and an individual’s financial contribution to their public medical care is directly determined by the amount they earn: The more a person earns, the more they will pay for their medical care. In 2018, individuals insured in the public system will contribute 14.6% of their gross monthly income to public medical care. This contribution, which is shared equally between employer and employee, is capped at a monthly income of Euro 4,425.00.

In addition to this fixed contribution, public health insurance bodies are allowed to levy an additional surcharge to meet ever increasing medical costs. In 2018 it is expected that most public health care bodies will on average charge an additional 1.0% thus increasing the total contribution for medical care to 15.6%. This surcharge is carried entirely by the employee with no employer subsidy.

As well as medical insurance, all adults must contribute to the compulsory long term nursing care insurance (Pflegepflichtversicherung) which helps to cover costs should an illness or accident leave an individual requiring qualified home-help or permanent institutionalised care. In the public system, individuals contribute 2.55% of their gross monthly income to long term nursing care, this too is capped at a monthly income of Euro 4,425.00 and shared equally between employer and employee.

Taking all this into consideration, in 2018 those insured in the public system and earning Euro 4,425.00 or more will contribute a total of Euro 690.30 per month for medical care and HAHNENBERGER Risk & Service Management GmbH Pet Health Care Insurance Euro 112.94 for compulsory long term nursing care, so a total of Euro 803.14, with their employer reimbursing some Euro 379.44.

The public health system continues to provide “family insurance” by which a traditional family unit comprising of a single breadwinner, non-working spouse and minors in full-time education may be insured as a group financed solely by the monthly contribution paid by the employed family member.

Private Health Care

The Private Health System is operated by insurance companies who offer various insurance plans with different levels of benefits for which individuals pay an insurance premium. The insurance premium is based upon the level of benefits; the benefits provided, the age of the individual to be insured and their medical history. An individual’s income has no relevance for insurance premium calculations however, to be insured in the private system an individual must have a certain income level, currently a minimum of Euro 4,950.00 per month/Euro 59,400.00 annually before tax. Unlike in the public system, premium rates in the private health care system are not capped and will continue to increase over time. Furthermore, the private health care system offers no “family insurance”; each individual who has a private health care plan must pay a premium based on their entry age, chosen insurance plan and medical history. An individual who is privately insured and has a partner and children at home must pay a premium rate for themselves and each family member.

Changing Between Public & Private Health Care Insurance

To be able to enter the private health insurance system, an employee must earn above the current threshold limit of Euro 59,400.00 p.a. before tax. All those who earn below the threshold have no choice and must arrange public health insurance, they are what is known as “compulsory members” of the public health care system. Those who earn above the threshold but choose to remain in the public system are known as “voluntary members” of the public system.

If you are insured in the public system voluntarily, you may change to the private health system at any time. Once you enter the private system, returning to the public system is HAHNENBERGER Risk & Service Management GmbH Pet Health Care Insurance very difficult, generally impossible, and for this reason it is important to consider carefully the move to private health care.

Those insured in the private system may only return to the public system if their earned income falls below the current threshold limit. If that happens, “compulsory membership” in the public health system takes effect and the individual must leave the private system. Note; having no income at all will not necessarily award the compulsory status needed to reenter the public health system. An individual who is privately insured and is made redundant or gives notice must remain insured in the private system and pay their insurance premium. Only if they receive unemployment benefits can a return to the public system be made possible, a decision which is made by the German authorities. In accordance with German law, it is not possible for a privately insured individual of 55 years of age or more to return to the public system, irrespective of income or personal situation.

Please note : If you are entering employment in Germany for the first time or are returning to work here after a longer period abroad and are earning in excess of the current threshold limit, you will not automatically be entitled to public health insurance unless you can demonstrate a right to “voluntary public health care membership”. This right is granted to EU citizens who have had similar, mandatory health care in another European member state prior to their transition to local employment in Germany and to non-EU citizens commencing work in Germany for the very first time.

Public or Private Health Care, What’s Right for Me?

There are a number of factors which need to be considered before deciding whether to arrange public or private health care. Ultimately, your level of income will decide whether you are eligible for private health insurance but there are other factors which need to be carefully considered before making a final decision. Following are some of the benefits and advantages of private and public health care. There is no right or wrong, it is your decision whether you decide to choose public or private health care.

Public Health Care:

  • Family insurance: The breadwinner pays their monthly contribution and all other family members are automatically covered for free
  • Income based contributions; the more you earn, the more you pay. Those financially less able will pay lower contributions yet receive the same health care as those on higher incomes
  • Contributions are capped at a maximum amount
  • Medical history and pre-existing conditions are irrelevant
  • Bureaucratic and hampered by government cuts and budgets
  • Treatment is decided by costs and budgets
  • Standard health programmes determined by those operating the system
  • Certain procedures, treatments and pharmaceutical products are not insured
  • Alternative and psychotherapeutic medicine excluded
  • Treatment by private doctors is not permitted
  • Long waiting lists for specialist consultations & treatments
  • Limited dental cover for adults
  • Financial surcharges for prescriptions, medical aids, consultations
  • No financial reserves built to offset ever increasing medical costs

If you choose public health care it is possible to purchase top-up private health care to close benefit gaps, e.g. supplementary dental and hospital care.

Private Health Care:

  • Monthly premiums based upon benefits provided, age and medical history of insured. Income is irrelevant.
  • Tailor made plans to meet your needs
  • Treatment by private doctors, dentists, consultants and specialists
  • Alternative medical treatments and psychotherapeutic medicine covered
  • Free choice of hospitals with treatment by a senior consultant or professor and accommodation in a single or double room
  • Financial rewards for limiting your medical costs
  • Minimal or no waiting lists
  • System is operated by insurance companies
  • Reserves are created to meet increasing medical costs
  • There is no maximum premium level
  • Medical history & pre-existing conditions will be considered during application process and may result in surcharges or rejection
  • Each family member must be insured separately
  • Insurance contributions continue even if you are not in active employment, e.g. on maternity/parental leave, sabbatical, unemployment etc.
  • Returning to the public system is virtually impossible