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This article gives an introduction to health insurance in Germany. The information is targetted primarily for English-speaking expatriates living in the country.

Health insurance is obligatory for everyone residing in Germany who is employed full-time by a company. The company pays half of the insurance contributions, the other half comes out of the employee's salary. The employee's half usually totals around 10% of their gross salary. When starting work with a company usually the employee won't have to worry too much about how the system works. The company will automatically sign them up with an insurance company and the contributions automatically deducted from the salary. Sometimes the employee may be asked if they have a preferred insurance company. It is recommended to simply go with one of the big names, like "AOK" or "TKK". They are all pretty similar.

Health insurance has been obligatory for everybody in Germany, including the self-employed, since 2007. Medical treatment can be hugely expensive.

There are two types of health insurance in Germany. These are the "public" and "private" systems. This system often causes considerable confusion. Full details are given below.

[edit]Public Health insurance
If you are employed in Germany and you are earning less than the threshold (Versicherungspflichtgrenze) of EUR 48,600.- gross per year (EUR 4,050 gross per month), you are automatically and compulsorily insured in a public health insurance scheme. This is also true for students at a state or state-approved university in Germany and certainly for interns too. This also means that your employer does not have the option of accepting an expat insurance scheme (see below). You are only exempt from mandatory public health insurance as an employee working in Germany if you are seconded ( German: "entsendet") by a company which has its HQ in a member state of the EEA (= European Economic Area; including all of the EU plus Iceland, Liechtenstein and Norway) or in certain contracting states (among them being Canada and Quebec, PR China, Israel, Japan and the USA; for the complete list please check with DVKA.de). "Secondment" exists if the employee goes abroad for work purposes on instructions from his/her employer and the work is time-limited in advance, inter alia because of the particularity of employment or by contract. Unfortunately I found no definition of the maximum acceptable "time-limit". The compulsory membership in German public health insurance while working here is protected by European Regulation No. EEC 1408/71, among others. It is furthermore laid out in the German SGB (=Sozialgesetzbuch), 5th book, § 257

All in all, what this means is: if you are employed by a German company or any other foreign company in Germany and you earn less than EUR 4,050 gross salary per month, you are f...ed, I mean, you are a mandatory member of the public German health insurance system. You pay half plus 0.9% and your employer pays roughly half of the insurance premium too. As of 2009, the premium has been standardised for all public health insurance companies at 15.5% of gross salary up to the threshold (Beitragsbemessungsgrenze) of EUR 44,100. This will drop to 14.9% from July 2009. Although they more or less offer the same services, it's still worth comparing.

Public health insurance is great, however, if you earn only a small amount (because you get a lot of insurance for a low sum of money) or if you are married and have a spouse and children with you - because they are covered by the public health insurance too (this may change in the near future, though, according to the latest political plans). But beware: since a lot of services from the public health insurance system have been downgraded or cancelled in recent years, you might want to consider getting additional private insurance to cover some services like 1- or 2-bed rooms in hospital, Chefarzt-Betreuung (operation and treatment by the head doctor of the hospital) or full dental services/replacement etc. Even then you might still have to pay some extra if you have a very complicated illness and you try to get the most-respected expert in Germany to treat you, because in these cases treatment is only covered up to a certain limit. If you want to be sure about having enough funds in the event of severe illness to get the best possible treatment, other insurance types (Dread Disease offered by Canada Life or Scandia for instance) are a possibility.

[edit]Private Health Insurance
Now if you are earning more than the threshold of EUR 4,050 gross salary per month, you can elect to leave the public health insurance and get a private health insurance while employed in Germany. Here the comparison between different offers is a bit more complicated and you may want to get the advice of a professional advisor or broker. I have seen some attempts to compare different quotations from different private health insurances, but you cannot just take one quote with the price XYZ and another one with ABC to be paid per month and say that the cheaper one is the better choice - it may vary strongly regarding the insured coverage. The best way to start a comparison is to ask private insurers to send you a quotation "Analog GKV", meaning with the same coverage as the public health insurance. Then you can compare the insurance quotations on an even footing. You can also lower your premium by using "excess options (Selbstbeteiligung)". This means that you are willing to pay for instance the first 300.- EUR every year out of your own pocket and you will receive reimbursement only for the costs in excess of that 300.- EUR. Since most of the private insurances offer to repay you 1 or 2 monthly premiums after one year of not having using the insurance at all, you should add this repayment amount to the excess-option-amount agreed in your contract and then you know at what medical cost per year it makes economical sense to hand in all invoices to the insurer during any given year. The highest excess option I know of is 2.400.- EUR per year; standard is between 300 and 750 EUR per year. If you take a very high excess option, you will achieve a similar coverage like with most expat health insurances: you are covered for all serious medical problems, but you will pay for all prescriptions and ordinary consultations of a doctor out of pocket. So, a Private Health insurance can be much lower in monthly premium than a Public health insurance while providing you with more and better coverage. Still: if you are married with children and your spouse does not earn any income here in Germany, public insurance covering all family members with your own premium can be the better deal. And if you want to have a better coverage than Public Insurance offers, you can always get an add-on insurance from private insurance companies, where you cover certain medical issues that you deem to be important for you.

[edit]Use of Foreign Health Insurance.

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It appears that people who earn less that 4,050 EUR are f..cked. You are, according to the article -a mandatory member of the German Health System.

The article says that the German Health System has downgraded or cancelled some of its treatments so it may be a good idea for a person to GET PRIVATE INSURANCE.

Usually I don't response to the posts of above poster.

But his conclusions are nonsense².
And I can swear that he has not the faintest idea about how our system works.

Anyone can be a member of the mandatory health insurance, offered by nearly 300 companies. (I am - my wife, without own income, is too, as is my mother, who gets pensions. Same with BIL, who is a CEO in one of Europe's largest insurance groups - SIL and their children are members due his his membership).

Pribate insurance doesn't cover spooses (no matter of same sex, married or unmarried) and children; the mandatory insurances do.

Mandatory insurance covers e.g. acupuncture, a couple of alternative medical treatments (depending on company); all cover 'cures' (as prevention and/or after operations) = three weeks (at least) in sanatoriums/clinics in spa towns ...

I admit that in some doctor's practises you get an appointment faster when private assured.
This has nothing to do, however, with 'emergency room' treatment or any other of (yearly) "check-ups" etc

cyclo, I'm all in favor of health care reform. I'm all in favor of universal coverage for at least basic and catastrophic services. The reason that we're in this hell-of-a-mess that we're in with the ever increasing cost of health care is that we continue to provide additional entitlement services that aren't basic or catastrophic with no way to pay for them.

For the House to come out with another plan that INCREASES entitlement benefits without a clear, definitive way to pay for them AND does not include a demonstration that it helps SOLVE the problem of too many services for too few dollars is outrageous (and, yes, I'm outraged and have let my representative know it). This isn't health care reform. It bureaucracy as usual and IT MUST STOP!

I don't see where your lengthy copy & paste contradicts anything Walter said in the post you're responding to. Where does your copied and pasted article contradict that the waiting time in German emergency room is seconds, and that hip replacements get done immediately in urgent cases, and within three weeks in non-urgent cases?

Back in the election campaign, the healthcare plans of Edwards, Clinton, and Obama all intended to finance healthcare reform by letting the Bush tax cuts expire. If that's still what Democrats intend to do -- and I heard nothing to the contrary yet -- they don't really need a plan, because Bush's tax cuts will expire automatically. Those taxes on soda bottles etc. are a sideshow. I don't understand why MSNBC is using them to paint a picture of confusion.

Thomas is correct that this plan will be paid for with higher taxes. It isn't politically palatable to talk about this more than necessary, b/c the Republicans use this topic to demonize the Democrats; so the discussion is limited by the nature of politics.

Cycloptichorn

Perhaps that was their expressed intention, however an analysis (CBO) of the current Democrat proposal for health care "reform" rather clearly shows that the expiration of those tax cuts will hardly make a dent in the real costs of the new entitlements.

Moreover most of the assertions about the "economies" that will be achieved through top-down management by government brueaucracies and our esteemed Congress are both laughable and obviously in contradiction to the accumulated facts concerning existing government health progrrams.

Oh ! I see ! The Democrats recognize that additional; tax increases will be required to pay for it all, but they are unable to acknowledge it, or address the side efffects of such taxes, because those nasty Republicans will criticize them for it.

If Herr Hilteler thinks I am going to "goosestep" over to the Mengele Clinic in Berlin to get medical care when I go to Berlin, he is nuts.

Of course, you get an appointment faster from a private doctor.

In the USA when you are suffering from a need for a new hip, you can have it done in a week.

Not in Chermany!!!!

What does writing some words in CAPITALS add to your argument?

I believe that shows emphasis.

are you from france?

I knew that. I just couldn't see why the emphasis was needed.



Why do you ask? Depends what you mean by "from". I am British, born in Bristol, I lived in Collioure in France for some years, and now I live in L'Hospitalet de Llobregat which is in Catalunya, which is either in or near Spain depending on your point of view.

i knew that. (where you was from and all)

dint think much of your post was needed either...

see the connection?

back to healthcare, mebbe.

Precisely. We cannot afford the entitlement programs we have today. We have no way to pay for additional programs that enhance existing programs but do nothing to reduce the cost of health care overall. Health care reform must do three things.

Provide basic and catastrophic coverage to all Americans
Be affordable
Reduce the overall cost of health care.

As the baby boomers approach retirement age and become recipients rather than payers, we must look at coverages that can be given to all but supported by a reduced work force.

Rockhead, perhaps you could go pound some sand?

i'd much rather see this (healthcare) debated, i have a personal stake in it.

cyclo, I've watched/read Obama's proposal thoroughly. Can you show me where in there he suggests increasing federal subsidies to current Medicare recipients? I simply can't imagine any reason other than politics as usual that the House would consider increasing benefits that compound the problems we have. Nor can I fathom why they would consider releasing a plan that doesn't include a cost analysis and think that non-Republicans aren't going to scream. Somebody in Washington isn't listening. The deficit/economy is now the number one concern of Americans.

I beg your pardon? The Bush tax cuts were worth $300 billion a year. Universal healthcare costs, very roughly, between $100 billion and $200 billion a year, depending on the particular plan you're talking about. How does the expiration of the tax cuts not make a dent?

Your estimate of revenue from the Bush tax cuts is out of date in this economy. Furthermore it ignores the known effects of such taxes on economic activity.

Medicare and medicaid currently cost more than $200 Billion.

great little piece in the current issue in Vanity Fair on this precisely.