Healthcare in Germany

Willkommen in Deutschland! Where the beer flows freely, football clubs are fan-owned, and the government avoided the worst effects of the coronavirus pandemic.

If you’re soon to become one of the more than 100,000 expats living in Germany, you should prepare for an excellent – and near-compulsory – universal healthcare system.

The oldest nationalised social healthcare system in the world is also one of the best, but there are always advantages to going private.

If you’ve decided to join the 9.1 million Germans who have private health insurance, check out our list of recommended healthcare providers.

From there, you can request free quotes from whichever company suits your needs.

What’s on this page?

01 | An overview of Germany’s healthcare system
02 | Quality of healthcare in Germany
03 | How much is health insurance in Germany?
04 | Do I need private medical cover in Germany?
05 | Summary

An overview of Germany’s healthcare system

In 1883, Chancellor Otto von Bismarck established the Health Insurance Act – and well over a century later, the German government continues to offer free healthcare to all its people.

87% of people in Germany use public health insurance (Gesetzliche Krankenversicherung), which obliges you to join one of 109 insurers, known as sickness funds.

This policy covers preventative services like dental checkups and basic immunisations, in-patient and out-patient care, surgeries, general practitioner (GP) appointments, optometry, mental health services, physical therapy, rehabilitation, and maternity care.

You’ll also have the freedom to book an appointment with any registered GP, meaning you can easily switch doctors.

Another 11% of people have bought private health insurance (Private Krankenversicherung) from one of the country’s 41 providers.

But you can only go private if you fulfil one of the following criteria:

• You earn at least €64,350 (£56,100) per year
• You’re a student aged 23-30
• You’re a civil servant
• You’re self-employed

If you don’t meet any of these requirements, you’re obliged to take out public insurance.

The remaining 2% of people in Germany are either covered under special schemes for police, soldiers, and the like, or have not registered with the state.

As a British expat, you can access public healthcare in the same way as a German citizen if you started living in the country before the end of 2020.

That means you’ll have the choice to either join a public health provider (usually through your employer) or go private, if you match any of the descriptions on the list above.

You don’t have to go 100% private, either – you can get a public option, then add on private services like major dental work, which isn’t fully covered by the state.

The picturesque Neuschwanstein Castle, in Schwangau

Is healthcare free in Germany?

Yes. The universal public healthcare system is funded by the government, through taxation, and it covers almost all necessary medical treatments.

You will have to pay a statutory copayment for prescriptions, but these are limited to between €5 (£4.50) and €10 (£9).

Germany has also legislated that people with chronic diseases can’t be charged more than 1% of their annual gross income for public healthcare.

The maximum for everyone else is 2%. If you need more healthcare after reaching the limit, it’s free.

How is healthcare funded in Germany?

Healthcare in Germany is funded by the government.

The federal Ministry of Health supplies the great majority of funding, while the country’s 16 state governments supply the rest.

As ever, the government gets this money from taxes.

14.6% of your monthly gross salary will go towards funding the healthcare system, plus an extra 1.1%.

But, crucially, you split the costs 50-50 with your employer, so you’ll have to part with 7.85%, at most.

And because the maximum amount you can be taxed on each month is €4,688 (£4,200), the most you’ll ever pay monthly for public healthcare is €368 (£330) – and that covers your children, too.

Quality of healthcare in Germany

Germany has top-notch healthcare, at a lower price than many other developed nations – which is why 85% of people in Germany are satisfied with their healthcare, according to a 2015 survey.

The country came 18th in the world for healthcare in a 2018 study published in The Lancet and funded by the Bill and Melinda Gates Foundation – five places higher than the UK.

In the UK, around 5% of people have unmet health needs. In contrast, the same figure in Germany is nearly zero.

One reason for this is Germany’s short waiting times. The health service runs so smoothly that the government doesn’t record national data on the subject, so it’s left to academic studies to show exactly how quickly patients are seen.

Just 25% of people in Germany wait a month or more for specialist appointments, compared to 41% in the UK, according to the Organisation for Economic Co-operation and Development (OECD).

And a 2018 study by University of Oldenburg researchers found the average waiting time for primary care (GP or family doctor appointments) was just four days.

In contrast, NHS England patients have to wait 15 days, according to a 2019 survey of NHS England doctors.

Having eight hospital beds per 1,000 people has definitely helped Germany to slash waiting times. For context, that’s over three times better than the UK, which has just 2.5 beds per 1,000.

Germany spends £4,719 per person on healthcare, according to the OECD, nearly 50% more than the UK’s expenditure of £3,208 per person.

That figure encompasses 11.2% of Germany’s GDP, above the UK’s 9.8%, and the third-highest proportional healthcare expenditure in Europe.

Out-of-pocket spending is also low, with the average person in Germany parting with £581 per year, on average.

That means 12.3% of healthcare spending is out-of-pocket, which is low compared to OECD average of 20.5%, and the UK’s 16% figure.

However, there is evidence that private policy holders are seen up to four times quicker than public healthcare patients.

A 2017 study found that those with public insurance waited an average of 30.7 days for outpatient appointments, while privately insured people only had to wait for 7.8 days.

A spectacular sunset in Frankfurt

Healthcare in Germany after Brexit

Let’s not beat around the bush – most aspects of Brexit are confusing. Many of the rules have been murky for a long time, including how healthcare for expats in Germany will be impacted by Brexit.
The German Government has, however, recently reassured the public that British expats will continue to benefit from its healthcare system.

For temporary stays in the country, the European Health Insurance Card (EHIC) and Provisional Replacement Certificate (PEB) – issued by German health insurance companies – will continue to be valid.

Nevertheless, in some cases, it will be necessary to make healthcare contributions, in order to get full access to the healthcare system.

Plus, any pensioners who were residing in Germany before the 1 January 2021 need not worry. If, on 31 December 2020, you had an S1 form, the United Kingdom will continue to finance your healthcare, should you need long-term care. This will apply for as long as you continue to live in Germany and are covered by the regulations contained in the Withdrawal Agreement.

How much is health insurance in Germany?

Average cost of medical cover for an individual

Public health insurance will cost you a maximum of 7.85% of your salary, up to €368 (£330) per month, at most.

Private health insurance is generally the better option if you’re young and healthy, coming to as little as €150 per month – up to 59% cheaper than public insurance.

However, your premiums will be higher if you’re a bit older, and significantly more expensive if you have any pre-existing issues or chronic conditions.

If you’re over 45, it’s rarely cost-effective to buy private insurance, as it can cost as much as €1,500 per month.

Then again, if you have the money, and you want a superior level of treatment, it may still be the right option for you.

Average cost of medical cover for a family

Private insurance for a young couple and two children would cost around £424 (€473) per month, with an excess of £1,000.

Getting a higher excess is a good way to reduce costs, as long as you’re confident that you’ll be able to comfortably part with it should the worst happen.

Considering this plan would only be €105 more than the maximum amount you’d pay for public insurance, it may be worth shelling out for the best health services around.

If you’ve decided private health insurance is the one for you, check out our list of recommended healthcare providers. From there, you can request free quotes from whichever company suits your needs.

Do I need private medical cover in Germany?

As noted above, those with private health insurance often access care quicker than their publicly insured counterparts.

You’ll also be able to enjoy a private room, more extensive services (particularly in terms of dental care), and no extra payments for prescription medications – all without breaking the bank.

However, unlike Germany’s public healthcare system, private insurance won’t automatically cover your children or partner.

And though private insurance companies aren’t legally allowed to deny anyone a policy because they have a pre-existing condition, they are able to ask for a hefty premium.

You should get private cover if:

• You’re relatively young and have enough disposable income
• You need specialist care without delay
• You want a private room
• You foresee needing serious dental services

Benefits of German private health insurance

• You’ll get an outpatient appointment four times quicker, on average, than public insurance holders
• It may be cheaper if you earn a large salary
• You can enjoy more privacy
• You’ll be seen by less overburdened doctors
• You’ll have peace of mind – should anything disastrous happen, you’ll get the best care around, as quickly as possible

If you want to join the Germans who’ve bought themselves peace of mind, you can sort out cover before you go.

Just check out our list of recommended healthcare providers. From there, you can request free quotes from whichever company suits your needs.

Healthcare in Germany for long-stay foreigners

If you’re planning on staying in Germany for a year or longer, and you’re from the European Union (EU), Iceland, Liechtenstein, Norway, or Switzerland, you’ll be able to access the healthcare system on the same basis as German citizens.

If you’re not from any of those countries, you’ll need to buy German health insurance to attain a residency visa.

In this case, the rules about whether you can go private or have to stick with the public system are the same for you as they are for German nationals.

Healthcare in Germany for long-stay foreigners

If you’re planning on staying in Germany for a year or longer, and you’re from the European Union (EU), Iceland, Liechtenstein, Norway, or Switzerland, you’ll be able to access the healthcare system on the same basis as German citizens.

If you’re not from any of those countries, you’ll need to buy German health insurance to attain a residency visa.

In this case, the rules about whether you can go private or have to stick with the public system are the same for you as they are for German nationals.

Health insurance in Germany for unemployed people

If you worked in Germany for a year before you were made redundant, you should qualify for unemployment benefits, which will fund your monthly health insurance payments.

If you’re unemployed, but your parent or spouse has public insurance, you can join their policy.

You may be able to get a private health policy, in which case your payments will be based not on your salary, but on your attributes – for example, your age, physical lifestyle, and pre-existing medical conditions.

Summary

Germany got a headstart on the rest of the world when it came to public healthcare, and the country is still one of the best around – and one of the cheapest.

However, if you want the best of the best, private insurance is always available, and at reasonable prices.

If you want to guarantee the highest possible level of care for you and your family, it’s a good idea to sort out private insurance before you go.

Just check out our list of recommended healthcare providers. From there, you can request free quotes from whichever company suits your needs.