Introducing the German health care system to total newcomers – How to do it in a nutshell?

41 comments

1. Just a minor thing: Make clear that the „longer waiting times at the hospital“ do not refer to life threatening situations and similar. It‘s just an inconvenience not anything that might threaten your health.

   Apart from that it looks good, but I‘m by no means an expert 🙂

2. While you can switch if you earn above the threshhold you don´t have to, a lot of people I know don´t make the switch, especially since the percantage rate that you pay in public is capped at a certaint point, that means you don´t pay any more health insurance costs for any euro earned above amount x (62.500 iirc)

   Another thing is that public servants (Beamte) make up a large portion of the privatly insured

   otherwise it looks good to me

3. What’s also interesting:

   Public: bills for treatment at the doctor/hospital goes directly to the insurance company

   Private: They get the bill and have to get the money back from their insurance.

4. * Private insurance costs also depend on the level of coverage you want, not just a health risk assessment
   * Employer also pays 50% of costs for private insurance (up to the level they would have paid for public insurance)
   * I would put the earning limit as an approximate number, as it changes every year, and you don’t want your guide to go out of date so quickly
   * Con for private insurance: pre-existing conditions only covered at additional cost – or they can refuse to take you altogether if you have pre-existing conditions (or you can put that as a pro in the public insurance column, where pre-existing conditions are always included at no extra cost, and as long as you’re formally eligible they have to insure you)
   * What “extra perks” are you referring to for private insurance?
   * “Only partial treatment coverage” for public is a bit misleading. Private also has limits on treatment coverage, and they’re usually more severe than for public. Public covers all medically necessary treatments – perhaps you could write something like “non medically necessary treatments not necessarily covered”?
   * “Private insurance: for single people” – I would add “who never want to have children”. The whole “trap” aspect to private insurance is that it looks *great* to a high-earning single twenty-something. But when they get to middle age with a family, then it starts to suck, and they’re stuck.
   * “Private insurance: for people with a safe pension plan” – I would rephrase that to “people who expect high earnings even in retirement or who will not retire in Germany”
   * Public insurance costs are capped by the Beitragsbemessungsgrenze (to around 710 € / month, minus the 50% for employees) – I would add that to the row on “costs”, otherwise someone earning 200k a year might wonder whether they really have to pay 3k a month for health insurance 🙂
   * I would add that public never has deductibles or (non-trivial) co-pays, whereas private *can* have them, depending on the plan you choose
   * Con for private: “hard to go back in some cases” – I would rephase that as “most cases”. Yes, you can artificially drop your earnings below the Versicherungspflichtgrenze (at least until you’re 55), but that’s *very* hard for most people to do, as their lifestyle has already adjusted to their higher earnings.
   * Con for private: “Unpredictable rates long-term”. I think we should clearly say that rates rise more quickly than in public insurance (where they’ve been static for over a decade now vs somewhere between 3 and 6% per year for private, depending on whose numbers you trust) – the only question is *how* quickly they rise.
   * You could also add that private insurance is usually a good deal for public servants (*Beamte*)

   In your intro blurb (header of the table) you might want to include a warning like “if you’re thinking of choosing private insurance, then do your research carefully, as it can have large-scale ramifications for ther rest of your life, so don’t just rely on this table to take that decision”.

5. It’s impossible to go back from private to public in “most”, not “some” cases.

   You should stress that private rates raise reliably and a lot with age, only the amount of the raise is “unpredictable”

   Public insurance only offers free additional coverage for spouses that make 450€ or less and children if the main household earner is in public insurance, not for “household members” or unmarried “partners”.

6. One FYI, once you go on private you can’t get on public unless you go bankrupt. If you get a bad chronic disease and you’re on private, it’s going to cost you more in the long term.

7. You can usually get extra insurance on top of your public one, called Zusatzversicherung. My family has two, one for hospital stays (access to single room, for example) and one for teeth (makes a few treatments you would have to pay out of pocket cheaper). Has the benefit of public insurance, but is more tailored towards your needs without costing too much.

8. „Unpredictable rates long term“: the rates are predictable insofar as they will be most probably be higher than public insurance once you retire (at retirement age).

   Lower priority in hospitals with public insurance is misleading. You will certainly be treated with the same priority, you just don’t get all the perks like a single room or „chefarztbehandlung“.

9. Maybe add, that additional private insurance can often cover some of the perks at a reasonable rate.

10. Apart from longer waiting times it’s worth noting that some doctors don’t work with public insurance at all, only private or paying for oneself. If it’s some narrow specialist you happen to need, it may be pretty critical.

11. I’d add that even if you’re above the Private insurance threshold, you may not be “accepted” after their health assessment. Basically any conditions they might consider “chronic” (which could be anything), would render you ineligible. Loads of people don’t have a clue about that and are left disappointed. So, realistically, you’re not always eligible, even if you earn above the threshold, to manage expectations.

12. Echoing some of the other comments here, I think this is generally overly negative on public insurance. Some of the “cons” aren’t really negative points, they’re just special extras that you would get with private insurance. Given that most people are on public insurance anyway, I think it’s a bit misleading to say things like “lower priority” when really it’s just “you’ll have the same priority as everyone else”.

    In addition, I think it would be worth pointing out some general points that might be unfamiliar to people from different systems: Regardless of your insurance, *you* have to find a doctor or specialist that’s right for your problem. And you often have to ask specifically what to do or where to go next, if you need further treatment. It won’t be just handed to you.

13. Watch the clip on YouTube from the Black Forest Family about Insurance. I think it’s well explained there.

14. longer waiting time and shorter waiting times is an urban myth. if a small doctor like a family doctor has patients with appointments, he’s not going to shove those aside to serve a private patient.

    my mum works in that field for over 30 years and at no point had a private patient ever gotten favored treatment and the reason for that is that the extra financial gain is borderline nonexistent in the first place and just having private insurance does not entitle you to favored treatment.

    for hospitals i can’t say for sure, but a few people pointed out that it depends on the seriousness of the case, which I’d assume means that you are likely going to wait as well in most cases.

    private patients sure do expect to be able to skip waiting times though, so there’s that…

15. As someone working in health care and having been in both systems, I got 2cents too:

    In emergency room we don’t care about insurance.

    You can always top up your public with ‘Zusatzversicherung’ and benefit from both.

    In private it’s a lot of paperwork, especially for non germans that can be an issue. Most people get bills sent to them, then you gotta fill forms to get your money back.

    Some of them don’t give you a card (private), it’s a hassle sometimes.

    Private in a hospital can also be a disadvantage, if the higher ups have to see you before discharge that can be a several hour wait.

    In difficult cases, you get treated by higher ups no matter your insurance. In ER you get the young doctor on duty, no matter your insurance.

16. From a design perspective, I think the table is problematic, because the most crucial information isn’t *in* the table, but in the bullet points above it.

    These bullet points are excellent. Except for number 5, which seems far less important than the others (mostly since it only applies to specific groups).

17. In the first box on the right, you have “Freelancers who cannot afford public”. Here, you would at least need to add “or who are not permitted to opt into public” – freelancers who come from outside of the EU often have to get a private insurance policy of some kind (proper private or expat insurance) to get a residence permit, but this in turn disqualifies them from opting into the public system after they get the permit. Also, as I understand it, freelancers from other EU countries can opt into the public system if they enrol within a certain time window, but many miss this time window and I’ve heard from others that did tried to enrol promptly that the Krankenkassen rejected them for bureaucratic reasons (i.e. they couldn’t supply proof that they were “insured” in the public system in another EU country even though that other EU country has a tax-based rather than an insurance-based healthcare system, and thus doesn’t supply proof of insurance).

18. One more thing there is also a max limit for the deduction for Health Insurance in public one. So then it does not follows the 14-17% mark.

19. Something that might be important: private insurance has, in general, no mental health coverage.

20. If you need a private insurance because you earn too much money to stay in your parents health insurance package, but you also do not qualify for the public health system, you can re-enter your families public health insurance package without any problems after you earn less money. That’s never a problem.

21. I would not say that public GKV is suitable for only those earning less than the income threshold. It’s suitable for almost everyone. Especially families. Those earning above the threshold can choose between public or private, but to me it only makes sense for those who are single, younger, childless and earn much more than 64k per year. Make it clear that switching to private is not automatic once you earn above the threshold, is entirely voluntary, and is a one-way process for most.

    My income is somewhere around that threshold and there is no chance in hell that I would even consider private health insurance.

    Also, public dental coverage is often only very basic. Lots of insurers offer extra “on-top” dental insurance (Zahnzusatzversicherung). Glasses are also not covered, with partial coverage for children.

22. i’m a 22 year old student and pvt insurance is half the price for me, is there any reason to choose public?

    also if i chose pvt i cant go back to public?

23. well done, sir. – under special rates you should add freelance journalists; ksk is very important for them.

24. Looks like an american wrote this

25. Just to make it clear: Only about 10 % of Germans have a private insurance. It’s a niche.

    ​

    Edit: Had a wrong number before.

26. One more thing regarding “pro” under “private”

    You can get a cost participation from your employer up until what his costs would have been if you were publicly insured, maxxed at 50% of your costs.

27. I think be more clear on the type of audience this is tailored for.

    If its someone earning in the 70k range and Private insurance usually means you get better, preferential treatment because you’re willing to pay for it.

    I would be more clear about exactly whats a better offer in that situation, is it customer service, English speaking, internationally trained, shorter waiting times etc.

28. Drive to France or Denmark. German system is expensive and sucks.

29. Thanks for sharing! Looks accurate to me.

    One thing I have wondered over the years is what is the actual cost to be on private vs public. No one can seem to give me an answer (even using hypothetical figures) to show how much less it can be.

    FWIW – my wife and I are both on public and have had good luck with getting appts and waiting times over the year. But I agree that this can be a con of public vs. private for some.

30. Private …. Insuree (?) here.
    Two things to consider:
    1. Going back to public insurance is of course still possible and easy to get back into once you are losing the requirements to stay in private insurance. Like if your income drops below the threshold, you need to go back to public. These difficulties stem from stop people abusing the system where they profit from low rates while younger and swap back once they are older.

    2. There are plans which let you pay a bit more while younger to prevent you from paying super more when older. In my case it is called EBE63 by Generali. Since I swapped and even factoring in my deductible, I am able to save around 100€ per month which I can invest in a pension.

31. I’ve just moved to Germany and would like to ask something… I was accepted in public insurance, voluntary pay, but it was not so easy because I don’t have a job (quit my job in my country – my boyfriend got an offer and we moved to Berlin) and never worked in EU before. I think things went well because I have German citizenship and sent info of my bank account showing that I can pay. However, I had GAD and depression in the past, was in therapy for several years and needed medication only two times, but now I feel that things are getting worse again and need to see a psychiatrist. Can the insurance cancel my contract that they just accepted because of my mental health? They didn’t ask me anything about previous conditions.

32. Regarding waiting times, I would like some clarification. Does this refer to already being at a medical provider and waiting to be seen? Or does this refer to the time you have to wait for the next available appointment?

    I had private insurance in Germany. There were a few instances where I called a doctor’s office and was originally given weeks before the next appointment until I tell them that I had private insurance. Once they find out, they were able to schedule me for the same day.

    I can also share that when I had to get stitches and ended up going to a local hospital my private insurance did not put me ahead of everyone else. I was actually prioritized based on severity. I was told 30 minutes wait originally. Then, it changed to 1 hour. Then, 2 hours. I was finally seen 3 hours later. The doctor explained that they had several cases come in with a higher priority (example, broken arm).

33. Public vs Private waiting time different normally isn’t that bad. It’s based on urgency, so if you’re hit by a car you’re in the hospital and looked after straight away. If you have a cold then you’re likely to wait longer (as you should) because it is less urgent.

34. A minor Addition:

    – You can book additional Services such as single bedroom in the hospital or guaranteed Senior Physician treatment (Chefarztvisite) depending on your Insurance Company

    – Teeth are not covered under normal Insurance Plans, they are covered under the “Zahzusatzversicherung”

35. Everything is possible, the professionals are mostly way more decent than in Britain for example, just be ready to wait upt to one and a half year for an appointment in certain specialties.

36. Great work! As you already know, I wrote a similar plain English guide [here](https://allaboutberlin.com/guides/german-health-insurance). It has been reviewed by 5 independent brokers and got many, many rounds of revisions to reduce ambiguity. People make really important decisions based on that stuff, so precision matters.

    Props for not pushing Ottonova like other affiliate blogs. I can totally vouch for Feather, but Ottonova is… [eh](https://allaboutberlin.com/guides/ottonova-review). Lots of people promote them because they pay insanely high affiliate commissions. It’s good to have principled people giving good advice. That’s the sort of competition I’m glad to have 😉

    The cost of public health insurance is more complicated than it lets on. I made a [calculator here](https://allaboutberlin.com/guides/german-health-insurance) that gives you a more accurate price. Like you, I learned that you can’t get too technical without my audience. Calculators let you get to the point (and teach you a lot about edge cases).

    I switched to private health insurance, and it does feel like being in manual mode. This is something people don’t accurately explain. The reimbursement stuff is simple, but it’s still paperwork. However my insurance covers more stuff, is significantly cheaper, and gets me better coverage and faster treatment.

    > Higher costs long term: the more you age and/or have conditions, the higher the costs will be.

    **This is NOT true.** Once you’re in, you’re in. The prices only account for your condition *when you join*. After that, it goes up according to the costs of running the bucket of people you’re in. Even then, you can switch to a cheaper bucket if the price gets too high, as it can do if you stay with the same insurance for really long.

    Regarding brokers: I’ve talked to a dozen of them by now. Your blurb about selling more expensive products for higher commissions is not true. However, *independent brokers* are much better than *insurance agents*. I explain a bit more [here](https://allaboutberlin.com/guides/german-health-insurance#insurance-brokers) Your statement rings true for financial advisors though. **Talking to a broker is the best advice I can give anyone thinking of getting private insurance.** I’ve been researching that stuff for years by now, and there’s no way in hell I’d pick private insurance myself.

37. So that I understand this correctly, the 14.7 – 17.3% pays for half of the cost, and the other half is paid by my employer? What occurs if I lose or quit my job? Am I required to now pay for both halves or is my heath insurance dropped as it is in America?

38. Unrelated but can we see the bills as someone with health insurance. No real reason for it, I am just curious how much health insurance is paying to the doctors.

39. Little fix needs to be made: public insurance is also available for people with more than 64xxx income. Then it is called freiwillige krankenversicherung. Pro: with same costs the family is included.

40. What you explained isn’t the German Healthcare System. It is the German Health Insurance System (although part of the healthcare system).

41. Also, from what I can see, the standard of Private is alot higher in other countries where the majority of senior consultants also have a private practice/clinic on the side and you can access them if you pay higher tiers etc. Have more personal and bespoke treatment.

    Not sure if private healthcare in Germany would match that standard or if the perk is simply waiting times.