public health insurance in Germany

Public Health Insurance in Germany

Germany has an excellent public (statutory) healthcare system, whereby all residents can access comprehensive medical care. The public healthcare system is paid for by a combination of employer and employee insurance contributions, but it is also heavily subsidized by the German government to ensure that those out of work or on a low wage remain covered and are able to get necessary medical treatment as well. It is mandatory by law for every German resident to have public health insurance (unless they are part of the small percentage of the population with private coverage).

This article will explain how the public healthcare system in Germany works mentioning the benefits of the country’s popular, award-winning provider, Techniker Krankenkasse (TK).

Public health insurance in Germany

Germany's state-run public healthcare system is funded by employers and employees through social security insurance contributions and is also subsidized by the government, so that those on pensions and unemployment benefits can still access healthcare. The vast majority of the population are enrolled in the public healthcare insurance system or Gesetzliche Krankenversicherung (GKV), with the other 10% choosing/having access to private healthcare insurance or Private Krankenversicherung (PKV).

You can only opt out of the public healthcare system if you qualify for one of a few criteria, such as being self-employed, earning over a €60,750 year, being a student aged 23-29 (in some cases), or working as a civil servant. Once somebody has opted out of the public healthcare system, it's not that easy to get back into it, although it is possible.

How much does public health insurance cost in Germany?

In Germany, all employed workers pay a statutory healthcare insurance contribution as part of their social security contribution. This is normally 7.3% of their gross paycheck, and this is typically matched by the employer who pays a further 7.3%. totaling 14.6%. This amount rises to just over 8% for higher earners but is capped at €683 a month. A new law in 2019 allows healthcare insurers to charge an additional contribution of up to 0.9%, which is again shared by both employer and employee. Employers and employees also share a 3.05% nursing care insurance contribution, intended to help fund care in later life.

Student public healthcare costs

Students are able to pay a set and discounted amount for healthcare at €106.93 a month (for students aged 23 to 30). This fee is related to long term care and it includes a contribution to nursing costs. However, students aged under 30 are one of the only groups of people in Germany who can opt-out of the public healthcare system and choose private healthcare should they wish. The vast majority choose to pay €106.93 per month, which is often the more cost-effective choice and ensures their nursing contribution is being covered during this time.

How to apply for public health insurance in Germany?

For all employed staff, enrollment in the public system is generally automatic, and contributions will be taken from wages at source, although employees have the option of choosing which provider they use. There are over 100 non-profit insurance providers, known as Krankenkassen. These associations collect the contributions and pay out claims from hospitals and doctors every time one of their insured members uses a medical service. Some of these are very large and popular funds with millions of members, such as the Techniker Krankenkasse (TK), whilst others have a few thousand ‘insurees’.

An employer will take care of the process on behalf of the employee, but those who want to request a specific provider will need to let their employer know before they are enrolled. Once someone has contributed to a provider for more than 18 months, they can change to another provider should they wish. Although most providers offer similar benefits, there are small variances between them, so it's important to check what each one offers. Larger funds such as TK tend to offer the best in terms of both cover and member support.

Once registered, each individual will receive a public healthcare insurance number and a card which details their provider. It’s important to take this card to every doctor appointment, treatment, or hospital visit.

Tip: Take a look at Healthcare Providers Comparison page to find out how different providers match up.

What is covered by public healthcare in Germany

Public healthcare in Germany covers GP (general practitioner) appointments, in-hospital treatment, out-patient treatments, surgery, maternity services, and basic dental care. It is possible to get an additional private health insurance plan that covers aspects of health which are not covered by the basic system, such as major dental work or a private room for a hospital visit.

Can I choose a doctor or practitioner?

Yes, unlike most countries with a public healthcare system, those in the German public scheme do not have to go to a registered doctor but get an appointment with any doctor registered in the public healthcare system, called Kassenärzte.

Doctor’s referral

You do not need a doctor’s referral to visit certain practitioners such a chiropractor. You can contact such practitioners directly and make an appointment.

TK public health insurance in Germany

There are more than 100 non-profit insurers in Germany that administer a public healthcare fund. One of the most consistently dependable is the Techniker Krankenkasse (TK), which is also one of the largest and most popular (as well as award-winning) public healthcare funds in Germany. Techniker Krankenkasse has 8.8 million registered insurees across Germany.

What are TK health insurance benefits?

TK covers all basic healthcare but also teeth cleaning (dental hygiene) appointments, which many providers do not, as well as comprehensive sickness insurance. Members can take advantage of excellent online support and advice as well as an English-language application process and even a customer portal that is available in the English language, making it a popular choice with those who do not speak fluent German. TK support is available seven days a week.

One excellent advantage of the TK health insurance plan is that it offers many services to its members which focus on illness prevention, which aim to encourage people to maintain healthy lifestyle habits in order to lead illness-free, healthy lives for the long-term. These include preventative health, fitness, exercise, mental well-being, and nutrition classes which members can attend for free or for a reduced cost.

TK also offers members cover when they travel to other EU countries, as the TK Heath Insurance Card features an EHIC element too. Traveling members of the fund can access vaccination advice via its TK-TravelMedi call service.

What is the cost of TK health insurance?

As one of Germany’s public healthcare insurers, the payment to TK is the same for everyone regardless of age or health. Those in employment will pay 7.3% of their gross wages (matched by a further 7.3% by the employer). As per new rules for 2019, TK members (shared with employers) also pay a supplementary contribution of 0.7%. For students, find out more on our Healthcare Costs for Students page.

The cost of health insurance with TK works out as especially advantageous for members when the comprehensive level of cover and a high level of customer service is considered. For twelve years running, TK was lauded as the best German statutory health insurance provider by the Focus-Money health insurer test.

At Expatrio, we can assist with the digital registration with TK for public healthcare cover. We can make the process as simple as possible for those moving to Germany, including both students and non-students. Find out more on our Health Insurance page.

The EHIC card

Read on to know how the card works in more detail

An EHIC card is issued to nationals of EU member states (as well as Norway, Lichtenstein and Switzerland) so they can access basic and emergency healthcare when visiting a fellow member country. This is an extremely useful system for many people from European countries who are traveling to and studying in others.

Depending on the length of visit, those travelling to Germany may find that the EHIC will offer sufficient cover, but it may be necessary to take out private health care insurance or register with the German public healthcare system. 

European Health insurance Card (EHIC)

The European Health Insurance Card (EHIC) scheme is an agreement by 31 countries to offer parallel public healthcare to citizens visiting from one of the other states. It means that for someone covered by, for example, the NHS in the UK, they can receive state public healthcare in Germany during a holiday or trip. The EHIC is, generally speaking, designed for tourists and is not intended for those who are moving to Germany to work or study for longer than six months. Having a European Health Insurance Card is a bit like being a member of a club, with the opportunity to access sister clubs when you are away from home.

What does the EHIC cover?

The European Health insurance Card allows registered individuals access to basic or emergency medical treatment when visiting another member state. This treatment may be free, or there may be costs involved; either way it will reflect the same cost which a national of the country you are visiting would be charged. This may therefore be different to the treatment you can access as part of your own national health service.

An EHIC card is perfect for those who are on holiday in Germany, or who are moving for a short-term period. In Germany, visitors with an EHIC card are able to access the same medical treatment as someone who has German public healthcare insurance. However, the EHIC card can only be used for a period of less than six months. Those moving to Germany for any period over six months need to sign up to the public healthcare system or take out private healthcare insurance.

Possession of a European Health Insurance Card does not cover those who are travelling to Germany specifically for medical treatments. It also doesn’t cover the cost of travel home due to illness or injury. It can cover treatment for pre-existing and chronic conditions, such as diabetes, however those who need to access equipment such as a kidney dialysis equipment or oxygen tank should contact the local German hospital first to make sure they will be able to get the treatment they may need.

Those moving to Germany for a stay of longer than six months should look into either public or private healthcare insurance, as the European Health Insurance Card is only intended for short stays.

Applying for public or private healthcare

Students should apply for public or private German healthcare cover before they arrive; in fact, this is essential for being granted a student visa.

Those moving to Germany to work, on the other hand, may need to wait until they are employed before they can be enrolled in the public healthcare system, in which case they can rely on cover from a European Health Insurance Card in the meanwhile. Either way, private or public healthcare is mandatory by law in Germany.

You can find out more about how to register for public healthcare insurance on our Public Healthcare in Germany page. You can also find out more about private health insurance on our Private Healthcare in Germany page.

How can I apply for the EHIC?

Applying for a European Health Insurance Card differs from country to country. In some countries, you will automatically get a card when you register with your own public insurance or state healthcare system. Others require you to specifically apply for the card via the national healthcare provider or using a dedicated online portal. It’s important to remember that you need a card for each member of your family, including dependents.

How quickly can I get the EHIC?

The time it takes to process your first EHIC card will depend on your home country. In most cases, it’s a fast and simple process. In some cases, your national health card will already incorporate an EHIC element, so you don’t need to do anything at all. It’s really important to check whether your card is in date. UK-issued cards expire after five years, for example. You can normally renew an EHIC easily and quickly online.

Using an EHIC in Germany

A European Health Insurance Card can be used in Germany to access the same level of medical care that someone with public health care insurance has access to. If you need to visit a doctor or dentist, make sure they are registered in the public healthcare systems. These practitioners are known as Kassenärzte and are not private doctors or dentists. Make sure you take your card along with you. General practitioners appointments (for every newly arising medical issue within a quarterly period) are charged €10 each time. This applies to nationals on the public healthcare scheme and internationals using European Health Cover.

Travel Insurance

Some people visiting Germany for a short while may find that they are better covered with travel insurance, which can be better for specific instances such as a skiing trip. Most holidaymakers visit the country with both a European Health Insurance Card, which is free, and some level of travel insurance.

Healthcare in Europe

Most countries in the EU and the EEA, as well as many more countries in Europe, have a state-backed public healthcare system which operates in tandem with private healthcare providers. In the UK, this is called the National Health Service, in France the La Sécurité Sociale, and in Italy the Servizio Sanitario Nazionale.

Those moving from one EU country to another will find that the public health system is usually fairly comparable to the one in their home country, in that it is funded by social security contributions and subsidised by the government through taxation. However those moving to Europe from the US, Latin America or Asia will find that is a very different.

Healthcare across Europe is generally of a high standard; in fact, France and Germany are said to have two of the best public healthcare systems in the world.

In Germany, there is a robust public healthcare system whereby members pay social security insurance contributions via their salary and employers match their contribution. Some individuals in Germany are able to apply for private health insurance, usually those in the highest wage brackets.

All EU members (as well as Norway, Lichtenstein, and Switzerland) are also part of the EHIC system, whereby residents of member states can access emergency and basic healthcare in other countries they visit. This treatment may be free or it may be charged, depending on the situation for nationals of the given country the card is used in.

Tip

You cannot access state healthcare in another country if you haven’t registered or are not in possession of your European Health card.

Other names for EHIC

It’s important to familiarise yourself with the name for an EHIC where you live so you can make sure you have the correct cover when you visit Germany. In Italy, EHIC cards are called TEAM cards, in France they are known as CEAM, and in Spain as a TSE. In Germany, the UK, and Ireland, they are referred to as EHIC cards.

Participating member states

The EHIC card is an EU-wide initiative, but it includes some additional countries which have chosen to participate in the scheme.

All of the 28 following member states of the EU participate in the EHIC system:

  • Austria
  • Belgium
  • Bulgaria
  • Croatia
  • Republic of Cyprus
  • Czech Republic
  • Denmark
  • Estonia
  • Finland
  • France
  • Germany
  • Greece
  • Hungary
  • Ireland
  • Italy
  • Latvia
  • Lithuania
  • Luxembourg
  • Malta
  • Netherlands
  • Poland
  • Portugal
  • Romania
  • Slovakia
  • Slovenia
  • Spain
  • Sweden
  • UK*
  • Lichtenstein, Norway and Switzerland

*Note that the UK arrangement is likely to change after Brexit and almost certainly if the UK leaves the EU without a deal. UK residents moving to Germany should therefore seek to register with the German public healthcare insurance scheme or take out private healthcare insurance ahead of arrival in Germany.