Private health insurance in Germany: How it works

Health insurance is obligatory in Germany for all residents and international expats living and working in Germany. Private health insurance is open to all those on higher incomes, the self-employed, students and civil servants, who benefit from special advantages. This guide explains how private healthcare works in Germany and how to choose the best private insurance company for your situation.

Conditions, benefits and difficulties of German private health insurance

How health insurance works in Germany

There are different types of health insurance in Germany: public health insurance known as “Gesetzliche Krankenversicherung” (GKV for short) and private health insurance known as “Private Krankenversicherung (PKV for short). Also a combination of public health insurance and supplemental private healthcare is possible. Because everyone has different needs and expectations of health insurance due to their job, family situation and health, it is important to understand the system. This is the only way to find the most suitable tariff for your stay in Germany. It is also important to mention that you cannot switch between public and private health insurance at will, as certain criteria have to be met. Your options depend on your profession and income.

Independent advice from an experienced insurance broker, who knows the advantages and disadvantages of both systems and takes your individual circumstances into account, is strongly recommended. We are happy to support you free of charge and help you filter out the best options for your individual situation.

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The difference between public and private health insurance in Germany

At the beginning it is essential that you understand the difference between public health insurance and private health insurance. The GKV and the PKV differ in many points. In fact, these are two completely different insurance systems:

1. The public health insurance

In the statutory health insurance, or GKV for short, the scope of health services is prescribed by law and applies equally to all insured persons. The medical benefits of the statutory health insurance cover the necessary care, not a luxury. Inpatient care from the doctor on duty at the nearest hospital, outpatient care from panel doctors and basic dental care are covered.

Special treatments such as private doctors or surgeons, alternative and homeopathic care with naturopaths, or high-quality dentures are not covered. Dental cleanings are also not fully covered. You usually have to pay for glasses and contact lenses yourself. Statutory insured persons cannot arrange their insurance cover themselves, but the legislator can change and reduce the benefits at any time.

The costs for the monthly contributions to statutory health insurance are based on income. The statutory contribution rate is 14.6 percent of income subject to contributions. If you earn less, you pay less. If the income increases, the monthly contribution also increases. So those with a high income pay more. Unemployed family members who live at your place of residence in Germany are also insured free of charge. Children are covered until they are 23, or 25 if they are students. Spouses are insured if they are unemployed or earn less than 485 euros per month.

2. The private health insurance

In private health insurance, or PKV for short, the scope of insurance is regulated by private-law provisions. As a private patient, you can expect a higher level of service: Private health insurance covers a wider range of medical and dental treatments than the state system. You can get an appointment with a specialist more quickly and benefit from shorter waiting times. Privately insured people can also request special doctors, for example, doctors who speak your native language.

In contrast to public health insurance, the costs of private health insurance are not based on your income. So the prices do not increase when your salary increases. The costs of private health insurance depend on your age and individual state of health at the time you take out the policy. The younger and healthier you are at the time of signing up, the cheaper the health insurance will be. After you join, your health no longer affects the cost of your insurance. You can get very sick and still pay the same price. In addition, privately insured individuals can influence the amount of their monthly contributions through their insurance conditions: The insured benefits can be chosen freely and flexibly, and there are premium-benefit combinations for most budgets. Advantage in private health insurance: The insurance cover once agreed cannot be changed by the insurance company or benefits reduced afterwards.

For non-working spouses and children a separate tariff is required if they are to be insured privately. However, if your partner is employed, he or she is compulsorily insured by law anyway and there is no need for action. As the spouse of a civil servant, the employer assumes the medical expenses. This allowance is usually 70 percent for family members. The remaining small part must be covered by private health insurance. Different income limits for the partner apply in the individual federal states. The special conditions for civil servants in Germany and their cost advantages in private health insurance are explained below.

Who can choose between private and public health insurance in Germany?

The German healthcare system allows some professional groups to choose between statutory and private health insurance:

  1. All civil servants, civil servant candidates (civil servants in training) and civil servants on probation can freely choose between statutory and private health insurance. For example, if you work as a teacher, professor or in the police, federal police or fire department.
  2. Employees of a company with an annual salary of at least 66,600 euros (as of 2023) are free choose where they want to take out health insurance.
  3. The self-employed and freelancers are allowed to choose between GKV and PKV. Under certain circumstances, however, the statutory insurance may not accept self-employed persons from abroad.
  4. Students can choose between public or private health insurance.
  5. Persons without own income or with an income below 520 Euro per month. For example, housewives, househusbands or children.

Is it better to have private or public health insurance in Germany?

Most employees in Germany are compulsorily insured in the public health insurance scheme because their income is below 66,600 euros per year (as of 2023). Statutory health insurance is also the better and cheaper choice for low-earning self-employed people and people with serious chronic illnesses. The situation is different for civil servants: The vast majority opt for private health insurance for good reason. Civil servants benefit from the so-called “Beihilfe”, the allowance for private health insurance that covers a large part of the costs. As a result, civil servants and their family members only need residual cost insurance, which is particularly inexpensive.

What is the allowance (“Beihilfe”) for civil servants and what do I have to consider?

Civil servants in Germany are entitled to a special privilege: The allowance is a contribution by the employer to your medical costs (usually between 50% and 70%, for children up to 80%). The exact amount depends on the family status and the different regulations of the federal states. Civil servants on revocation (Anwärter and Referendare), civil servants on probation and civil servants for life are entitled to the allowance. The services that are not covered by the allowance must be insured through a statutory or private health insurance.

Special health insurance tariffs for civil servants

Private insurance companies offer special tariffs for civil servants, so-called „residual cost insurance“, which covers the remaining 50%, 30% or 20% of medical costs. A great and cheap solution for civil servants – in theory. But since we are in bureaucratic Germany, the reality is a bit more complicated: Because each of the 16 federal states and the federal government have their own aid regulations, which exclude or reduce various health services. Reductions are often made for remedies (physiotherapy, occupational therapy, speech therapy), aids (hearing aids, home dialysis equipment, orthopedic shoes, …), dentures (materials, laboratory costs, …) and cures.

To ensure that you do not have to pay the difference – for example the remaining treatment or material costs – yourself, your private insurance company should also offer you a suitable supplementary allowance tariff. A good supplementary plan closes the gaps in your allowance by absorbing exactly this co-payment and protecting you from additional payments. Therefore, before you decide on a private insurance company, you should also take a closer look at their supplementary allowance tariff and compare it with other providers. The goal should always be to get the full 100 percent of your medical bills reimbursed.

We will be happy to find out which insurance company offers you the best price-performance ratio in the overall package.

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Why private health insurance is the best choice for foreign civil servants in Germany

Civil servants are „supported“ by the state with the subsidy. You benefit from particularly low rates in private health insurance, as 50% to 70% of medical costs are covered by the federal government or the respective federal state. A well-negotiated contract for private health insurance offers you not only much better medical treatment options, but also lower monthly contributions than in the statutory health insurance. In addition, privately insured persons have a wider choice of doctors and hospitals, since they can turn to both public and private doctors. As a privately insured person, you can benefit from shorter waiting times and find a doctor who can communicate well in your native language.

How to get a private health insurance in Germany

Foreign employees moving to Germany must inform their new employer before they start whether they choose private health insurance and which company they choose. This prevents them from being automatically enrolled in the public health care system. Make sure you know the name and details of your private insurance company, as contributions will continue to be deducted from your salary and you will need to inform your new employer about this.

However, there is another bureaucratic hurdle to obtaining private insurance: Most private health insurers require foreign civil servants to prove that they have at least 24 months of prior German insurance. Of course, you can’t prove this if you are just planning to change jobs or move to Germany. Therefore, foreign employees who have not previously been insured in Germany must have a medical examination and need to answer a catalogue of questions about your health. This is because the private insurance companies are choosy – they must take a number of factors into account for the calculation of the costs. And of course, they want to insure people who are as healthy as possible. Pre-existing conditions are often problematic because they cause higher costs for the insurer. As a result, private insurance companies may reject prospective clients with pre-existing diseases or impose premium risk fees.

Which private insurance company is the best for foreigners and expats?

Finding the best German private insurance company is not easy. There are just over 40 private health insurers in Germany, so the first task is to research both in terms of coverage and prices. However, it is difficult for laypeople to compare the tariffs: There is no universal solution. Which private insurance company is the best for you depends on the benefits of the respective tariff and your individual requirements. And very importantly, not every private health insurance company offers good rates for civil servants or supplementary allowance tariffs. You should not be blinded by the largest and most popular insurers.

The best private health insurance for expats results from a comparison taking into account the following factors:

  • profession or civil servant status (civil servant candidate, civil servant on probation, civil servant for life)
  • the percentage covered by the Beihilfe
  • entry age at the time of taking out private health insurance
  • pre-existing conditions of the insured person
  • individual assessment and benefits you like to include (e.g. dental prostheses, visual aids, treatment by a senior physician, single room in hospital, cures or therapies)

There is strong competition between private health insurers in Germany (as in all other sectors) for young, healthy customers. Many private health insurers adorn themselves with good marks from rating agencies or entice customers with particularly cheap offers. The big online comparison calculators also lure customers with so-called „best prices“. Unfortunately, these „bargains“ contain many traps and later do not deliver what they promise. Since there is a lot of ignorance, especially in the area of civil service insurance, it is recommended to get advice from a reputable and independent broker before signing a contract.

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Why choose Beamtenservice?

  1. We work neutrally, independently and free of charge
    As our name (Service for Civil Servants) already suggests, we specialize in complex insurance products for civil servants and civil servant candidates. We have been active in this field as a health insurance broker for over 15 years. Unlike insurance agents, we work as brokers in a completely neutral and independent way. That means: Our recommendations are free of economic interests. We do not select products based on the amount of commissions and we are not bound to any insurance company. Therefore, we can objectively compare the services of different insurance companies and draw from the full range of the market. This allows us to filter out the best and cheapest tariffs for your private health insurance.
  2. We are your personal contact
    Unlike anonymous online comparison calculators, with us you benefit from a personal contact person. We are human and we take our time. We answer all your questions and translate the technical jargon of the insurers. We analyze your wishes, your current life situation and your future plans. From this, we determine your individual needs and create a tailor-made insurance concept. We are intermediaries between you and your insurance company. Because of our large network and our good connections to the companies, we can address your concerns quickly and unbureaucratically.