Private Insurance In Germany: Who Has It?

Health insurance is mandatory for all residents of Germany, and around 90% of the population is covered by public health insurance. However, some individuals qualify for both public and private insurance and can choose between the two. Private health insurance is chosen by around 10% of the German population. To be eligible for private health insurance, individuals must meet certain criteria, such as earning over a certain amount annually, being self-employed, or being a student. The cost of private health insurance depends on factors such as age, health status, and chosen coverage. Private insurance often offers benefits such as shorter wait times, additional services, and higher levels of care.

Who can get private health insurance in Germany?

In Germany, health insurance is mandatory for everyone, including international students, job seekers, and professionals. There are two options: public and private health insurance. While public health insurance covers around 90% of the population, certain criteria must be met to be eligible for private health insurance.

Firstly, those with a minimum annual gross salary of €69,300 (as of 2024) can opt for private insurance. This is a significant factor, as those earning higher incomes may find lower costs with private insurance, which charges a fixed monthly fee regardless of income.

Secondly, self-employed individuals can choose private insurance. They pay the full amount to the insurance company with no employer contribution, which can be advantageous if they are highly paid.

Thirdly, students can sometimes be eligible for private insurance, depending on their age and income. Older students, especially those over 30, may find private insurance more affordable than public insurance.

Lastly, civil servants can opt for private insurance, with their insurance subsidized by their employer.

It is important to note that not all who qualify for private health insurance choose it, as public healthcare in Germany offers extensive coverage. Additionally, returning to public insurance from private insurance can be challenging and is only possible in exceptional cases, such as a change in income or student status.

What are the pros and cons of private health insurance?

In Germany, health insurance is mandatory for everyone, with around 90% of the population covered by public health insurance. However, for those who meet certain criteria, private health insurance is an option. This includes those who are self-employed, students, or those with a minimum annual gross salary of €69,300.

Pros of Private Health Insurance:

• Better service: Private patients generally receive better service as doctors and clinics can earn more from private insurance. This includes immediate appointments, treatment by the most qualified doctors, and private rooms in hospitals.
• Individual choice of additional treatments: Private insurance often covers special treatments and services that public insurance may not, such as acupuncture, homeopathy, osteopathy, and Chinese medicine.
• Pay for what you need: Private insurance can be cheaper if you are young and healthy, with many insurances offering basic tariffs and reimbursement schemes for unused services.
• Lower costs for high-income earners: Private insurance charges a fixed monthly fee, which can be considerably lower for high-income earners than income-based public insurance fees.

Cons of Private Health Insurance:

• Difficult to switch back to public insurance: Once you choose private insurance, it is challenging to return to public insurance, only being possible in exceptional cases.
• Higher costs for families: Private insurance does not automatically cover family members, and you must pay individually for your spouse and children.
• More paperwork and upfront costs: With private insurance, you typically pay medical bills in advance and are reimbursed later, impacting your cash flow.
• Limited eligibility: Private insurance is not an option for everyone, as it requires meeting specific income or employment criteria.

How much does private insurance cost?

The cost of private health insurance in Germany depends on various factors, including age, health status, and the chosen tariff. Generally, the younger the person, the lower the premiums. Private health insurance providers typically offer a low-cost, a mid-range "comfort", and a premium health insurance plan.

The cost of private health insurance (PKV) in Germany varies depending on the age at entry, the desired scope of benefits, any deductible, and potential risk surcharges for pre-existing conditions. The professional group (employees, self-employed, civil servants) and the number of family members co-insured also influence the premiums.

For example, a young and healthy person can expect to pay between €350 and €550 per month for a basic plan, €450 to €700 per month for a comfort plan, and €550 to €900 per month for a premium plan.

Employees with private health insurance receive a subsidy from their employer, while self-employed individuals pay the full premium without an employer subsidy, which is higher for a similar scope of benefits. Children must be insured separately, and private health insurance must be purchased for them if their higher-earning parent is privately insured.

It is important to note that private health insurance is not available to everyone in Germany. Only certain individuals are eligible to choose private health insurance over public health insurance. This includes employees earning over €69,300 per year, self-employed people, freelancers, civil servants, and students.

How do you get reimbursed?

In Germany, health insurance is mandatory for everyone, with around 90% of the population covered by public health insurance. The remaining 10% are covered by private health insurance.

If you have private health insurance in Germany, you will usually have to pay your medical bills in advance and then get reimbursed by your insurance company. This is different from public health insurance, where you simply show your insurance card and the fees are directly transferred from the insurance company to the doctor.

Step 1: Understand your insurance policy

Before seeking any medical treatment, it is important to understand what your private health insurance policy covers. Different insurance companies and policies may have varying levels of coverage, so it is essential to know what expenses are reimbursable. Some common expenses that may be covered include medical operations, therapy, and medication. Additionally, private insurance may cover extra services like dental care, glasses, laser eye surgery, and travel insurance.

Step 2: Keep all relevant documentation

When seeking medical treatment, be sure to keep all relevant documentation, including itemised receipts, medical reports, and invoices. You will need to submit these documents to your insurance company as part of the reimbursement process. It is also a good idea to keep a record of any communication you have with your insurance company, as this may be needed for reference in the future.

Step 3: Submit a claim to your insurance company

After receiving medical treatment, you will need to submit a claim to your insurance company to initiate the reimbursement process. This typically involves filling out a claim form and providing the necessary documentation, such as receipts and invoices. Be sure to submit your claim as soon as possible, as there may be time limits for reimbursement claims.

Step 4: Follow up with your insurance company

After submitting your claim, it is important to follow up with your insurance company to ensure that your claim is being processed. You can usually do this by contacting their customer service team via phone, email, or online chat. They will be able to provide you with updates on the status of your claim and let you know if any additional information is required.

Step 5: Receive your reimbursement

Once your claim has been approved, you will receive your reimbursement from the insurance company. The reimbursement may be issued in the form of a cheque, direct deposit, or credit to your account, depending on your insurance company's policies. Be sure to review the amount received and verify that it aligns with the expenses you incurred.

Step 6: Handle any issues or disputes

In some cases, there may be issues or disputes with your reimbursement claim. For example, your insurance company may deny your claim or reimburse you for a lower amount than expected. In such situations, it is important to carefully review your insurance policy and understand the reasons for the decision. You may need to provide additional documentation or appeal the decision if you believe the reimbursement is insufficient.

It is important to note that the reimbursement process may vary depending on your specific insurance company and policy. Be sure to carefully review the terms and conditions of your private health insurance plan to understand their specific requirements and procedures for reimbursement.

How do you switch to public health insurance?

Switching from private to public health insurance in Germany can be difficult, and sometimes even impossible. However, there are a few ways to make the switch:

• Get unemployment benefits: If you lose your job and start receiving unemployment benefits, you will usually be required to switch to public health insurance.
• Lower your income: If you are an employee and your income falls below €69,300 per year, you will have to switch to public health insurance. This does not apply to self-employed individuals.
• Join the Künstlersozialkasse: If you are self-employed and join the Künstlersozialkasse (artists' social insurance fund), you can switch to public health insurance.

It is important to note that individuals over the age of 55 cannot switch to public insurance. This is to prevent people from taking advantage of the system by opting for cheap private insurance when they are young and then switching to public insurance when they are older.

When switching from private to public health insurance, it is crucial to follow the proper termination procedures. This includes giving proper notice to your private health insurance provider, requesting a confirmation of termination, and sending proof of your new public insurance to your employer or old insurance company.

• Cancel your private health insurance: Properly cancel your private health insurance policy by providing notice and following the necessary termination procedures.
• Request a confirmation of cancellation: Specify your desired end date for your private insurance coverage and request a confirmation of termination. You should receive this confirmation within 14 days, as stipulated by the Social Security Code.
• Send proof of new insurance: Obtain a "proof of the existence of other coverage in case of illness" document from your new public health insurance provider and send it to your previous insurance company and employer.

Keep in mind that you must inform your public health insurance company in a timely manner when switching from private to public insurance. Failure to do so may result in a delay in the switch, as you will remain insured with your previous company until they are properly notified.

Frequently asked questions