My name is Alexander Kühne. Since 2008 I am an independent financial advisor and insurance broker. I am working on your behalf and not for any insurance. I specialize in consulting German health insurance for Expats.
You are probably on this page because you don’t understand the German health insurance system and/ or trying to find the right plan for you in Germany. This might help you:
- I have gathered some information for you below.
- This website designed for Expats may also help you.
- Last but not least I simply recommend to contact me and let me help you. My service is free of charge since I am getting payed from the insurance company I would possibly broke you to.
Consulting German health insurance for Expats.
Health insurance in Germany
- It is obligatory for everybody registered in Germany by law.
- You can choose among public healthcare insurers (Krankenkasse) but not necessarily between public and private health insurance.
The cover offered by public health insurance is regulated by law. Therefore there is almost no difference between public insurers. Same applies to the price which is connected to your income. - I recommend to chose your public health insurance by the service (i.e. English speaking)
- Health insurance is not connected to your job. You cannot lose health insurance coverage.
- Anyone employed and earning less or equal to about 66.000 € per year (threshold 2023) is obliged to be member of a public health insurance.
Who is eligible for private health insurance in Germany
- Anyone employed and earning more then about 66.000 € per year (threshold 2023) or self employed may choose between public and private health insurance.
- This applies to people who before registering in Germany had been living in Europe for the last five years or if not directly start a job paying above the threshold (see above).
- If this does not apply to you - regardless whether or not your nationality is European - private health insurance is your only option.
- The cover of private health insurance depends on the tariff you choose. You pay for the quality. The price does not depend on your income. Therefore private health insurance is in most cases cheaper and has a better cover.
- If you have not been living in Europe for the last five years, private health insurance may require not only the normal health questionnaire but also a check at the general practitioner, blood test and/ or visit to the dentist. This depends on the insurance. Also the number of insurances willing to accept you is quite limited.
Please note: this is to be meant as a first approach to the topic. It is unfortunately very complex. I strongly recommend talking about your personal situation in a meeting!
Differences between public and private health insurance
The cover of public health insurance (GKV)
is defined by the Social Code Book V (SGB). The law defines in § 12 the efficiency requirement: "The benefits must be sufficient, appropriate and economical; they must not exceed the level of what is necessary. Insured persons cannot claim services that are not necessary or uneconomical, the service providers [= doctors] may not provide them and the health insurance may not approve them.”
Impact in practice
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Whether medical treatment is reimbursed is not determined by the doctor or the patient but by the law or the public health insurance
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the doctor cannot treat exclusively according to medical aspects
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According to the German school grading system, "sufficient" in Germany means less than average performance. Medically sufficient is to restore the respective bodily function to the extent that this appears reasonable from an economic point of view
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If the health insurance company refuses to pay for a treatment, the patient only has the option of taking legal action. The insurance companies deliberately prolong these lawsuits because they know that time is working for them.
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good but possibly expensive therapies are not paid for
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new therapies find their way into law only very slowly
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Medicines: the patient is only entitled to generic drugs and not to more effective or newer drugs with fewer side effects
The cover of private health insurance (PKV)
is mostly openly and generally defined by the terms and conditions of the contract and can only be changed by the insurer for the benefit of the customer. The customer can choose between different service levels. Due to the open definition of the insurance conditions, new methods or drugs are included and do not have to be discussed with the insurer. The insurance covers medically indicated treatment. This is determined by the doctor in cooperation with the patient.
At the doctor’s as a member of the GKV
are mostly openly and generally defined by the terms and conditions of the contract and can only be changed by the insurer for the benefit of the customer. The customer can choose between different service levels. Due to the open definition of the insurance conditions, new methods or drugs are included and do not have to be discussed with the insurer. The insurance covers medically indicated treatment. This is determined by the doctor in cooperation with the patient.
The doctor bills his services to the patient's health insurance company according to the German scale of fees for doctors (Gebührenordnung für Ärzte - GOÄ) or dentists (Gebührenordnung für Zahnärzte - GOZ). In this regulation, every action of the physician has a price tag. In the case of a "public patient", this price is multiplied by a factor of 1.3 on the invoice.
Each patient has a legally defined budget per quarter. If it is used up, although further treatments are necessary, the doctor is not allowed to bill the treatments - he works without payment or will refuse the treatment. This is why chronically ill patients in the GKV have difficulty obtaining appointments at the end of the quarter.
For services that are comparatively expensive, such as computer tomography or operations that can be planned, customers of the GKV sometimes have to wait more than three months for the above-mentioned reasons. This is counterproductive for diseases whose effects could be alleviated by a quick therapeutic response.
At the doctor’s as a member of the PKV
Here, too, the doctor bills his services according to GOÄ or GOZ. However, this price is multiplied on the invoice by a factor of 2.3 or 3.5 or possibly higher. This means that the doctor knows at the moment the patient steps into his practice that he will earn at least about twice as much with the same treatment. As a result, "private patients" are favoured when waiting rooms are full and, in addition, always receive appointments.
This also means that further therapies, examinations (e.g. computer tomography) or plannable operations are available within a few weeks or days.
The patient receives the bill directly from the doctor and (theoretically) goes into upfront payment. However, after receiving the invoice, he can forward it via an app to his private health insurance company for reimbursement. Reimbursement usually follows within one week. This means that there are approximately three weeks left to pay the doctor's bill.
The premium for GKV
is made by applying a percentage (currently 14.6%) to gross income up to a fixed maximum limit. This is called the income threshold (BBG KV) and is € 59.850 in 2023. In addition, the customer must pay an additional contribution of approximately 1.6% of his gross income up to the BBG for most insurance companies. Together with the compulsory nursing care insurance, about 19% of the gross income is due. This is currently (2023) 977 € per month with an income greater than or equal to 59.850 € per year. The income threshold is slightly increased every year, so that this contribution increases every year. However, the cover of the GKV has also been adjusted, but unfortunately only downward for the last 20 years. In addition the GKV receives an annual subsidy of €14.5 billion from tax revenues. Strictly speaking, those who pay a lot of taxes pay an even higher contribution to the GKV. This effect is politically intended.
Extraordinary burdens, such as the impact of the Corona pandemic, are not yet included in the prices.
The premium for PKV
is based on a contractual agreement and is independent of income. It increases if inflation, medical progress and/or statistical life expectancy make this necessary. In order for the premium to be allowed to increase, a trustee of the Federal Financial Supervisory Authority (BaFin) must check the figures of the private health insurance.
Increase in premiums in PKV and GKV
Both systems are subject to the same factors influencing prices: inflation, medical progress and an aging population. Whereas the PKV cannot withdraw from contractually agreed benefits, in the GKV there can always be a reduction in benefits instead of an increase in contributions. If this effect is taken into account, the increase in premiums in both systems is roughly the same, at around 3-5% per year.
High contributions in PKV in old age?
The PKV is obliged by law to build up reserves for the insured in order to keep their contributions stable or to reduce them in old age. It has built up a balance of over 260 billion euros for this purpose. As a rule, premiums are stabilized from the age of 60 with the help of these reserves.
In addition, customers can take advantage of PKV offers to reduce premiums from the age of 65. Since they generally realize (sometimes considerable) premium savings compared with GKV when they are young and healthy, the money is also available for this purpose.
In the hospital as a member of the GKV
Hospitals in Germany are legally obliged to charge according to so-called flat rates per case. These define budgets for operations, therapies and treatments. If complications arise in an individual case, or if a patient has to stay longer than planned, the hospital cannot bill for these additional costs and makes a loss on the case.
To avoid this, the patient is discharged "bloody". In other words, he is discharged even though he needs treatment so that the flat rate can be billed. A day later, he is readmitted as a new case, making the flat rate available again. Of course, many patients have already experienced (even fatal) complications on that day without medical care.
In the hospital as a member of the PKV
If the chosen PKV tariff provides for the lowest service level in the hospital, the statutory case flat rates also apply to the privately insured patient. With one crucial difference: in the PKV the service always takes place after the principle of the medically necessary therapeutic treatment.
Additional costs or complications incurred can always be billed by the hospital according to private medical methods (see "At the doctor's as a member of the PKV"). A discharge of the patient due to purely economic aspects is thus excluded. In addition, the patient undergoes all necessary medical measures or examinations that are not included in the per-case flat rate.