- The involved parties in the health system in Germany are:
- The recipients/patients
- Staff, such as doctors, pharmacists, nurses etc.
- The financiers of the health system, i.e. those paying health insurance (compulsory public, voluntary public or private – the differences will be explained below), employers and those paying directly for each health visit
- The state including the federal states, individual communes etc.
Aside from state-run hospitals, the large proportion of the health system is based on independently practicing doctors, pharmacists etc. and private companies, such as the pharmaceutical industry. It is a specialist-oriented system, e. g children always go to a paediatrician (Kinderarzt) and not to the family GP as in the UK. As an adult, it is advisable to have a GP (Hausarzt) who will then refer you to a specialist if required.
Once you become a member of a health insurance company, you will receive a chip-card (similar to a debit card). This chip card will be required at any doctor visits or trips to the hospital so make sure to keep it on you at all times.
Health insurance has existed in Germany since 1883, of course not in its current form however! Since 2009 the Allgemeine Krankenversicherungspflicht exists (since 2009). This means that every person living in Germany must be insured by health insurance. The type of health insurance can differ however, from compulsory public to voluntary public to private insurance. If you do have a choice (i.e. not compulsory public), both public and private have some advantages and disadvantages, depending on your situation. I will try to explain the differences below.
Public Health Insurance
The large majority of people in Germany are publicly insured. All employees that earn under a certain salary (see figures here) fall into the compulsory category. This means that these persons do not have a choice what type of health insurance they have and must be publicly insured, but can chose which public health insurance company they insure themselves with, e.g. with AOK, TK. The public insurance premium is calculated based on income, and is currently at 15.5 % (Source) of Brutto income.
It is also possible to be insured on public insurance voluntarily. Usually those eligible are members of public insurance companies that were previously on compulsory public health insurance but do not fall within this category anymore, e.g. previously on family insurance. Public health insurance offers the benefit for families that stay at home spouses, with no or very low income and children, can be insured without extra charge. Before deciding on an insurance company, it is worthwhile checking under what circumstances families can be insured on one insurance premium. If you are planning a baby, it is also worth checking whether you will have to pay an insurance premium during your maternity leave. The AOK-Nordost offers premium free insurance for compulsory insured women on maternity leave and men on Elternzeit. This does not apply to voluntarily insured parents.
A common question is “What is covered by public health insurance?”. This is a difficult question to answer, as, of course each situation and insurance company is different, but in general, public health insurance covers any costs that are medically necessary (i.e. voluntarily incurred costs may not be covered). Hospital costs and pregnancy and birth-related costs are generally covered, however if you decide to have e.g. more ulstrasound (Ultraschall) screenings than the three that are standard in Germany during pregnancy, you may have to pay for these directly. Some other pre-natal screenings are covered by health insurance (e.g. Feindiagnostik – 3D anomaly scan around week 20-23) and some not (e.g. the new Praena test) – it is worth discussing this with your gynaecologist (Frauenarzt). Public health insurance also covers a midwife (Hebamme) to come to your home after you have given birth to check on you and your baby’s health for a duration of eight weeks (and longer if necessary). If you are unable to perform household duties whilst pregnant or after giving birth, your gynecologist can prescribe a home help for you and this will also be covered by your health insurance company. As an example of what is typically covered during pregnancy, here is the list of covered health costs from the AOK Nord-Ost (in German.)
Some preventative health costs are also covered, e.g. a smear test for women every year, skin cancer check-up from age 35 and prostate cancer check-up from age 35 for men. Preventative health courses such as yoga or pilates can also be covered, see more details here.
Each insurance company also has special coverage options for certain things which may or may not require an extra premium to be paid. For example, the AOK Nord-Ost covers the cost of the pill for those under 20 without extra insurance cost (Source.)
Public health insurance also covers the cost of prescribed medication, however a small contribution by the patient is required for certain medications (often €5). This does not apply to children and all prescribed medication should be covered by health insurance. Non-prescription medication is not covered, however I would advise keeping receipts as they can be handed in when doing your tax returns at the end of a year!
Private Health Insurance
Private health insurance is allowed for those that do not fall into the compulsory public insurance category, e.g. self-employed, civil servants, employees above a certain salary. The health insurance cost is risk-dependent, meaning a health check and prior illnesses are taken into account when the premium is calculated. Private health insurance works on a refund basis, meaning the patient pays directly and gets reimbursed by his/her health insurance. The private health insurance companies offer different combinations of coverage, so the patient can chose what he/she wishes to be covered by the health insurance (the premium also depends on this of course). For some on very high incomes private health insurance can work out better, however I would always recommend asking about their policies on family insurance as, unlike with public insurance, children and non-earning spouses are not usually covered without extra charge.
Other Types of Health Insurance
There are other types of health insurance available, such as the Künstler Sozialkasse, an insurance for writers and artists. You can find out more about this health insurance (in English) here.
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