Private Health Insurance in Germany
- Compared to statutory health insurance scheme, private health insurance (private Krankenversicherung) offers a much wider range of benefits – very often at lower costs.
- Privately insured people can choose which services are particularly important to them for their healthcare.
- Private health insurance premiums depend on the contractually agreed benefits, as well as the age and state of health at the time the contract is concluded. Insurance should therefore be taken out as early as possible.
- Private health insurance can be taken out by employees with an income above the compulsory insurance threshold (2024: €69,300), as well as by the self-employed and freelancers, students, and civil servants.
- The insurance companies ottonova and Feather offer the best private health insurance for expats in Germany.
What is the difference between statutory and private health insurance?
The health insurance system in Germany is based on two pillars: statutory and private insurance (gesetzliche und private Krankenversicherung). Statutory insurance is the main part of German health insurance: around 73 million people were insured with a public health insurance fund in 2020. Around 9 million policyholders choose private health insurances.
The two parts of German health insurance — statutory and private health insurance — differ in terms of the requirements for taking out insurance and the scope of benefits.
Basics of statutory insurance in Germany
There are currently 95 public health insurances in Germany, from which those with statutory insurance are free to choose. The level of contributions depends on income. It is currently 14.6% of the income, subject to contributions. For employees, the employer pays half of the contributions.
The contribution assessment ceiling is currently (status 2024) €62,100 per year/€5,175 per month; income above this limit is not included in the calculation of the health insurance contribution.
In principle, statutory insurance works according to the solidarity principle — high earners pay more than people with lower incomes. The personal state of health plays no role in the level of contributions.
Who must take out statutory health insurance?
Compulsory insurance in a public health insurance fund applies to all employees whose annual income is below the compulsory insurance threshold. This is currently (2024) €69,300 per year/€5,775 per month. The compulsory insurance threshold defines the income at which employees can switch to private insurance. Employees with an income above the compulsory insurance threshold are free to decide whether they want to remain covered by statutory insurance or opt for private health insurance.
Children and non-working spouses of people with public health insurance are insured free of charge.
Self-employed people, freelancers, and students can choose whether they want to take out statutory or private insurance. There are no income limits for this.
Public health insurance coverage
Most statutory health insurance benefits apply regardless of public insurance provider. The so-called standard benefits include medical, dental, and psychotherapeutic treatment, the provision of medication, remedies, and aids, hospital treatment, home nursing care and medical rehabilitation services, provided they correspond to the recognized state of medical research. Their use must be medically necessary and economical. Statutory co-payments are made by the insured person for medicines, remedies, and aids. For dental prostheses, but also for various other dental services, public health insurance only pays a fixed subsidy.
Insured people must pay for services that go beyond the standard benefits of public health insurance themselves. In some cases, private supplementary insurance can be taken out for this. These include supplementary hospital insurance (treatment by the head physician, single room in hospital) and private supplementary dental insurance for higher-value dental benefits and dentures.
The European Health Insurance Card also provides insurance cover in emergencies in other EU countries as well as in the UK, Iceland, Liechtenstein, Norway, and Switzerland.
Statutory and private health insurance — general features
The basics and how private health insurance works are described in detail below. First, we will look at the differences between the two health insurance options.
Statutory health insurance system
- Institution under public law
- Financed from the contributions of the insured and from tax revenue
- Contributions are calculated based on the insured person’s earned income
- Statutory standard benefits, restrictions on the scope of benefits by the legislator are possible
- No alternative practitioner services
- Remuneration of doctors based on the so-called uniform assessment scale and based on budgets
- Billing according to the principle of benefits in kind.
Private health insurance system
- Provided by private companies
- Financing through capital cover
- Premiums are calculated according to the equivalence principle (according to the scope of the policy)
- Privately agreed scope of benefits, benefit security
- Remuneration of doctors according to the scale of fees for doctors and dentists
- Billing through reimbursement of costs to the insured person, who initially pays for medical services themselves.
How does private health insurance work?
Private health insurance offers policyholders higher benefits, shorter waiting periods and, at least in some cases, lower premiums than public health insurance. However, policyholders must meet certain requirements to be able to take out private insurance. Private health insurance is an individually agreed contract. The insurance companies offer different tariffs with graduated benefit catalogs.
In addition, all private health insurance companies offer as social tariffs a basic tariff or the standard tariff for insured people with older contracts. Their benefits correspond to those of public health insurance.
Target groups for private health insurance
The prerequisite for private health insurance is that you are exempt from insurance — i.e., you are not required to be insured with a statutory health insurance scheme. A distinction must also be made between people who can or, in certain cases, must take out private insurance.
Who can take out private insurance?
The following groups of people are free to decide between statutory or private health insurance:
- Employees whose income exceeds the compulsory insurance threshold (2024: €69,300 per year/€5,775 per month)
- Self-employed and freelancers
- Students
- People without income or with an income below the marginal earnings threshold of currently €518.44 (e.g., children, stay-at-home spouses, or mini-jobbers)
- Civil servants and their family members, provided they are entitled to a private health insurance allowance.
Who must take out private insurance?
Some groups of people must take out private health insurance. These include:
- People who currently do not have any health insurance and who were last privately insured
- People who had previously neither statutory nor private insurance, provided their profession — such as the self-employed and freelancers — justifies exemption from insurance.
Are there special regulations for expats?
For expats who live in Germany for longer than 12 months, the same regulations apply for both statutory and private health insurance as for insured people with a German passport.
Foreign health insurance is impractical for long-term or permanent residence in Germany. Insurance policies from a health insurance provider based in the EU or the European Economic Area are theoretically possible if they meet certain minimum legal requirements. However, private health insurance taken out directly in Germany is the better alternative for expats:
- German insurance law does not provide the insurer with an ordinary right of termination.
- In financial emergencies, insured persons can switch to the basic tariff or to the standard tariff for longer existing contracts.
- Privately insured employees with a German private health insurance company are entitled to an employer subsidy of 50% of the insurance premium.
Does private health insurance include family members?
Private insurance does not provide for non-contributory family insurance. Each family member must take out their insurance, which means that a separate policy must also be taken out for children.
The private health insurance scheme offers special tariffs for children and young people, with low premiums compared to adult tariffs. On the one hand, healthcare for children and young people is inexpensive — for example, they usually only need a small amount of expensive specialist treatment and medication. On the other hand, private health insurers do not build up any old-age provisions until the age of 21, which later serve to reduce premium increases in old age.
What benefits does private health insurance offer?
The scope of benefits of private health insurance is agreed individually in the insurance contract. Various tariffs make it possible to tailor the desired insurance cover precisely to your personal needs. Medical services are only reimbursed if they are included in the insurance contract. The policies have a modular structure. Insured people can choose between various additional modules in their tariff — such as extended insurance benefits for visual aids and dentures, daily sickness benefits and daily hospital benefits insurance.
Unlike statutory insurance, the benefits in private insurances are guaranteed for the entire term of the contract. Increases or decreases in the scope of benefits are possible by changing tariffs or booking/canceling additional modules.
In private insurance, too, there must be a medical necessity for treatment — however, in most tariffs, the benefits provided exceed the standard benefits of public health insurance by far.
Treatment costs should be reimbursed by a good private health insurance provider at as high a percentage as possible — ideally 100%. Depending on the tariff, costs are either covered up to the maximum rate of the scale of fees for doctors (3.5 times the rate) or an unlimited amount. Privately insured patients can also make use of the services of private doctors who are not licensed by the public health insurance scheme.
The range of services covered by private health insurance providers includes outpatient and inpatient medical services, dental and orthodontic treatments, physiotherapy and psychotherapy, remedies, and aids. Private insurance also includes compulsory long-term care insurance, the benefits of which correspond to those of statutory long-term care insurance.
The following points are particularly important when choosing a good private health insurance provider and tariff:
Direct access to specialists
Access to specialists should be possible by default or optionally without having to go through the GP, without this resulting in restrictions on reimbursement.
Reimbursement of costs for visual aids, dentures, and medical aids
For spectacles, contact lenses and dentures, the highest possible percentage of the costs should be reimbursed at 3.5 times the rate of the scale of fees for doctors. For dental implants and other dental prostheses, it makes sense to reimburse at least 75% of the costs.
Some private health insurance companies reimburse aids such as prostheses, walkers, wheelchairs, or insulin pumps as standard if they are medically necessary — such a tariff is usually the better choice. Other insurers include lists of reimbursable aids in their policies.
Treatments by alternative practitioners, complementary medicine
The costs of recognized complementary medical therapies and treatment by an alternative practitioner are reimbursed in most tariffs. They should — if there is interest in this treatment option — be covered up to the maximum rate of the fee schedule for alternative practitioners.
Single room and chief physician treatment in hospital, free choice of hospital
Private insurance providers offer optional benefits in terms of accommodation and the attending doctor during a hospital stay. These options also include a free choice of hospital. Private patients who forego this can reduce their premiums.
Health insurance cover abroad
Worldwide insurance cover should be one of the standard benefits of private insurance. Within the EU, the insurances offer unlimited cover. Outside Europe, there should be flexible options for insurance cover, ranging from several months to at least one year.
Daily sickness allowance
Unlike statutory health insurance, private insurance does not provide for an entitlement to sickness benefit, even for insured people who are employed. As a rule, daily sickness benefits insurance can be integrated into the insurance tariff to compensate for loss of earnings. The daily rate is agreed individually. The upper limit is the last net income earned.
How much does private health insurance cost?
Especially for younger insured people, the premiums for private health insurance are cheaper than statutory insurance. Private insurance is particularly attractive for the self-employed and freelancers who do not receive any employer subsidies for their health insurance.
The contributions for statutory health insurance depend on earnings — high-earning self-employed people currently pay an average of €845 per month. Depending on the tariff, their contributions to private insurance would be on average between €400 and €600. Private insurance is even cheaper for employees, who pay an average of €200 to €350, also depending on the tariff.
Factors influencing the premium amount
Several factors influence the premiums for private health insurance:
Scope of benefits of the tariff
When choosing their tariff, privately insured people should make sure that they only choose benefits that they really need to limit their insurance premiums.
Age, state of health and occupation
The age and state of health at the time of the contract have a major influence on the premium amount. Based on these two factors, the insurance company conducts a risk assessment — higher premiums are charged for higher risks.
Private insurance should be taken out as early as possible to benefit from favorable premiums. In addition, later premium increases are also based on the initial costs.
Pre-existing illnesses can also lead to the insurance application being rejected or related benefits being excluded. If benefits are excluded, it is possible to apply for a review to determine whether this health risk still exists.
The profession practiced also influences the premium amount — insurance companies sometimes charge a risk premium for high-risk professions.
Deductible/excess
Privately insured people can choose between tariffs with or without a deductible. Deductibles are agreed in the insurance contract and reduce the monthly insurance premium that would be payable without a deductible. You are not free to choose the amount, but the insurance tariff determines it. When choosing the right deductible, policyholders should not only consider the premiums, but also their current and future state of health — a tariff with a low deductible makes sense for frequent medical treatment.
The deductible is either a fixed amount per year or a percentage of the costs. Self-employed people should choose a plan with a maximum excess of €1,000, while an upper limit of €650 is recommended for employees. A percentage excess is usually between 10% and 30% per invoice, with an upper limit per year.
German insurance law stipulates that the deductible may not exceed €5,000 per year. However, most private health insurance companies keep it well below this limit.
Premium refunds
Premium refunds are granted by private health insurance providers if no benefits are claimed over a certain period. They are higher if a tariff with a low deductible has been agreed.
Subsidies
For employees, the employer pays 50% of the contributions for the insurance. The maximum amount for this is currently €421.77 per month. Employees with voluntary statutory health insurance would also receive this amount as a subsidy towards their health insurance. Special regulations apply to the private health insurance of civil servants.
When will insurance premiums increase?
The contributions for private health insurance are calculated based on the equivalence principle. For this purpose, an insurance collective of the same age is considered at the start of insurance. The premium income must cover the expenses for this collective during the entire insurance period. Premiums are increased if this cover is no longer provided by the original premium calculation. The reasons for this are:
- The benefit requirements of the group of insured people
- Increases in benefits due to medical progress (new therapy methods and medical-technical devices)
- The general price trend in the German healthcare system.
Individual premium increases due to frequent or long-term illnesses are excluded.
According to studies, the increase in premiums in private health insurance between 2013 and 2023 was even slightly lower than in statutory insurance (+ 2.8% private vs. + 3.4% statutory).
How do the premiums for private health insurance develop for seniors?
One argument often put forward against private health insurance is that premiums rise very sharply at retirement age, so that some of those insured will get into financial difficulties as a result because the employer’s subsidy ceases to apply to employees after retirement.
However, private health insurance companies are legally obliged to build up old-age provisions to stabilize premiums at retirement age. Between the ages of 21 and 60+ privately insured persons pay a surcharge of 10% of the monthly insurance premium for old-age provisions.
Pensioners can apply to the statutory pension insurance fund for a subsidy towards their private health insurance. They are also exempt from the surcharge for old-age provisions and the daily sickness allowance, which means that they pay lower premiums for their health insurance.
Best private health insurance for expats in Germany
You can find private health insurance that best meets your needs by comparing different private health insurance providers and tariffs. Expert advice can be helpful here, as there are sometimes major differences between the benefits and conditions of the various insurance companies. The Berlin-based FinTech Getsafe, for example, offers purely digital advice on choosing the right private health insurance. The company itself has various insurance products — private liability, legal protection, household contents, dog liability, pet health insurance and private supplementary dental insurance — in its range. Additionally, Getsafe acts as an advisor and broker for comprehensive private health insurance.
Below, we present the private health insurance policies from ottonova and Feather, which are ideal for expats in Germany. Both providers are high-performance digital insurance companies that operate both a German and an English website. All insurance matters can be managed quickly and easily via digital channels. Personal support is available in German and English.
ottonova
FinTech ottonova specializes in various health insurance products. In addition to comprehensive private health insurance, the insurer offers supplementary private dental insurance, supplementary hospital insurance and company health insurance for businesses. The independent analysis company Morgen & Morgen has given ottonova’s private health insurance top marks, and in a test conducted by Money magazine, the company was ranked first for its customer service.
ottonova’s private health insurance is available in two versions — as special expat insurance and as regular private health insurance. With its expat insurance, ottonova is aimed at expats from non-EU countries who are planning to stay in Germany for a maximum of five years.
Digital services in the ottonova mobile app
All ottonova services are available in a mobile app. The private health insurance provider offers a so-called concierge service here. Medical services, doctor’s appointments and personal consultations can be ordered via the app. Medical documents such as doctor’s letters or X-rays are stored in the app, which also has a reminder function for appointments and recommended treatments. Healthcare services are also billed directly in the app.
The range of services offered by the insurance company includes:
- Search for a suitable doctor, including specialist search and appointments
- Optional: video chats with doctors, receiving diagnoses and sick notes directly in the app
- Support in obtaining a second opinion
- Health consultations
- Assistance abroad.
ottonova’s regular offer is open to employees, freelancers and the self-employed, students and civil servants. On the ottonova website, you can first calculate your personal offer and then decide whether you would like personal advice, first check the offer, or take out your insurance directly online.
Rates in ottonova’s regular insurance
There are three different tariffs to choose from, which ottonova markets as Premium Economy Class, Business Class, and First Class.
Some benefits can be flexibly configured in all tariffs and then influence the monthly premium. These include:
- Deductible: 10 %/maximum €500 per year, 25 %/maximum €1,250 per year, 50 %/maximum €1,000 per year
- Daily sickness benefit: between €50 and €100 per day
- Old-age provisions: between €100 and €460 per month.
The following monthly premiums are based on a freelancer aged 35 at the time of taking out the policy without pre-existing conditions and are therefore shown without an employer’s contribution. A deductible of 10%/maximum of €500 per year was specified for the deductible, €100 for the daily sickness allowance (from the 43rd day) and €100 per month for the old-age provisions.
ottonova insurance for expats with temporary stay
ottonova insurance for expats with a maximum stay of five years is aimed at employees, the self-employed and freelancers, students, post-docs, and researchers. Family members can also be insured under the policies, subject to contributions.
Here too, there are three tariffs, which differ only in terms of hospital accommodation (single or twin room) and benefits for visual aids (First Class Expats and Business Class: €300 every two years, First Class: €500 every two years). They apply worldwide and offer all the benefits of private health insurance, including treatment by the head physician during an inpatient stay, free choice of doctor and full coverage of dental treatments (excluding dentures).
ottonova gives the following monthly premiums as price examples for employees:
- First Class Expats: €167
- Business Class: €295
- First Class: €314
Feather Insurance
The Berlin-based FinTech Feather offers various digital insurance products. Its portfolio includes private liability insurance, legal expenses insurance, household contents insurance, supplementary dental insurance, and comprehensive private health insurance. Feather has specialized strongly in expats with its offers.
Feather’s offers all benefits of comprehensive health insurance. In the first step, the premiums for the insurance can be calculated on the Feather website, after which an offer is sent by e-mail. Expert advice is also offered as an option.
The insurance is available in three tariffs. The following prices are also based on the example of a 35-year-old freelancer without pre-existing conditions. There is no excess for the Feather tariffs. Medical practitioner costs are not reimbursed. Return transportation is only included in the two higher-priced tariffs. Worldwide cover outside the EU is limited to one month.
How do I apply for private health insurance?
You can either apply for private health insurance directly with an insurer of your choice, or seek advice from an insurance broker beforehand. Ideally, this should be an independent insurance consultant, who not only offers products from certain insurance companies, but also has comprehensive knowledge of the private health insurance market and selects the best offers for their customers.
Insurance application and health questions
You can almost always apply for private health insurance online.
In addition to personal details, various health questions must be answered in the insurance application. The insurance company uses this information to calculate the risk associated with the insurance.
The health check for private health insurance is conducted in writing. Digital forms are provided for this when taking out insurance online. All previous illnesses and medical treatments for a specified period must be stated for the last three, five or ten years. Most companies require psychotherapies to be listed for ten years.
The health questions must be answered completely and truthfully. Incorrect or missing information can lead to reduced benefits, retroactive risk surcharges or termination of the contract by the insurer.
If you have a pre-existing medical condition, you should always consult a broker when looking for private health insurance. The insurance companies use different criteria to decide whether and under what conditions the insurance can still be taken out. It is problematic if an insurance company has already rejected you because of pre-existing conditions and this rejection has been stored in the joint information system of the private insurers. In this case, other insurance companies will also reject your application. The broker will first contact various providers anonymously to find out whether you are eligible for insurance.
If you have pre-existing medical conditions, you should always commission a broker to search for private health insurance, who will contact various insurance companies anonymously in advance to find out whether insurance is available and at what conditions.
Waiting periods
Anyone who previously had neither statutory nor private insurance must expect waiting periods with all providers before treatment is reimbursed for the first time. The general waiting period is three months, with waiting periods of eight months for childbirth, dental treatment, dentures, and orthodontics as well as psychotherapy.
If you were previously insured with a statutory health insurer or another private health insurer, the new insurer will reduce the waiting period or waive it altogether.
Waiting periods are also waived after accidents and subsequent insurances — for example, if the policyholder takes out private insurance for their newborn child or their partner after marriage.
Conclusion: Is private health insurance worthwhile?
Private health insurance is particularly worthwhile if it is taken out at an early age when there are no pre-existing conditions. The scope of benefits of private health insurance almost always significantly exceeds the standard benefits of statutory health insurance. By choosing the right tariff, you can put together your tailor-made insurance cover.
It is important that you can afford the insurance in the long term and in the event of changes in your personal life situation. A crucial point here is starting a family — private health insurance does not provide for premium-free co-insurance for spouses or children.
Expats in Germany can find particularly high-performance offers for private health insurance from digital insurers such as ottonova or Feather.
Frequently asked questions
In terms of benefits, private health insurance is usually the better choice. Young, healthy policyholders also benefit from low premiums. However, there is no non-contributory family insurance in private health insurance — families with children should therefore think carefully about switching from statutory to private health insurance.
If your income falls below the compulsory insurance threshold, a return to statutory health insurance is usually unavoidable. If it is foreseeable that your income will rise again in the future, you can take out qualifying insurance for your private health insurance — you can then return to private insurance without having to undergo a new medical examination.
There are two exceptions: In the case of part-time work after parental leave, private insurance can remain in place if the income from a full-time position would be above the compulsory insurance threshold. Who choose private health insurance cannot return to statutory health insurance regardless of income.
Termination of a private health insurance is not advisable for two reasons. Due to your advanced age and previous illnesses, you usually must expect a significantly higher premium when you choose a new private health insurance company. You would also lose some of your old-age provisions. It is better to switch to a different tariff with your current insurer.
