How much does health insurance cost in Germany?

Health insurance is mandatory in Germany, and so expats often get signed up for cover by their employers without really knowing what exactly they are paying for, or even how much it costs. Expat health insurance experts ottonova are on hand to explain exactly what’s going on with health insurance in Germany. 

The German healthcare system is among the best in the world. Since 2009, when the government made it mandatory to have health insurance, everyone resident in Germany has been guaranteed healthcare if they fall ill. 

As an expat living in Germany, you too can enjoy the benefits of cutting-edge medicine and the security of universal healthcare. First, however, you face the same choice as everyone else: deciding between two insurance systems. 

In Germany, there are two types of health insurance: statutory health insurance (gesetzliche Krankenversicherung - GKV), also known as public health insurance, and private health insurance (private Krankenversicherung - PKV). 

So that you can make an informed decision and choose the system best suited to your healthcare needs and life - and know what you can expect to pay for each kind of insurance - this article compares the two systems in clear, uncomplicated terms. 

Facts please!

Let’s start with a few simple facts about health insurance in Germany: 

• Insurance is mandatory: Health insurance is mandatory for everyone living in Germany. This obligation is called Versicherungspflicht.  
• Visa: Depending on your nationality, how long you plan to stay, and your employment status in Germany, you may need to obtain a visa before being allowed to travel to Germany - and having health insurance is often a requirement for this. 
• Private health insurance: Not everybody is eligible for private health insurance in Germany. To qualify, you must earn more than 64.530 euros per year, be a civil servant, or be self-employed. 
• Health certificate: Expats usually need to pass a medical examination in order to be approved for private health insurance.  

Public versus private healthcare in Germany: At a glance 

Unclear about the key differences between public and private health insurance? The video below explains all in three minutes: 

The cost of public health insurance

Now that we’ve taken care of the basics, let’s move onto the big question: how much does health insurance cost in Germany? 

The truth is, people with public health insurance (by which we mean people covered by insurance companies like AOK, TK, BKK and so on) are often unaware of how much they pay for their insurance each month. 

This is because their premiums are not taken from their bank account; instead, they are deducted from their paycheck as a percentage of their salary, just like taxes. So, if you take out public health insurance, the easiest way to find out how much you’re paying is to examine your payslip. 

Public health insurance premiums in Germany are calculated as a percentage of your salary, up to a so-called “contribution ceiling” (Beitragsbemessungsgrenze), a maximum salary limit beyond which no premiums are due. Your contribution is split equally between you and your employer, so that you pay 7,3% each.

Health insurance funds are also entitled to charge an “additional contribution” (Zusatzbeitrag) of up to 1,6%, which is also shared equally between you and your employer. In addition, you are obliged to contribute to long-term care insurance (Pflegeversicherung - PV), which covers you in the event of your needing care due to old age, accident or illness. 

But what does this mean, in concrete terms? The example below should give you an idea of how high your monthly premiums might be with public health insurance, assuming a gross monthly salary of 5.400 euros: 

When might private health insurance work out cheaper?

Even with the contribution ceiling in place, the fact that public health insurance premiums are charged as a percentage of one’s salary means that top earners could be paying up to around 890 euros per month. This is why those on higher salaries are allowed to opt for private health insurance instead - it may work out cheaper. 

Rather than as a percentage of one’s salary, private health insurance premiums are calculated using several factors, such as your occupation, your age and your pre-existing medical conditions. Even if you opt for private health insurance, you can still split your contributions with your employer - up to a maximum of approximately 385 euros per month. 

To illustrate this, take a look at this comparison chart of the cost of both public and private health insurance for a single, 30-year-old employee with an income above the assessment ceiling: 

Making an informed decision

Totalled up across their life, the average German will pay 250.000 euros in public health insurance premiums. Even as an expat, your premiums will still mount up. Given the sums of money involved, it seems baffling that some people leave their choice of health insurance to chance. 

Wherever large sums are involved there is scope for savings. For expats, private health insurance can actually often work out cheaper. 

By signing up with ottonova, you could save a lot of money - and still get much better coverage compared to health insurance. Non-EU expats could save even more, by taking advantage of the special ottonova expat tariff.