How does the German healthcare system work for families?16 February 2023 | Before Your Baby is Born | By Lisa H
As an international couple expecting a baby or a family moving to Germant from abroad, it’s even more important to understand the German healthcare system. So here are the basics you should know.
This article was written in collaboration with Dr. Claude Grenzbach, who is a pediatrician with a private practice in Berlin-Mitte. She provides personalized medical care with the focus on preventive medicine, pediatric pneumology and allergology.
First of all, you should know that there are two different types of health insurance in Germany: private insurance and public insurance.
90% of people living in Germany are publicly insured with the remaining 10% being privately insured.
So what are the differences between private and public insurance?
Private Health Insurance 101
Private insurance is only available to those who are not subject to compulsory insurance: these are self-employed individuals, civil servants and all employees with a salary above the compulsory insurance threshold of €66,600 per year (as of 2023).
Your premium will depend on a couple of factors: One is the scope of the benefits and the second is the individual’s risk, which is calculated by a combination of the individual’s age, health condition, employment and gender.
It’s important to note that there is no family insurance for privately insured individuals – family members need to have their own private insurance.
Also, you will pay for your doctor’s visits, treatments and medication out-of-pocket. After submitting your paperwork, you will be reimbursed by your insurance.
The benefits of private health insurance include better services at the family doctor or dentist and in the hospital. Privately insured individuals will likely get specialist appointments faster and benefit from shorter wait times.
Public Health Insurance 101
With public insurance, you join one of the nearly 100 different public insurances, with Techniker Krankenkasse (TK), AOK, Barmer, DAK, IKK being some of the biggest ones in Germany.
As an employee, half of your insurance premium is paid by your employer, the other half is automatically deducted from your paycheck. You can also be voluntarily insured with a public insurance company, for example if you are self-employed. In this case, you pay the whole premium yourself.
If certain conditions are met, you can insure family members free of charge.
Depending on your health insurance, different services and treatments may be covered, so think about what’s important to you when you choose your insurance (such as alternative medicine, bonus programs but also specific contributions during pregnancy and for children’s treatments).
Usually, you need to stay with your health insurance for 12 months before you can switch to a different one, if desired, for example when you find out you're expecting a baby.
If you’re publicly insured, you can visit both doctors working with the public insurance companies (for your standard treatments, these visits will be free of charge) and private doctors. However, if you visit a private doctor, you will need to pay out-of-pocket. For example, Dr. Claude’s fees range from €60 to €180 per appointment, depending on the type of appointment and treatment.
Why would I want to visit a private doctor if I am publicly insured?
You may be able to get an appointment sooner with a private doctor, although, as an example, current wait times in Dr. Claude’s practice are still around 4 weeks. If you’re new in town and urgently need a doctor (to get medical paperwork done to start Kita, for example), then visiting a private doctor may be a good solution.
It may also be easier and faster to get an appointment for special treatments such as Ergotherapie (occupational therapy) if you are paying out-of-pocket. Finally, certain types of specialists, such as osteopaths, are only covered by a few public health insurances, so you may also have to pay out-of-pocket for these types of appointments.
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