Germany

Understanding the healthcare system in Germany. 

In Germany, health insurance is mandatory to make sure that every resident has equal access to healthcare, regardless of their income or health status. The country operates a dual healthcare system, with both public (statutory) and private health insurance options. The public system, regulated by the Federal Ministry of Health (BMG), is used by most residents. It’s administered through non-profit public health insurance providers known as Gesetzliche Krankenkassen (State Sickness Funds), such as AOK, Techniker Krankenkasse and Barmer. 

Public health insurance contributions are based on your income. The minimum contribution is 14.6%, which is shared equally between employer and employee. If you earn €57,600 or more annually, you may opt out of the public system and choose private medical insurance (PMI). Additionally, PMI is available as a supplement for those looking to cover extra benefits such as dental care, private hospital rooms and more. 

Accessing public healthcare in Germany is straightforward with an electronic health card (eGK), while PMI requires a pay-and-claim system where you pay upfront and file a claim for reimbursement later.

Germany’s health insurance requirements for expats and student travelers. 

Regardless of your status as an expat, student or freelancer, Germany requires that you have health insurance if you plan to stay long term.

Expats and International Workers 

If you’re working in Germany, you’ll likely be eligible for public health insurance if you’re on a local payroll. Contributions are automatically deducted from your salary, and you’ll have full access to the public healthcare system. However, if you earn above €57,600 per year (about $63,000 USD), you can opt for private health insurance. 

If you’re an expat staying in Germany but working on a foreign payroll, you can maintain your existing health insurance from your home country. However, to apply for a visa, you’ll need to show proof of adequate coverage. The health insurance policy should cover essential services without substantial exclusions, have reasonable deductible limits (typically no higher than €300 annually) and ensure comprehensive coverage for illness or injury. 

Local authorities may interpret these federal regulations differently, and some regions might require additional documentation or insurance policies regulated by Germany’s Federal Financial Supervisory Authority (BaFin). 

Students Studying Abroad in Germany 

International students under 30 years of age must have health insurance to study in Germany. They can choose to enroll in the public system (GKV), or if they prefer private insurance, they must apply for an exemption. However, once a student opts out of the public system, they cannot return. The public system covers essential health services, including medical, dental, hospital care, preventive measures and even benefits like sick pay if you’re unable to work.

Regional differences in health insurance requirements. 

Germany is divided into 16 states, and while national health insurance laws apply across the country, local authorities may have different interpretations and requirements. Some areas might have stricter rules, especially when it comes to the acceptance of foreign health insurance policies. For instance, the cities of Hamburg, Munich and Nuremberg may have more restrictive guidelines for foreign insurance policies, making it harder to have them accepted without additional modifications. 

When applying for health insurance or exemptions, be prepared for possible local variations and ensure your policy meets the criteria for your specific region. If you’re unsure, it’s best to consult with local authorities, an insurance expert familiar with the region or an international health insurance provider like Blue Cross Blue Shield Global Solutions^SM. 

Practical considerations for accessing healthcare in Germany. 

Once you’ve secured health insurance, understanding how healthcare works in Germany will make accessing care easier.

Arranging Appointments 

German doctors typically have limited office hours in the afternoons, and many doctors prefer walk-in patients during specific hours. If you need an appointment, be prepared to visit during the available walk-in hours or wait for an available slot. The system may feel different from what you’re used to, but this approach is common in Germany.

Non-Contracted Providers 

If you seek care outside your health insurer’s network, you may encounter issues with direct billing. Germany's healthcare system often works on a pay-and-claim basis, meaning you may need to pay the provider upfront and then submit the receipt for reimbursement. This can sometimes be tricky, especially if the provider doesn’t fully understand how deductibles work. Be prepared to pay the invoice yourself and then submit it for reimbursement through your insurance. 

By securing health insurance that meets local requirements and understanding the practicalities of the German healthcare system, you can ensure a smooth and worry-free experience during your long-term stay in Germany.