Germany spends more than 390 billion euros in healthcare on its population of 83 million inhabitants. Health insurance funds cover these costs. It is mandatory to have health insurance, but because of private and statutory health insurance, the system can appear complicated to foreigners. We’ll go over the different health services in the country and explain which type of health insurance covers what.
The German healthcare system
The German healthcare system is based on social insurance: health insurance funds finance medical care with contributions from employers and with contributions and premiums from members 87.7% or approximately 72.8 million of the population have statutory health insurance, while 10.5 % or 8.7 million have private health insurance. There are just a few more than one hundred health insurance funds in Germany.
For private health insurance, how much you pay depends on your age and health, while contributions to statutory health insurance are based on your income. Those who earn more than a certain threshold (€5,212.50 in 2020) or work in specific professions can opt for private health insurance. With statutory health insurance, everyone receives the same level of services.
Still confused about the statutory and private health insurance in Germany? We’ll show you how to get coverage!
Where do you receive healthcare in Germany?
Around 5.7 million people work in healthcare in Germany. The healthcare network consists of nearly 2,000 hospitals, 150,000 doctors, roughly 30,000 outpatient care facilities and close to 20,000 pharmacies.
Germany’s complex healthcare system is divided into three levels:
- The federal government, the individual states and the municipalities provide a political and legal framework.
- Associations and bodies define the structure of the system.
- Patients receive care by health insurers, doctors, healthcare professionals, hospitals and pharmacies.
The statutory health care spending is roughly divided as follows, giving you an overview of what treatment patients need:
- 34% hospital treatment
- 17.5% treatment by doctors
- 17% medicines
- 7% medical products and aids
- 6.5% dental care
- 18% other, such as nursing care and prevention
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You receive inpatient treatment at Germany’s nearly 2,000 hospitals, most of which will treat you regardless of the type of insurance you have. Your doctor will refer you for treatment at a hospital, except in emergencies when you show up at the ER.
As a patient, you can choose the hospital you want. Private companies, non-profit organisations and municipalities run hospitals in more or less equal proportions. With statutory health insurance, a hospital stay will require a supplementary charge for accommodation and meals, which is defined in a contract between you and the hospital.
Outpatient care providers are independent doctors, that is general practitioners and specialists as well as dentists, therapists and other healthcare professionals. If you have statutory health insurance, the care provider needs to be approved by the health care fund, which is the case for most independent physicians, dentists and therapists.
When you make an appointment for the first time with a doctor, they’ll typically ask which insurance you have. Statutory health insurance will cover basic care and treatment. This is based on contracts between the insurance funds and the doctor’s associations. Some treatment will require a premium or is simply not covered by statutory insurance.
You can fill in a prescription from your doctor at any pharmacy. The prices for medication are regulated, meaning the price is the same across the country. Statutory health insurance does not cover over-the-counter drugs. For medication that is prescription only, there is a supplementary charge of 10% with a minimum of €5 and a maximum of €10.
The total costs for medicine per year are capped at 2% of your annual income. Statutory health insurance also means that your doctor will also prescribe the cheapest medicine, which in most cases is a generic drug with the same active ingredient.
Rehabilitation and nursing
Rehabilitation is available both on an outpatient or inpatient basis at facilities and through caregivers. Rehabilitation helps patients resume their normal lives after an illness or incident in the form of therapy and support.
Nursing care is covered by long-term care insurance, which is part of Germany’s health insurance. However, the insurance doesn’t assume all the costs of nursing care and the patient, their relatives or social security has to make up the gap.
Germany also dedicates healthcare and social security resources to promote healthy living and prevent illness. Statutory and private insurance companies support their insured with advice on diet and healthy food, exercise and relaxation programmes and incentives to stop drinking and smoking.
These measures can differ from one health insurance provider to another. Examples are supplementary payments to your gym membership or yoga class, classes to correct your posture, a payback bonus when you stop smoking, don’t require medicine, or exercise regularly.
Which healthcare costs does German health insurance cover?
All health insurance providers in Germany have to cover a mandatory minimum regulated by law. Therefore more than 90% of the services which statutory health covers are therefore identical across providers. The main differences are in dental, nursing and preventative care as well as in services for other family members. Private health insurance is more flexible, allowing you to choose a more custom plan specific to your needs. As a rule of thumb: the more you want, the more you pay.
Statutory health insurance coverage
For a complete list of covered health services, ask your individual statutory health insurance provider. The mandatory minimum includes regular check-ups, standard vaccinations, treatment and aftercare in case of accident as well as therapy for serious, long-term illness. You are free to choose your general practitioner, specialist and hospital as long as they work with statutory health insurance.
For a hospital stay, you have to pay a charge of €10 per day for a maximum of 28 days per year. Note that you don’t get a private room. Prescription medication is covered except for a supplementary charge, we previously mentioned, of 10% with a minimum of €5 and a maximum of €10.
Insurance covers recommended cancer examinations for women from the age of 20 and for men from the age of 45 on. For therapy such as physiotherapy, speech and occupational therapy, there is a 10% deductible as well a €10 charge per prescription. The cost of psychotherapy is completely covered in case of therapists which work with public health insurance.
Statutory health insurance covers regular dental treatment, but implants, dentures and dental prostheses are only covered up to 50% of the “standard” therapy, which is most likely only the cheapest option.
Medical aids and technology such as a wheelchair, prostheses or hearing aids are covered up to a fixed amount.
Private health insurance coverage
If you have private health insurance in Germany, you can elect which options and services you want to include in your plan. Among the major differences to statutory health insurance are benefits for dental treatment and implants, extensive inpatient and outpatient treatment and a daily allowance in case of sickness when you’re self-employed. Read our guide on how to get private health insurance in Germany to learn more.
You can choose to include alternative practitioners and alternative treatment in your private insurance plan. The range of services is the main factor for the higher cost, but insurance providers must also offer a standard, a basic and an emergency plan.
The most important aspects of private health insurance coverage are:
- Coverage of doctor’s fees up to 3.5x the rate of the listed fee
- Coverage of dental implant costs of at least 60%
- Payment for dental treatment of at least 90%
- Hospital stay in a twin room or better and treatment by the head physician
- At least 75% coverage of the cost for medical tech and aids
Getting sick? In need of a check-up? Want to schedule an appointment? Learn useful phrases and vocabulary for going to the doctor in Germany!