10 key things you need to know about healthcare in Germany

If you’re living in Germany or thinking of making it your home, you’re in luck. Germany’s healthcare system is widely regarded as one of the best in the world, and ranks above the OECD average on most key indicators as of 2023.

Navigating a foreign healthcare system can be a little tricky for any foreign resident, especially new arrivals. So we’ve created a guide to some of the most important aspects of Germany’s healthcare system. 

Do I need health insurance?

Yes. Health insurance is mandatory for all German residents, so you’ll need to take out a form of insurance even if your current policy from your home country covers you whilst in Germany. 

The German health insurance system operates through two co-existing insurance types; private and public.

If you’re working in Germany, you’ll need to be covered by one of the two. Some visas allow for a special expat insurance instead, however, there are specific requirements for this. 

How does public insurance work?

Public health insurance, or Gesetzliche Krankenversicherung (GKV), is the most common form of health insurance in Germany. The German Bundesministerium für Gesundheit (Health Ministry) estimates around 90 percent of the population are signed up to GKV funds.

If you opt for public insurance, you’ll pay a monthly premium to your health insurance provider, which is calculated according to your income. Your employer will also pay mandatory contributions to your insurance. 

You have free choice of your health insurance fund, with over 100 public health insurance funds to choose from. Each will provide you with different levels of benefits and coverage, so it’s wise to take a close look at the fine print for each option. 

READ ALSO: Can you switch from private to public health insurance in Germany?

Public health insurance pays for healthcare that is „sufficient, appropriate and economic“. This includes medical treatments, prescribed medications, vaccinations, psychotherapy, and allied health care. Your health insurance will also pay the cost of hospital treatments, if the need arises. 

While most treatment providers will charge the cost of your care directly to your health insurer, some healthcare costs require a co-payment. This includes prescriptions and hospital care, however, the co-payments are generally small and scaled to your annual income.

Your public health insurance will also pay you a sickness benefit, or Krankengeld, if you’re certified unfit for work for more than six weeks. 

If you’re coming to Germany to work for a company, this is most likely going to be the best form of insurance for you. However, if you earn over a certain amount, or are self-employed, you may have to opt for private health insurance. 

When you sign up to a public health insurer, you’ll be given the all-important Gesundheitskarte (health insurance card). It’s important to always bring this with you when accessing any healthcare services. It's also helpful to carry it around all the time in case of an emergency. 

What about private insurance?

Private health insurance, or Private Krankenversicherung (PKV), is the other form of health insurance in Germany. 

If you’re self-employed, a small business owner, a freelancer, or work in the public service, you’ll most likely have to sign up for PKV, although there are still notable exceptions to this.

If you earn over the compulsory social insurance threshold - currently set at €69,300, according to the Verband der Privaten Krankenversichrung - you become eligible for private insurance. 

Premiums for PKV are calculated based on a risk assessment done by the insurer, and generally vary based on your age and health. It’s important to note you can be rejected by a private insurer if you’re deemed too risky to cover. This isn’t the case with public health insurance. 

If you’ve come to Germany with dependents, such as children or a spouse, they also aren’t automatically covered by your private health policy and will generally require separate premiums. 

READ ALSO: How creative freelancers can pay less for German health insurance

If you decide on private insurance, you’ll have to cover the upfront costs of seeing doctors, going to hospital and obtaining medication. You’ll be either fully or partially reimbursed afterwards by your insurer. 

PKV might not be for you if you hate being bogged down with admin tasks, as claiming the payments from the insurer means filling in forms in German, although there are some providers that offer services in English.

If you’re a member of a public health insurance fund, you can take out additional cover with a private insurer to cover you for certain benefits, such as comprehensive dental treatment. You’ll bear the cost of any additional coverage yourself. 

What about expat insurance?

Another option is expat insurance, also known as incoming insurance. It provides coverage for people newly arrived in Germany and is suitable for some visas without work contracts. 

Temporary expat insurance could act as a good stopgap if you’ve just entered the country, but it doesn’t provide as comprehensive a coverage as PKV or GKV.

Coverage varies across providers, and you’ll generally have to pre-inform them of appointments and other medical care and be reimbursed. 

However, if you’re planning on renewing or changing your visa soon, it’s worth mentioning that having expat health insurance isn’t sufficient. You’ll need to be covered by a public or private insurer for it to be approved. 

Finding a doctor 

If you don’t speak German, the prospect of finding a doctor might seem a little daunting. Fortunately, there are plenty of services to help you find a doctor who works in your native language. 

A site like doctolib.de is a fantastic resource for finding and booking appointments with a variety of different health practitioners, from GPs to cardiologists.  

READ ALSO: What you need to know about making a doctor's appointment in Germany

How GPs work in Germany

General Practitioners, or Hausärtze, either operate by themselves as solo, practice-based physicians or within a medical centre. While registering with a local GP is encouraged, it isn’t compulsory. 

GPs in Germany can provide prescriptions, offer vaccinations, perform minor medical procedures and conduct routine check-ups. You’ll need to book an appointment in advance, but some GPs offer open hours where you can wait in the practice to be seen (and expect long waits).

Unlike many other healthcare systems around the world, GPs in Germany don’t act as a gatekeeper to more specialised care. While you won’t need to see a GP for a referral to a specialist such as a dermatologist or gynaecologist, there are a few specialities (such as radiology and laboratory services) which are exceptions to this. 

Seeing specialists

Free choice of medical practitioners is a core principle of the German healthcare system, so you’ll be able to pick and book appointments with specialists without a referral from your GP in many cases. 

When searching for specialists, you’ll likely see some specialists are only available to those who are privately insured or self-paying. Finding a specialist who works with publicly insured patients is possible, however the wait times will likely be a little longer. 

If you have any questions, your health insurer or your GP should let you know how you can access a specialist doctor. 

READ ALSO: How to get a faster appointment with a specialist doctor in Germany

What about the dentist?

Public health insurance doesn’t fully cover dental care. While basic dental is covered, such as a yearly checkup, many German residents rely on supplementary private insurance for more comprehensive dental treatments because care can be expensive.

However, you should check with your insurance to see what extra dental services are covered. For instance, some insurers contribute a one-off payment to supplement teeth cleaning, but they won't explicitly tell you this information when you take out insurance. 

Pharmacies and medicine 

If you’ve been given a prescription by one of your physicians, your next stop should be at a pharmacy, or Apotheke to have it filled. 

You’ll typically have to present your Gesundheitskarte to the pharmacist, and depending on your health insurance you might have to make a co-payment for the medication. This will be a maximum of 10 euros and a minimum of five euros. 

If Sunday rolls around and you find yourself in need of a prescription, there are emergency pharmacies, known as Notdienst-Apotheke, which operate on a rotating schedule within one area or district. You’ll generally be able to find the schedule at your regular pharmacy or online.

If having prescriptions delivered to you works better, there’s a service called MAYD which will deliver anything you need from your local Apotheke to you.

READ ALSO: The new rules on digital prescriptions in Germany

Going to hospital  

Germany has a comprehensive hospital network, with most people able to reach an acute care hospital within 30 minutes by car. 

The quality of hospital will depend greatly on where you live. Federal states are responsible for hospital care, and some operate better hospitals than others. 

When you arrive at a hospital, you’ll need to have your Gesundheitskarte on you for the registration process. The hospital will need to know about your health insurance status for the billing process. 

It’s also important to note here that the disparity between public and private insurance is most apparent when it comes to hospital care. If you’re privately insured, you will generally have better access to more senior doctors, your own room, and be seen faster.