Public or private – especially as a freelancer/self-employed you have to choose your health care option in Germany. Read here about their costs, practical usage, and setup process.
The Simple Cases
The German healthcare system is divided into a public and a private sector, so your first decision will be to choose between one of them, and then also pick a particular option.
That decision can be challenging – but often enough, it is also very easy – if your case is simple.
This is why I start out with the very simple cases where there’s only one option possible or recommended – so if this situation applies to you, you don’t need to read more than necessary.
I am employed in a regular job
If you are employed in a regular job (not a so-called Minijob with 450 € / month), and you are making less than 60,750 € gross per year, then you have no choice: By law, you have to get a public option. (There’s even an English-speaking one!)
I am a student under 30
As a student (at a regular university or Fachhochschule) under 30 years of age, you can go both to public or private, but public is almost always the best choice.
I am a (young) freelancer from outside EU/EEA and plan to stay only a few years in Germany
Very likely, a private option will suit you better: Being young, your rates will be rather low, and as a non-EU/EEA citizen without a long stay, you don’t need to pay premium reserves, so your rates can be only half as high as regular ones.
I am employed with >60,750 EUR gross per year
Then you can (but don’t have to) leave the public option and go for a private one. Again, Feather and Ottonova* can give you a free consultation in English, and Foyer a quick quote just on their website.
I am a student from outside EU/EEA and first need a visa
Then check out Fintiba*: They provide a package, consisting of
- a public health insurance policy after your studies started
- in case you arrive before uni starts: a private option to cover this time
- and a blocked bank account
None of these cases… but I still want someone else to figure out what’s best
Then you need an insurance broker for incoming health insurance or expat health insurance. And the most trustworthy one I think is Feather*.
Usually, brokers focus on private options because there’s much more commission money in that field. Not so Feather. They also do public options, know the little details important for expats – and they speak English. I’ve met them even in person here in Berlin and had a good impression.
I am in trouble right now because of no (sufficient) health insurance
Even people without insurance can get treatment. Please contact the Clearingstelle by phone or e-mail. They will then provide you with a Kostenübernahmeschein (certificate for the coverage of the costs) with which you can go to a physician in Berlin.
They also can counsel you in many languages, read more here.
Still reading? OK, then we have to dive into the details.
Who can get which insurance policy?
First things first: Which one can you get at all?
Public Health Insurance:
Private Health Insurance:
- Self-employed / freelancers or
- Students (must setup within first 3 months after enrolment) or
- employees with a gross salary above 59,400 EUR per year
So as everyone can get public ones, only some of you can get a private option.
How do they work in practice?
Using a Public Health Insurance
With a public health insurance, you get a chip card and can go to doctors who accept publicly insured patients. Nearly all of them do, however some might give earlier appointments and better treatment to privately insured.
The good thing is: There is nearly no paperwork to do for you. You simply go, show the card and if they accept it they will treat you and will deal with your health insurance on their own.
Using a Private Health Insurance
This is different with private insurances: There, after the treatment, you will receive an invoice from the doctor which you then need to send to your insurance. They will then pay the costs to you, so you can pay your doctor.
Problem: If there’s any issue with the invoice, and your private insurance does not want to cover it then you have to deal with it: Ask the doctor what went wrong, go back to the insurance and so on.
On the plus side: Private insurances often cover more things than public ones, and doctor’s are often happier to accept you – since they can bill higher rates.
How much do they cost?
Costs of a public health insurance option
Students are the easiest: A fixed fee of around 70 EUR per month needs to go to them. That is by far the cheapest and simplest option (compared to the coverage you get). (However, you need to be under 30.)
For freelancers, they calculate your rates by your income: Roughly 16% of what you make goes to them.
However, they have a minimum assessment base (Mindestbeitragsbemessungsgrundlage). It means that they assume you make at least 1038 EUR per month – no matter how much you actually make. So you will pay at least around 171 EUR per month.
Your rate is calculated by your (actual) income, it will be all done by the bookkeepers of your boss, so nothing to worry or deal about.
Costs of a Private Health Insurance
Private Insurances don’t care about your income, they practically only go by your age, gender and health status / history. So their rates can be very different, depending totally on you.
They often also offer a deductible (Selbstbehalt): For instance, with a deductible of 1000 EUR per year, you will pay the first doctor’s invoices up to 1000 EUR from your own pocket, only the ones above will be covered by your insurance.
Why would you want a deductible? Usually, it makes your monthly rates much lower. So if you rarely go to the doctor and just want to be covered in cases where you get hit by a truck or similar, a deductible might be a good option.
Roughly speaking: If you’re a freelancer, healthy, very young and male, then a private health insurance (with a high deductible) starts at 120 EUR monthly. But since there are a zillion options and tariffs from private insurances, I’ve included a calculator at the end of this page.
How to setup an insurance policy?
Setting up a public health insurance policy
First, you need to pick one. There a quite a dozen option or more but their coverage of treatments is almost the same, as they are regulated by the law. There might be only some little benefits and plusses where they try to distinguish against each other.
However, most expats are happy with TK, because they are among those ones with some English communication skills. And there’s even a nice signup service:
The simplest way: SignupTK.de
SignupTK.de* provides neat signup form, completely online and in English. And before they submit the data to TK, they check your data and will message you if something is missing or seems incorrect.
And the best: SignupTK’s submission service is completely free for you!
If you want to pick another public option, then these English speaking links might be useful:
They also have English-speaking signup services:
If you’re employed in a regular job then things are simple: Most of the setup work will be done by your employer, so you shouldn’t worry too much about the process. Your health care contributions will also be deducted automatically before you receive your net salary.
Students and Freelancers
If you’re a student or freelancer, you have to take the steps on your own:
- Choose one of the public insurances
- Find their registration form, either
- for students (Studenten)
- for freelancers (Selbständige / Freiberufler).
- On the form you might be asked how much your current income is. (Yes, you will need to predict your income of the upcoming year.)
For freelancers: Your monthly rates will then will be calculated by your provided income.
Somewhen later you will send in your tax declaration and receive your tax bill, finally stating your actual income of that year. This tax bill you send to your health insurance, and they will reactively recalculate your rates. If you predicted more than you actually made, you will get money back, otherwise you will need to pay the difference.
Freelancers: How to estimate your future income?
Many freelancers wonder how they shall predict their future income. In fact, that’s often hardly possible. You simply have to make a (rough) estimation, and nobody will be angry if you will diverge from it a lot.
And here’s a BerlinCheap tip: I recommend to make a rather low estimation, pay low rates – and at the same time save up some additional money, ideally on an account with an interest rate. Then, after handing in your tax bill, you will need to make the additional payment – but that’s ok, you saved it up on your savings account and gained some interest rates on the side.
Setting up a private health insurance policy
In the private sector, there are many more options, with very different prices. So a good way is to first find an honest insurance broker that you trust, that can show you the most suitable options for you.
Feather is such a Berlin-based broker. They will thoroughly look at your situation and even point you to a public option if they notice that your case fits better there.
You can book an appointment for a free consultation here:
Besides, I know about two further good offers: Foyer Global Health insurance and Ottonova. Foyer will even give you instantly a quote online, after giving them only your age, gender and what coverage you need:
And then there is Ottonova, a new, English-speaking insurance from Munich, coming with a fancy smartphone app where you can manage everything online. You can book a free English consultation on the phone, too (and practice understanding a Bavarian accent 😉 ):
After having found your option, you will need to provide your medical history to the insurance company, things like operations you had and especially ongoing conditions and illnesses. Based on that data they will calculate your contributions.
- If you’re employed and making less than 60k per year, it’s easy because you have no other choice than the public one.
- If you’re a student under 30, the public system is likely the cheapest and easiest for you.
- If you’re a freelancer and young (under 25 or 30), you probably can find a good deal with a private option. I’d say, just get a free consultation with Ottonova* or via Tarifcheck.
For all the other cases, it very much depends on your situation.
What is also relevant: Changing / going back from the private to the public system can often be difficult, especially when you’re older like after the age of 55. So keep that in mind if you settled long-term in Germany – if you’re just here for some years, you can ignore that.
I hope I could give you some insight into the pros and cons of both systems. Feel free to ask a question in the comments, though!
Update March 2020: Find more guides on Expatwiki’s article about German health insurance.
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