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 Charité, Berlin’s largest clinic. If you want to get treated here, you need… health insurance!

Who can get which insurance policy?

First things first: Which one can you get at all?

Public Health Insurance:

  • Everyone

Private Health Insurance:

  • Self-employed / freelancers or
  • Students (must setup within first 3 months after enrolment) or
  • employees with a gross salary above 59400 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.

Good things 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

For Students

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 you can get. (However, you need to be under 30.)

For Freelancers

For freelancers, they calculate your rates by your income: Roughly 16% of what you make goes to them.

The tricky thing: They have a minimum assessment base (Mindestbemessungsgrundlage). It means that they assume you make at least 2283 EUR per month – no matter how much you actually make. So you will pay at least around 365 EUR per month.

(Yes, this is unfair, and freelancers are complaining about it for years already. Rumours are that this might change with the new government coalition.)

What can save you: If you are a founder and get funded by a founder allowance (Gründungszuschuss) from the Jobcenter, this base gets reduced to 1522 EUR, leading to a monthly insurance contribution of only around 245 EUR.

Employees

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 or more but the following ones offer information and forms in English:

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.

Employees

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

First of course, you need to find one. The easiest way is to look around on the Internet for comparisons. I’ve also included one here, simply fill out the form here to get an individual offer for yourself:

Comparison of German Private Health Care Options

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.

Summary

  • 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 give it a try in the form above.

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!

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