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An expat's guide to health insurance in Germany – for freelancers (2020)

Business tips · 09/10/20 06:00 · Daniel McLeod

Healthy snack

Your health is the most important thing in your life. It's also the solid foundation of a successful career. But... life is unpredictable. That’s why health insurance is mandatory in Germany. There's no way around it, doctor’s orders. And the market is big. 

As a freelancer, you have a range of options to choose from. Here's our guide through the Wirrwarr (that's chaos) of German health insurance.

 

 

Statutory health insurance (Gesetzliche Krankenversicherung)

The first and most popular form of health insurance is statutory, or public, health insurance – in German, Gesetzliche Krankenversicherung (GKV). Most Germans (approx. 73 million people) use GKV. As an employee, becoming a member of a GKV provider is mandatory if you earn less than €4,800 a month. However, as a freelancer or sole trader, you can choose whether you join a public or a private insurance company.

Health insurance under GKV covers a standard set of benefits, with some companies offering additional plans, e.g. a Zahnzusatzversicherung for dental work, or plans covering homoeopathy, naturopathy and massage therapy. Mmmmm, yes please.

 

How much does German statutory health insurance cost?

The GKV Beitrag –  or membership fee/premium, in English – amounts to 14.6% of your income. In 2020, the minimum monthly income taken into account for calculating your Beitrag is €1,038 per month. (This is an improvement: until 2019, the self-employed paid contributions based on projected monthly earnings of €2,284.)

This means that if your income is lower than €1,038 per month, you still have to pay 14.6% of that €1,038. So, for example, if you earn €900 per month, your contributions will be calculated as if you earned €1,038 a month. Not ideal.

On the other hand, the maximum income is €4,688. If you earn more than €4,688 per month, you do not pay a higher insurance premium. If your income is between €1,038–€4,688, your Beitrag will be calculated accordingly.

 

How to choose a German statutory health insurance provider

Of the 108 GKV providers – or in German, Krankenkassen, literally ‘sickness funds’ – some have millions of members and others have only a few thousand. Despite this, their service remains fairly consistent across the board, as every GKV provider must meet the government’s minimum regulations for healthcare provision. So, how do you choose?

Additional contribution rate (Zusatzbeitrag)

On top of the 14.6% of €1,038 per month, some GKV providers charge an ‘additional contribution rate’ (Zusatzbeitrag), which can change year to year depending on healthcare expenditure.

The additional contribution rate varies between providers (from around 0.3–1.1%) and is payable based on a percentage of your income. It can also come with added benefits, such as:

  • Professional tooth cleaning or dentures
  • Flu and travel vaccinations
  • Cancer screening under 30
  • Osteopathy
  • Homoeopathy
  • Contraception

Additional contribution rates are one factor to consider when choosing a German health insurance provider.

English-speaking GKV providers

Another factor to consider is English language support. The three most common GKV providers are:

All three providers offer services in English, including English websites and English-specific phone support lines.

 

Tip – Krankenkasse comparison site

If you have a German-speaking friend, you can also run through this German-language Krankenkasse comparison website together. It’ll help you dive deeper into different GKV plans.

 

 

 

 

This is a private banana

Private health insurance (Private Krankenversicherung)

As a freelancer or sole trader, you have the right to use private health insurance – Private Krankenversicherung (PKV) – at any time. When it comes to PKV, you have an advantage over employees, as you don’t need to earn a certain amount to be eligible.

PKV (private) can be less expensive than GKV (public). This depends on many factors, including your ‘risk profile’ – if you’re young and in good health, your costs will be lower than if you’re older with a chronic disease. You can keep costs low by adapting your plan to your needs. But as life unfolds, unexpected things can happen.

 

Private health insurance co-payments (Selbstbeteiligung)

In case of an accident or a complicated illness, things can get expensive if treatment is too specific and not covered by your plan. This is where co-payments, also known as deductibles or excess (in German, Selbstbeteiligung) come in. 

Private health insurance works like this: each month you pay a monthly premium (Beitrag) and choose a level of excess. An excess of €200 means that if anything goes wrong, you pay €200 before your policy kicks in. It’s a trade-off. You can choose a private plan with less co-payment, but then your Beitrag will be higher.

 

Tip – Ask an insurance expert (it's free)

Ask a private insurance provider about co-payments directly. While you’re at it, ask about other discounts, too! If you have the savings, it might be possible to save money by paying for a year’s insurance upfront.

 

Private health insurance benefits

PKV comes with perks, too. You can expect easier access to specialists as well as better treatment in hospitals. More expensive plans guarantee the chief physician taking care of you personally. But it all comes at a cost. It’s important to do your research, otherwise you can end up overpaying. You can, however, get yourself an inexpensive plan in the beginning and later adapt it.

Just be careful: once you’ve joined a PKV, changing back to GKV is very difficult. You could be stuck with a relatively high Beitrag even if your income declines.

 

What’s the best German private health insurance provider for expats?

Finding the right private insurance plan is a personal choice – in case you haven’t noticed, this is true for all things healthcare-related. However, Ottonova is the only private health insurance provider in Germany to offer an expat-specific plan – at discounted rates. They also offer 24/7 English support, and satisfy the requirements for getting a visa.

 

Tip – Start by comparing these companies

When choosing your plan, a good place to start would be to compare Ottonova (private) against the top 3 public insurance providers, TK, AOK and Barmer GEK.

 

 

This is a supplementary avocado

Supplementary health insurance (Krankenzusatzversicherung)

There’s a third option that lies somewhere between GKV and PKV. That’s Krankenzusatzversicherung – or supplementary health insurance. This covers the costs that GKV either doesn’t cover or only partially subsidises. For example, GVK might cover inpatient treatment, but it won’t get you a private hospital room. Supplementary insurance plans can be tailored to your individual needs.

 

Tip – Think twice before going this route

We’re including it here for completeness, but as a freelancer this option doesn’t make much sense. Why pay both GKV and supplementary insurance when you could just go private?

 

 

Expat health insurance – international plans, from home!

As an expat, you have an alternative to the German health insurance system. You can buy expat/international health insurance outside of Germany – maybe even from your home country.

Compared to German plans, expat plans are usually inexpensive. But they can also be risky. When purchasing a plan like this, make sure your insurance company is BaFin approved. Only BaFin-approved companies can provide their services in Germany. 

 

Tip – Read the fine print

Look closely at what your expat health insurance actually covers. Some international plans cover only a fraction of what GKV must offer as a minimum. If you’re not careful, your inexpensive health insurance plan could end up costing you much more than the GKV or PKV in the long run.

 

 

Many different blood oranges to choose from

What to choose: statutory or private health insurance, or other?

GKV is a good option for those who earn closer to €1,038, the minimum monthly income. If you’re earning much more, PKV becomes an attractive, affordable alternative.

But we can’t tell you what to choose. Only you know what’s best for your needs. Here’s a comparison table to help you get started. 

Remember, not having health insurance isn’t an option in Germany.

 

Comparison table of health insurance options

 

GKV

PKV

Expat

Cost

- Starts ~  €188 /m - Starts ~ €165/m
- Additional co-payments vary by plan

- Starts ~ 120 /m
- Additional co-payments vary by plan

Coverage

- Hospital treatment
- Visits to GPs and doctors
- Rehabilitation, such as home care or physiotherapy
- Health checks from the age of 35
- Cancer screening
- Medicines, dressings, therapies and aids such as hearing aids or wheelchairs
- Dental check-ups
- Dentures and crowns
- Orthodontic treatment up to age 18
- Varies by plan, but expect preferential treatment at hospital and doctors’ offices
- Can get expensive if unexpected things happen
- Varies by plan
- Can get expensive if unexpected things happen

Dependents

- Covers you and non-working family members

- Covers only you

- Covers only you

 

Whatever you choose, don’t forget to eat lots of fruit (but not too much) – and stay healthy!

 

 

 

Glossary of health insurance-related terms

German term

English translation

Angehörige

Dependents

Antragsfrist

Deadline for application

Beitrag

Premium

Beitragsrückerstattung

Reimbursement of premiums

Bezugsberechtigter

Beneficiary

Betriebskrankenkasse (BKK)

Company health insurance fund

Freibeträge

Exemptions

Freiwillige Versicherung

Voluntary insurance

Gesetzliche Krankenkasse

Statutory health insurance fund

Gruppenversicherung

Group insurance

Haftpflichtversicherung

Liability insurance

Karenzzeit

Waiting period

Krankenhausbehandlungen

Hospital care

Krankenschein

Physician's sick notice

Krankentagegeld

Daily sick pay

Krankenversicherung

Health insurance

Künstlersozialkasse

Artists’ health insurance scheme

Lebensversicherung

Life insurance

Leistung

Benefit

Pflegeversicherung

Compulsory care insurance

Pflichtmitglied

Compulsory member

Prämie

Premium

Reiseversicherungen

Travel insurance

Rückversicherung

Reinsurance

Selbstbeteiligung

Deductible (or co-payment/excess)

Unfallversicherung

Accident insurance

Versicherungsmakler

Insurance broker (represents the client)

Versicherungsvertreter

Insurance agent (represents the insurance company)

Vollversicherung

Comprehensive insurance

Zahnzusatzversicherung

Supplementary dental insurance

Zusatzbeitrag

Additional contribution

 

We hope this article helps simplify one aspect of your work life – health insurance in Germany! If you want to explore more expat questions, check out: 

Always curious? Sign up to Holvi’s blog for makers and doers.

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