Hello and welcome to the Feather insurance guide. We’ve made this as quick and straightforward as possible, so you can scan through to find all of the information you might need when deciding on which health insurance you’ll have in Germany.
In this guide, we cover the main three types of insurance:
- Public Health Insurance
- Private Health Insurance
- Expat Health Insurance
We’ll start with a brief overview of the healthcare system in Germany and then move into more specific topics like how to decide which healthcare provider to choose. While most Krankenkassen or public health insurances provide similar coverage, they differ slightly. For example, TK provides the best English customer service, while DAK provides the best coverage for childbirth.
The last part of our guide will focus on the nitty-gritty details about applying for health insurance, including membership, eligibility, requirements, estimated monthly costs, visa and residence permit regulations, and more.
We know what reputation the insurance industry has and the feeling that goes along with it. That’s actually why our CEO Rob and our CTO Vincent decided to found Feather.
A majority of our team are also expats who have struggled to navigate the complexities of German healthcare. We’ve gone through the paperwork, hours of mind-numbing German, and finding experts to answer any questions you might have and write articles for others to use when trying to navigate the system in a foreign language.
When we say that we’re “honest, simple insurance,” we want you to know that we mean it. Every day we face new challenges and use them to improve our product and our services to make insurance in Germany a bit less of a hassle.
Our top priorities:
Transparency: Want to know how we operate? We’ll tell you.
Feather is a licensed insurance broker in Germany. We receive a commission from directing our customers to sign up for public and private health insurance policies. We identify as a “public-first” company, meaning we will always suggest signing up with one of Germany’s many Krankenkassen or public health insurance companies if it makes the most sense for our customers.
There are some cases where private insurance makes more sense (like if you earn over a certain amount), so we’ll let you know what we think is best for your particular situation.
Customer service: Unlike the Germans, we value customer service.
We want to talk about insurance in a way that makes you comfortable, so you can ask us questions directly via email or through a call.
Our experts also know about various insurance products, from health insurance, life insurance, and liability insurance to household insurance among many others.
We can also advise you in a number of different circumstances. For instance, we know that a single freelancer staying in Germany for a year has very different health insurance needs than someone with a family who’s planning to stay in Germany long-term. That’s why we will always recommend the best health insurance for your lifestyle. We earn commission on both private and public health insurance, so we only recommend private insurance when it actually fits, unlike other brokers who only make a commission on private sales.
Digital-first approach: We create digital processes so the Germans don’t have to.
As you might have noticed, technology in Germany isn’t moving at the same rate as other places in the world. This means that insurance documents tend to be filed in person. Things need to be printed and sent through the post office. Most Germans own a binder or two of documents they’ve collected throughout their lifetime.
As expats ourselves, we’ve made it our mission to create digital processes to eliminate the need for complex paperwork. Things like applying online and filing a claim can now happen digitally (and thankfully in English).
The German health insurance system
German health insurance is divided into two tiers: public and private insurance providers. Both offer comprehensive coverage for patients, but they have slightly different requirements when it comes to eligibility. Here are some of the most common factors:
- Income: If a German company employs you, you need to earn over a certain amount each year to apply for private health insurance.
- Plan to stay in Germany: Depending on your future goals, we will recommend either private or public health insurance.
- Family and family planning: Getting your children covered under health insurance is essential — and depending on the size of your family or your plans, it might be better to go with public or private insurance.
- Citizenship: Insurance is different if you’re not from the EU, so it’s important to consider that when deciding.
- Employment status: Are you employed by a German company, or are you a freelancer? This actually can affect your eligibility for some policies.
- Length of time in Germany: Because health insurance is required, it means that you’ll have an insurance history if you’ve been here longer. This history can affect your eligibility.
- Overall health: Pre-existing conditions and some medications can make signing up for private health insurance pretty challenging.
If you’re interested in seeing which of the many policies might be a good fit for you, we’ve created this health recommendation tool to help you explore!
What to watch out for
Sometimes, it might not be possible for someone to join public or private insurance. This is due to several different eligibility requirements that both private and public healthcare have.
For example, a freelancer from outside of the European Union will most likely not be allowed to join the German public insurance system. If they have a pre-existing condition on top of that, they may not be able to get private insurance. Although it might not be ideal, our advice would be to get a full-time job to join the public insurance system immediately. They can also get temporary expat insurance while searching for a job or trying to get a German residence permit.
It can be a lot of information to keep in the back of your mind if you’re someone who doesn’t spend all their time looking at insurance applications, documents, and processes. We also offer the possibility to book a call with one of our experts to help you determine whether private, public, or expat insurance is the best for you.
Public health insurance
Public health insurance or gesetzliche Krankenversicherung is state insurance provided by more than 100 individual not-for-profit Krankenkassen or public health funds. Out of the many, we’ve partnered with TK, AOK, DAK, and Barmer. Our partners are operated by contributions from its members and the German government.
Here, we have an overview of how these public insurances differ from each other:
Each public insurance provider offers comprehensive coverage to all of their members. This includes an extensive range of preventative services, acute care, and full/ partial reimbursement for medications.
Signing up for public health insurance
It’s easier to sign up for public health insurance than it is for private, but there are still a few requirements that you should watch out for:
- Under 55 years old
- Employed at a German company or a student
- Moving to Germany from another EU country where you were insured publicly
If a German company employs you, you can sign up with one of our public health insurance providers in a matter of minutes. If you’re a student, it will take a bit longer since we’ll need to gather some additional information for your application.
Still, even if we need to ask you for some additional documents, it will only take a matter of days to get you signed up for insurance, so there is no need to worry.
How are public insurance costs calculated?
There is a standard fee for students up until a certain number of semesters when the contribution amount increases. If you’re over a certain age and a student, you’ll need to speak with us about other insurance options, as you may no longer be eligible for public health insurance.
For people who are not students, public health insurance providers operate on a salary-based system for contributions. This means that the more you earn, the more you’ll pay per month. Your employer will also pay 50% of these fees. If you’re a healthy, single high-earner, it can actually be less expensive to switch to private insurance for this very reason.
In 2021, the official health insurance contribution is set at 14.6% of total income (though any public insurance provider will have additional contributions, averaging 1.1% of total income). Monthly payments top out at a salary of €58,050 annually (€4,837.50/month). This means that you won’t end up paying more than €700/month in total in health insurance costs (that’s €350/month if your employer is paying half).
If you get a new job and your salary changes, your monthly contribution will be automatically adjusted to your new income. If your employment status changes (e.g., if you quit working full-time and start freelancing), you may need to take extra steps to ensure that you’re paying the correct amount. Freelancers generally pay estimated taxes, and then the amount is adjusted to reflect their actual earnings when they file their yearly tax returns.
Pre-existing conditions will never exclude you from coverage in the public system. Your insurance will cover any pre-existing conditions as long as you are eligible to join a Krankenkasse or public health insurance provider.
The public insurance system is generally the cheapest way to insure multiple dependents. If you have children, they will be covered at no additional cost by your provider. As long as your children live in Germany and are not earning more than €450/month, they can be covered until the age of 23. If they are students, then they can be insured under your policy until the age of 25. Your public insurance provider will also cover non-working spouses.
For additional information on insuring dependents, check our blog.
Can I switch to private health insurance?
If a German company employs you, you may choose to switch to a private insurance plan as long as you’re earning more than €64,350 a year (as of 2021). If you are a freelancer, you can choose to switch to private insurance even if you earn less than that amount. But you will likely need to make at least €40,000 a year for private insurers to accept you.
Read more on our private insurance page:
Private health insurance
Forty-two companies provide private health insurance in Germany. They all provide comprehensive health insurance to their members and are regulated by the government, so there is no need to worry about their legitimacy.
There are two basic categories of private health insurance:
- Joint-stock companies (Aktiengesellschaft — AG)
- This is a type of company that is owned solely by its shareholders. Any profits made by the company are distributed to the shareholders. Policyholders do not receive a share of the company’s profits.
- Mutual insurance company (Versicherungsverein auf Gegenseitigkeit, VVaG)
- This type of company is owned by its members, and any profits made at the end of a financial period are redistributed among the members. The purpose of this type of insurance company is to serve the interest of the policyholders.
While many are interested in getting private insurance in Germany, not everyone can be on a private health insurance plan. Eligibility depends on a few factors, including income and what type of work you do.
How do I know when I’m eligible for private health insurance?
- I’m a freelancer or self-employed
- My annual income is more than €64,350 (2021 requirement)
Unlike public health insurance which accepts pre-existing conditions, private health insurance does, in fact, discriminate based on your health. They do this by asking in the application for a medical history form. Depending on the provider, this includes any treatments you’ve received within the past 3 to 7 years. You will also need to let the company you’re applying to know about any chronic conditions, surgeries, inpatient hospital stays, and overall mental wellbeing (among other questions regarding your health).
Based on your answers, the insurance company will determine your eligibility. If you have any severe conditions, the private health insurer may add an additional surcharge to your monthly premium after classifying you as “high-risk.” Private health insurers do this since covering ongoing treatments for certain conditions is sometimes quite expensive. The additional surcharge keeps costs down for other customers.
People with pre-existing conditions are sometimes too risky to take as customers, so private health insurance companies reject these applications.
Suppose the pre-existing condition has been fully treated. The insured person can provide proof the condition will no longer require costly treatments over a significant period of time. In that case, the insurance company can remove the additional surcharge. For example, risk surcharges often apply to patients with obesity because they are at greater risk for developing chronic conditions like heart disease and diabetes. But, if a patient loses weight and remains at this weight over a period of time, they can apply to have the surcharge removed.
In rare cases, the private health insurance company may accept someone with pre-existing conditions but exclude treatment for it. In our experience, helping people get private health insurance, previous treatments, and chronic conditions won’t result in an all-out rejection. Most companies would rather add a surcharge than reject someone.
The cost of private health insurance is calculated based on your health status at the time of joining. The main reason why private health insurance can be so costly is dependent on age and pre-existing conditions. If you join private health insurance when you’re young and healthy, the monthly costs are quite often lower than income-based payments.
If you’re a full-time employee and qualify for private health insurance, your employer will cover half of your monthly premium — just like they would if you had public insurance.
Do costs go up over time?
Yes, private health insurance costs will get more expensive over time, but at similar rates to public health insurance. Under German law, public and private insurance providers can only raise expenses if they show that the cost of healthcare has gone up.
Between 2010 and 2020, the average cost of the contribution per person for private health insurance has increased by 2.3%, while public health insurance has risen by 3.8%. So, whether you choose private or public health insurance, you can expect the cost to increase over time.
Will the cost of health insurance increase with age?
While it is true that if you join private health insurance when you’re older, you’ll most likely pay a high premium. But, the earlier you enter the private health insurance system, the more affordable your payments will be when you’re older. This is due to Alterungsrückstellungen, or Ageing Provisions, an important strategy that private health insurance uses to keep premiums consistent.
So, how would the system work for someone in their late 20s who is relatively healthy? The monthly premium is intended to be fairly consistent over several decades, increasing due to proven increases in healthcare costs. So you should be paying a similar amount when you’re 80 as you would pay in your late 20s.
Let’s assume that the person applying has no major health problems. The current premium cost would be relatively low. A significant portion of your monthly premium would go into these aging provisions for the future. This keeps monthly fees consistent although you use your insurance plan more often.
Family & dependents
If you’re not single, young, and healthy, it might be a good idea to consider public health insurance. Under private health insurance, you would have to add each family member, which can get a little expensive. Public health insurance covers dependents at no additional cost.
Learn more about public health insurance
Can I switch from private back to public?
This is a fear many have when switching to private insurance. Generally, it’s possible, but only if you fulfill two requirements:
- You’re under the age of 55
- You earn less than a certain amount (in 2021, that’s €64,350)
If you’re a freelancer, you’ll have to seek out full-time employment to make the switch to public health insurance. You cannot choose to switch to public insurance if you’re still freelancing.
You can read more about it in our blog post.
Expat health insurance
We are a public-first company and will almost always recommend that you find a way to join public health insurance if you plan on living in Germany for an extended period of time. We only recommend joining expat health insurance if entering the public system is not an option. Expat health insurance is a temporary solution as you cannot use expat insurance to apply for a visa renewal.
With that being said, it might not be possible for you to get public or private health insurance at the moment. In fact, in some instances, it’s impossible to get on either plan, which means that expat health insurance might be your last option to get a visa.
What makes someone ineligible for public and private health insurance?
Our most common case is with freelancers with pre-existing conditions or who are over the age of 55 from non-EU countries.
What is expat health insurance?
Expat health insurance is also known as incoming insurance because it provides coverage for people who have newly arrived in Germany in case of an emergency or acute health problems. It generally covers costs associated with accidents or unexpected injuries, including inpatient hospital stays and related (doctor-ordered) visits to medical professionals.
You can sign up for expat health insurance for a maximum of 5 years from the time you enter Germany. Therefore, unless you only plan to be in Germany for a short period (under 5 years), we highly recommend going on public or private insurance. If you currently cannot enter into either private or public insurance due to your circumstance, we recommend getting expat insurance until you are able to switch.
Expat health insurance does not cover medical needs related to pre-existing conditions or chronic illness. So, while your insurance will reimburse you for costs associated with a broken bone or a sinus infection, it will not cover treatment for pre-existing illnesses like diabetes or hypothyroidism. If you get treatment for pre-existing conditions, you’ll have to pay out of pocket.
Family & dependents
Expat health insurance does not cover children or other dependents. Additional family members will need to get their own plans.
You can get a visa with expat health insurance, but you cannot renew your visa with expat health insurance.
If you’ve decided to stay in Germany long-term, you’ll need to either join the public or private health insurance system. Otherwise, you will not be able to renew your residence permit.
We’ve changed their names for their privacy, but here are some examples of people we’ve helped get health insurance in Germany and how we made that decision.
The following case studies show how we make recommendations in some relatively common cases.
Peter is a 46-year-old man who is moving to Germany with a full-time job offer. He will be earning €113,000 annually with his new job as an art director, so he qualifies for private insurance. However, Peter has high blood pressure, is married, and has two children. His wife does not plan to enter the German workforce for the time being.
We would recommend that Peter get public insurance since he has a pre-existing condition and three dependents.
Theresa is a 27-year-old woman and works as a freelance graphic designer. She is from the U.S., single, has no children, and has no pre-existing conditions. Theresa moved to Berlin with no set plan in place — she’s not sure if she’ll stay for just a few months or for a longer period of time. She plans to apply for a freelance residence permit and explore Germany before creating a plan.
We recommend that Theresa take expat health insurance to get started in Germany. Since she’s a freelancer from the U.S., she won’t be eligible to join public insurance immediately. Since she could only be in Germany for a few months, expat health insurance is the best option as it will help her get a freelance residence permit and requires no commitment like private health insurance.
Christina is a 35-year-old woman from Canada. She is married to another Canadian citizen and plans to have children in the next couple of years. She does not have any pre-existing conditions; however, she was regularly seeing a psychotherapist in Canada. She is moving to Munich to take a job offer with an annual income of €66,000.
We recommend that Christina get public insurance. Even though she qualifies for private insurance based on her income, her history of mental health counseling means she is not eligible to join private health insurance. In addition, since she is planning to have children, public insurance will be cheaper for her family in the long run.
Pablo is a 39-year-old man from Mexico. He just moved to Hamburg to take a project management job and has an annual income of €71,000. He is single, has no children, and doesn’t have any pre-existing conditions. He plans to stay in Germany for a few years, but he wants to return to Mexico eventually.
In Pablo’s situation, we would recommend private insurance. Because he is a single, healthy high-earner, it will be cheaper for him to go on private insurance in Germany rather than public insurance.
Health insurance add-ons
Health insurance companies in Germany offer comprehensive coverage, but even with these plans, you might need to get an add-on to fit things like dental insurance or travel insurance which aren’t covered under standard plans.
You can think of these add-on policies as building blocks to the coverage you’d like to have. Some people don’t go to the dentist for more than just an annual check-up, so they won’t be interested in adding this to their plan. For others, going to the dentist multiple times per year is expected, so they need to add this to their coverage.
Public health insurance covers a significant portion of the costs for medically necessary dental care (e.g., root canals or wisdom teeth extractions). Most public providers offer supplemental dental coverage. But, you might want extra preventative care or full coverage for more advanced treatments like laser therapy or periodontitis. If this is the case, we recommend looking into a dental care add-on for your insurance plan.
Find out more on our website:
Thankfully, if you’re traveling within the EU, your German insurance will still cover your treatment. Still, if you’re looking to leave Europe, you’ll need additional travel insurance to cover you abroad. Most public providers have travel add-ons for short- and long-term travel.
Sometimes, private insurance already has travel included, but it’s important to check before leaving on your trip.
This can be a controversial term, but generally, alternative medicine encompasses acupuncturists, chiropractors, herbalists, and homeopaths (among many others). Public health insurance, in most cases, will not cover treatment from these practitioners.
Feather currently doesn’t offer an alternative medicine add-on to your health insurance coverage, but you can find plans by searching for “Heilpraktikerversicherung” to learn more about your options.
Considering how many people need glasses or contact lenses, it’s not a surprise that there supplemental insurances for vision. If you are insured through a public provider, vision coverage will cost extra. Some private insurers include vision as part of their package.
Generally, we do not recommend purchasing an additional vision policy. For most people, out-of-pocket costs for vision aids are cheaper than the cost of a vision policy. But, if you’d like to see what a vision add-on looks like, you can search for “Zusatzversicherung Sehhilfe” or “Brillenzusatzversicherung” online.
Premium Hospital Care
One of the main reasons people get add-ons in the first place is after they have to spend the night at the hospital with “roommates.” With supplemental insurance for premium hospital care, you can get a private room and be seen by head practitioners. Most public insurance providers have their hospital add-ons, so you can stop to ask about adding to your plan or search for “Krankenhauszusatzversicherung” to find other policies online.
How do I find a doctor in Germany?
Finding a doctor in Germany is hard if you don’t speak the language. Luckily, there are resources online to help you find an English-speaking doctor (or your native language).