Health insurance: What are the options for employees, students and pensioners?

Everyone in Germany has to have health insurance. That’s clear. What might not be quite so clear, however, is what options are available to you as an expat employee, student, or pensioner. Siemens-Betriebskrankenkasse, one of the largest statutory health insurance funds in Germany, has put together this simple guide. 

Germany prides itself on having one of the most comprehensive healthcare systems in the world, to support all residents in the event of illness. The German system works on the basis of contributions: everyone who works, studies, or claims a pension in the federal republic contributes to a health insurance fund, ensuring that they are covered for treatment if they fall sick or need medical advice. 

Broadly speaking, there are two types of health insurance in Germany: public (statutory) or private. The type of insurance you take out depends on your employment status and how much you earn. Let’s take a look at the different options for workers, students, and retirees.  

Health insurance options for workers in Germany

Most workers in Germany (around 90 percent) are covered under the statutory health insurance (GKV) scheme. This is because you are only allowed to opt for private health insurance if:

• You are classed as a high-earner (with a gross income of more than 64.340 euros per year in 2021)
• You are classed as a low-earner (with a gross monthly income of less than 450 euros per month)
• You are self-employed
• You are not employed
• You are over 55 years of age and not working

Everyone else is subject to mandatory contributions to the public health insurance system. 

Cost of health insurance for workers

Rather than a regular premium, all workers covered by public health insurance in Germany pay a portion of their monthly income to health insurance as a contribution. Currently, it is 14,6 percent of your gross salary (up to a maximum ceiling of 4.837,50 euros per month in 2021), plus an “additional contribution” of up to 1,6 percent. 

This is split equally between you and your employer, so you pay around 7,3 percent. 

Taking out private health insurance

If you fulfil any of the criteria listed above, you can choose to opt for private health insurance (PKV), which, depending on your income and health status, may work out cheaper. Around 10 percent of the German population have private health insurance. 

While PKV generally offers more comprehensive cover, including things like alternative treatments and private hospitals, it does work on a risk-related premium system, meaning that your contributions will usually go up with time, as you age and become more likely to fall ill. Once you have opted into the private insurance system, it can be difficult to switch out, unless your circumstances change significantly. 

What about self-employed workers and freelancers?

Self-employed workers, including freelancers, business owners and entrepreneurs, are free to select their own health insurance coverage. If voluntarily opting for public health insurance, self-employed people are generally expected to cover the entire 18,6 percent contribution on their own. Private health insurance premiums are based on a calculation of risk factors. 

Health insurance options for pensioners in Germany

Retired people in Germany are also expected to take out health insurance. However, a slight distinction is made between those who work and then retire in Germany, and those who work abroad before coming to Germany in their retirement. 

If you work and retire in Germany

If you have worked in Germany before retiring, the type of health insurance you have as a pensioner normally depends on what you had in the years leading up to your retirement. In Germany it’s tricky to switch from the PKV to the GKV scheme (or vice versa) beyond the age of about 55, so if you’re privately insured when you retire, you will usually stay that way. 

Privately-insured retirees will likely see their premiums increase into retirement, as they are based on age and risk factors, whereas publicly-insured pensioners continue to pay the same contribution rate of 14,6 percent (of their pension benefit), half of which is paid by the pension insurance provider. Voluntary members of the GKV (for instance self-employed people) will be expected to cover the entire contribution. 

If you are a member of the PKV but are drawing a statutory pension, you have the option of applying for a contribution subsidy from your pension provider. 

If you work and retire abroad, and then move to Germany

If you worked abroad before coming to Germany as a retired person, your pension is treated a little differently. As of July 1, 2011, all pensions paid by foreign pension funds are subject to health and long-term care insurance contributions under German law, meaning you will likely become a compulsory member of statutory health insurance. This applies to pensions paid out by both EU countries and so-called third countries. 

To ensure that recipients of a foreign pension do not have a higher contribution burden, they pay a special contribution rate of 7,3 percent plus the additional contribution. They do not receive a subsidy from German pension providers.

Health insurance options for students in Germany

People who come to study in Germany have three options when it comes to health insurance. You can:

• Bring an existing foreign health insurance policy with you
• Take out statutory health insurance
• Take out private health insurance

Your options are largely determined by your age, and your country of origin. 

Bringing your health insurance with you

A number of countries, including the EU & EEA member states, have agreements with the German federal government to have their health insurance plans recognised in Germany. If your policy is recognised, you do not need to take out German health insurance. For more advice, contact your health insurance provider. 

If you are aged under 30

If your policy is not recognised as valid in Germany, you can freely choose to take out either public or private health insurance, so long as you are under the age of 30. 

Instead of being charged as a social security contribution, public health insurance in Germany is provided at a set contribution rate of around 100 euros per month. Depending on your circumstances, and the type of coverage you require, private health insurance can work out cheaper, with premiums starting from around 30 euros per month. 

Health insurance for students aged 30 and over

If you are a student above the age of 30, you do not qualify for the discounted public health insurance rate for students. If you cannot bring your home health insurance policy with you to Germany, you have no choice but to take out private cover. 

The situation is slightly more complicated for PhD students, since some are employed by their universities while others are not. If you are employed as a lecturer or teaching assistant, you will be automatically enrolled in the public healthcare system, as a worker (see above). 

Check your options

Whatever your situation, there are plenty of resources available to help guide you through the health insurance system in Germany. 

Not sure what applies to you? Check out your options using the free expat health insurance tool, created by Siemens-Betriebskrankenkasse. Check your social security status, see your insurance options, and save your result as a PDF to submit to your employer.