Public and Private Health Insurance in Germany

Two Types of Health Insurance Options in Germany

Health insurance in Germany is a complex topic and it’s also highly personal, so in this article, I will discuss the difference between public and private options, and which ones are accepted by the Ausländerbehörde for freelance visa seekers (a caveat: the foreigners office can change things or make a different decision the day of an appointment).

In Germany, there are two types of insurance (private and public): government-regulated public insurance (GKV) and private insurance from a German or international insurance company (PKV). First, I am going to give a rundown on these two and then I will discuss who qualifies for them.

GKV (Gesetzliche Krankenversicherung) is the government-regulated health insurance, and if you are an employee then this is the insurance you qualify for, and your employer and you share the costs. Employees earning less than 64,350 EUR per year (gross) are usually obliged to take out public health insurance. If your income exceeds this amount, you can still join a public insurance fund but on a voluntary basis.

If you join the GKV you can choose to register with any of the 110 Krankenkassen, which are non-profit associations administering the government health scheme. I am not going to list all 110, I just know some of the bigger named ones are AOK, TK, DAK, SBK, Barmer; they all have to follow the government regulations and laws so all will be pretty similar. Just check which voluntary supplemental programs are offered.

The largest and most popular Krankenkasse in Germany is TK. They have been awarded as the best health insurance fund in Germany for 15 years in a row; also they provide excellent customer service in English, which is rare in Germany! You can sign up for TK here (It's free!)

From my research, I read that most German residents are members of the public health plans, and the 110 different Krankenkassen all charge the same basic rate of 14.6% plus a possible median supplemental rate from the health insurance fund (E.g. TK has a contribution rate of 15.5%, which consists of the general contribution rate of 14.6% and the fund’s supplemental rate of 0.9%).

The PKV (Private Krankenversicherung), or private-regulated health insurance, generally covers a wider choice of medical and dental treatment. The private sector offers all sorts of plans for all sorts of budgets and you must do your research to find the one that works for you. To be honest, this is where a good health insurance broker will be quite helpful- there are so many rules regarding which insurance is acceptable for the Ausländerbehörde (Immigration authority) and the freelance visa that I can’t (and won’t) cover it all here.

Be aware that if you take out private health insurance, you can only switch back to public health insurance in 2 cases:

If you go from being self-employed to becoming an employee and your income is below the threshold,
If you become unemployed.

Also, you must be under 55 years old. If you are older, it is usually not possible for low-income earners or unemployed people to switch back to public health insurance.

Suffice it to say, it is imperative that you find and choose a good health insurance that meets the government requirements for the freelance visa; I have heard of many people being delayed/denied their visa until they returned with acceptable insurance.

I spoke with a local insurance broker who directed me to plans that would be accepted for the freelance visa within my budget and I chose one; it was accepted for the freelance visa.

This is the basic information regarding the two different systems for health insurance within Germany and who qualifies for them; now I will share the information I have regarding what insurance is accepted by the Ausländerbehörde for freelancers.

Remember, the public insurance is mostly for employees whereas freelancers and self-employed must usually get German private insurance. The only exception here is for professional working artists, who can join KSK (Künstlersozialkasse), and through that program get into the public insurance system.

There are many popular insurance companies available online, but some of them do not fulfill the requirements demanded by German law. Whatever health insurance you chose, make sure it includes long-term nursing/care insurance (in German: Pflegepflichtversicherung) because German authorities tend to demand this during your residence permit extension application. If you need health insurance from your arrival in Germany to the day before your residence permit extension, take out expat health insurance, which will cover you during that period. You can then switch easily to private health insurance if you need to extend your permit at the Ausländerbehörde.

Also, make sure you choose a plan for “workers” not “tourists”; you will receive a certificate of coverage with these plans to take with you to the visa appointment. If you are unsure whether the insurance policy meets or not the German statutory requirements for German health insurance, ask the insurer to confirm it in writing; if they are willing to confirm that their insurance fully complies with the German Social Security Code: Book 5 Sect. 257(2)(a), then their insurance plans are valid for living and working in Germany.

From personal experience, I used a certified insurance company who helped me to set up a valid German health insurance policy; this was accepted by the LABO at my visa appointment with no issues. Again, meet with an insurance expert- this is free for you and they have experience helping expats.

Whatever long-term health insurance you chose, make sure it includes long-term nursing/care insurance. Also, make sure you choose a plan for “workers” not “tourists”.

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Remember none of what I have shared here is legal advice or anything: it is solely a summary of the two types of insurance here in Germany and what most freelancers end up getting for their visas. If you need more details about the German health insurance system, you can also read this article.

Good luck!

Tres C is an American who’s lived and worked all over the world and who has traveled extensively. She moved to Berlin in July 2017 with her dogs; she’s excited to share her hard-earned knowledge about relocating to Berlin through her writing on this blog.