Private Or Public Health Insurance In Germany [Which One To Choose?]

You can't live in Germany without having health insurance. It is the law that you have to have one. However, choosing the right one might be an overwhelming and complicated process. But it doesn't have to. In this video, we're going to talk about the differences between private and public health insurance and hopefully give you enough information so you can pick the right one for your current life situation. So let's first describe briefly a framework around the public health insurance. What is it? First of all, the word in German is GKV, quite important for you know, because if you do additional research, you will stumble over those letters. There are 96 statutory health insurance funds in Germany, which are called And 89% of all Germans have this insurance. Statutory insurance simply means public health insurance. The important thing to point out here is that all these health insurance funds, the public ones, are regulated by the government. And also you are referred to if you have this health insurance, you're referred to as a Now, private health insurance is called or short PKV is a little bit the opposite. I mean, it's still also regulated by the government to a certain extent, but they're private companies. There's currently at the time of recording 41 private health insurance companies in Germany. And only 11% of Germans actually have private health insurance. And here, if you have a private health insurance policy, you are referred to as a These two words are important for, you know, because when you look for doctors, sometimes they refer or you can see on their website or on DrLib, who they accept in terms of insurance. And sometimes they're for private only, sometimes they are both. So depending on the insurance you have, you should look for that type of patient that you are. Now, just because there are two types of insurances, private and public, it doesn't necessarily mean that you have access to both. So first, let's actually answer the question, what health insurance do you actually have access to? Because the whole debate of which one might be right for you could go out the window, depending on your life situation. Yes. So to figure out which one you actually have access to, we need to look at your employment status and your salary. So if you are employed and you are earning less than 66,600 euros gross per year in Germany in the year of 2023, this number always goes up per year. Then you are compulsory health insured. In German, the word is Pflichtversichert. And that means that you have to have public health insurance. There is no other way. If you classify for public health insurance, you can check out the super easy sign-up process created by Feather Insurance. They allow you to sign up to different, actually, public health insurance companies in Germany, one of them being TK, which is the biggest one and most popular, I would say, in Germany. So you can check out Feather using the link in the description below. Now, if you are employed and you earn more than 66,600 euros gross per year in the year of 2023, or you're self-employed, you're a doctor, a student, or a stay-at-home spouse, then you are voluntarily insured, health insured, which means in German, Freiwilligversichert. And that means, in theory, that you can choose between public or private health insurance. Now, why do I say in theory? Because if you're new to Germany, it is very likely that the public health insurance funds will actually reject you, and private health insurance may be your only option. If you qualify for and are interested into private health insurance, then you should check out Otonova. At the time of recording, Otonova is the only, actually, private health insurance provider in Germany that provides their services in English, fully digitalized, and super user-friendly. You can check out Otonova using the link in the description box below. Now, if you are unsure what's best for you, because you might actually qualify for both, and you kind of, like, don't believe us that the public wants to reject you, or just would like to have a little bit more advice on your life situation, for example, you also have your family with you, then you can reach out to Feather in the link below and use their health recommendation tool. They provide a questionnaire depicting a bit more on your situation, and then they're expressing recommendations based on that, and you can also talk to them directly. The super cool thing about Feather is that all the services are in English, and they really recommend the insurance that is right for you, and not based on, like, the commission of insurance that they sell. They are really a very trustworthy service that you can use to figure out which one is the right one in your case. If you're finding the content of this video useful, then make sure to hit that like button. And if you want to keep up to date with content to help you settle into life in Germany more smoothly, then make sure to hit that subscribe button. And if you'd like to go the extra mile and support us and this channel, you can do so via a virtual ko-fi at simplegerm.com slash ko-fi. Thank you for your support. Now, let's look at what are the differences between public and private health insurance. To actually help you understand a little bit better, we have created a table where we will compare back to back a few of the most important criteria that we think are the most important criteria when it comes to choosing a health insurance. Let's start with the cost. So for public health insurance, the amount of money that you pay a month for the health insurance is based on your income. Whereas with private health insurance, your monthly payment depends on your health and your age. So nothing to do with how much you earn. How about family coverage? So for public health insurance, your spouse and children can actually be covered through your same policy without them having to pay extra. If they're not earning anything. If they're not earning anything. Yes. Fair point. With private health insurance, there's no such thing. Every individual, no matter the age or income level, need to have their own tariff. Now, what's the difference between the selection of doctors and hospitals? Here comes the interesting part. With the public health insurance, you have access to a lot of doctors and a lot of specialists, but by far not all of them. There are certain specialists that really just access or give their services to privately health-insured customers. That's what I mentioned before. You need to pay attention whether they treat only private patients and if they're a private practice or not. Of course, hence private health insurance, you can access any doctor. But most importantly, both health insurances give you access, a free choice. You don't have a designated doctor you need to go to, but you can choose freely. As long as they serve your health insurance type. Yes. And also to be clear here, don't think that, for example, cardiologists only accept privately health-insured customers in Germany. There are cardiologists that also accept publicly health-insured customers. Just know that there's a few that only accept privately insured people. Just to emphasize what we said in the beginning of the video, 89% of people in Germany are publicly insured and only 11% are privately insured. So that just, you know, sets again the stage of the availability of doctors. Yes, there are a few that only treat privates, but there are also plenty of others that accept the public health insurance. Now, how does the payment of treatments work? So in the public health insurance, the insurance, the health insurance, pays the doctors directly. That means when you go visit the doctor yourself, you don't pay anything to them. The only exception is if you need to stay, for example, overnight at a hospital. Most likely there, there is a very tiny fee. For example, when I stayed in the hospital, I had to pay 10 euros per night, which is, I mean, relatively peanuts if you compare it to other prices in other countries, right? Whereas with private health insurance, you pay the invoices of the doctors, hospitals, whatever, medical invoices you get yourself first and then get that reimbursed from the insurance. Now, when I say first, sometimes, you know, you can hand in the invoices to the insurance and for example, Autonova, since it's all digital, usually pays you quite fast and then you can use the insurance money to pay the doctor because it's usually a 30-day payment limit, but you have to handle that bureaucracy. You have to deal with the invoices, get the reimbursement and make sure you also pay the invoices. Depending on the tariff that you chose because unlike with public health insurance, where it's pretty much like one tariff fits all, more or less, with private, it highly depends on the tariff you choose and you choose to pay for and there are tariffs with deductibles, meaning let's say per year, you need to pay a thousand euro yourself and after that, the insurance kicks in. So, in that case, if it's your first bill, you're not going to get the money back. Exactly, but that really depends. It's highly individual and there, make sure to know your contract, speak to your insurance, that's why it's important that it's in English and you understand what's going on and figure that out for yourself. Now, what kind of treatments are covered? How is the general coverage? So, for the public health insurance, it's pretty much everything that you need. The moment you get sick, the public health insurance kicks in and it covers everything, except for certain things like hospital stays, certain medications you need to pay, maybe five euros for the prescription and stuff like that. However, there's also certain, depending on your age and the older you grow, there are certain preventative measures that become more included. For example, after I turned 35, I got a message from my health insurance, hey, now this, for example, preventative measure is available to you, which you can go and do this checkup as an example. Right, with private health insurance, all of that is also included. The only thing which you might sometimes hear is that private health insurance covers more. And that is true to the fact that doctors sometimes offer other treatments, especially when it comes to preventative care, more freely because they can kind of like get the money back through the private health insurance. One of them would be if there's no necessary medical reason for you to get, for example, an ultrasound at the gynecologist, that would be automatically included with the private health insurance, whereas for public, you would need to pay that for yourself. And then it comes to, let's say, the more comfortable luxury care in that sense. For example, a lot of private health insurances cover acupuncture or alternative medicines where the public wants sometimes or most of the cases don't. Yes, and also taking the ultrasound with the gynecologist as an example, you already mentioned it, but just to make it clear, I, for example, had a medical condition that required that I would need ultrasounds and after that was determined, I didn't need to pay for the ultrasound at all. So again, if it's preventative care, I would think the private offers a lot of other array things included versus if it's public, there really needs to be a medical reason to examine further, I would say. Now, what about the cover of pre-existing conditions? In the public health insurance, everything is covered. With private health insurance, that might be an exclusion point. So for private health insurance, you need to fill out a health questionnaire before they accept you. And depending on that questionnaire and your health, they will accept you or not. So depending on how serious pre-existing conditions are, they may actually reject you or reject that area of the pre-existing condition. So if you have further illnesses there, you need to pay that yourself, but the rest of your health may be covered. Yeah, so that is actually an exclusion point. Yeah. And what is the geographical cover of each health insurance? So with public health insurance, it's Germany overall, like everywhere you are in Germany, and if you are traveling in the EU, within the EU, then that's also covered, but very basic covers. So the rule usually goes that if you're publicly health insured in Germany, and let's say you travel to Spain and something happens and you need to be taken to a hospital there, your public health insurance would also kick in, but it would only cover what in Spain is the basics of their public health insurance. So in this case, maybe a good idea would be to have your public health insurance and an additional travel insurance, which is what we do. So you know that at least more things are covered in the case of an accident when you're abroad. Right. Whereas private health insurance usually covers worldwide, depends a little bit on your tariff, but that is a worry-free option for any travel destination that you go to in general. And the topic that is often discussed also in the media is what are the waiting times for specialist doctors? So for public health insurance, it is very, a lot of people complain a lot that it's a long waiting time, sometimes even months to reach a specialist. In our case, I mean, we're two young women, right? And I think I've wanted to go to a specialist once, and it was an orthopedic, I think, regarding some back injury that I had. And that I was able to reach one within maybe two weeks. I didn't have to wait months. It was harder for sure, but I had never experienced this super long periods of waiting time. Maybe the older you grow, the more specialists you need, and maybe there it becomes trickier to actually find people fast. With private health insurance, a lot of specialists, especially in, yeah, specialist is already the word, and in certain medical areas are more prone to the private health insurance. They have more open doors and you get appointments faster. Not always immediately though. It depends on the field. A field, for example, of mental illness, there it is definitely a big plus if you private health insurance in order to get access, because there we know from friends and acquaintances that the waiting time can be months. Because most of the doctors here are private only. What it comes down to is there is no one is better than the other. They both have the perks and the pros and the cons. And there is also no one is cheaper than the other. I mean, yes, if you're a single young individual healthy, then private health insurance may most likely be cheaper for you at that period of your life. But if you're a parent with children, then public health insurance may be the cheaper option at that period of time because your kids can be insured freely through your public health insurance. So it really is. That's what I think what we want to stress most. There is no one is better than the other. There is no one is cheaper than the other. It is a highly, highly individual question. And that's why, again, if you are unsure because you could have either or, then please reach out or click on the link below for the health recommendation tool from Feather Insurance. Yes, they are partner. If you choose to get an insurance with them we receive a little commission from them with no extra cost to you. But it is the best way to figure out what is best for you without wrecking your brain or spending hours with maybe contradictory information, not knowing the true sense of the market and stuff like that. Right. Totally. Did you know we have templates on our website that can help you settle into life in Germany more smoothly? You can check them out at simplegermany.com templates. Now continuing with the video. Now let's talk about another option that you could have. And that is a hybrid model. And this is pretty much bringing best of both worlds. And this model looks like you have public health insurance and you have add-ons that you can purchase from private health insurance companies. What companies? 36% of people in Germany that have public health insurance actually have a special add-ons from public health insurance providers. So what does that even mean? So that means, for example, the most popular additional private health insurance is dental insurance. Because in the public, in the general public cover, preventative care is quite good for dental treatment. However, implants, dentures or anything, any real big treatment has a very basic cover and low cover and you need to pay a lot yourself. So that area, because teeth are notoriously a thing, especially also the older you grow, that is something that a lot of people add to the insurance. For example, my mom has it. I don't have it yet because my teeth are good so far. But I always ask, every time I go to the dentist, I always ask, do I need this insurance? How are my teeth developing? Because this is something very, very popular. And Otanova also has a specific dental insurance tariff that you can purchase from them even if you're publicly insured. So if that is a thing for you, then you can also click on that link in the description below. Now that you have hopefully a better understanding of the differences between public and private health insurance in Germany, you might be wondering, but how does the whole health care system actually work? We have created a video where we talk about the eight things I didn't know about the health care system in Germany, which you can check out here on the left. Until next time. Tschüss!