Understanding the German Health Insurance and Healthcare System: An Inside Look
Welcome to an in-depth exploration of the German health insurance and healthcare system. This article delves into the two primary systems, Gesetzliche Versicherung and Private Versicherung, explaining how they function and providing insights into the costs, benefits, and regulations surrounding them.
The Basics and How to Navigate Them
The German healthcare system comprises two main components: Gesetzliche Versicherung (statutory insurance) and Private Versicherung (private insurance). If you do not specify which one you want, statutory insurance is automatically applied. This insurance covers all healthcare needs, but there are some limitations and additional costs that come into play.
Gesetzliche Versicherung
With Gesetzliche Versicherung, 7.3% of your income is charged automatically, and this amount cannot exceed 350 EUR per month. This is not considered a tax. The insurance covers all necessities related to health. For example, some check-ups have a minimum age requirement, unless there is a family history of a specific illness, allowing earlier access.
Medications typically cost 5 EUR per prescription. For additional services like chief-doctor treatment or a better hospital room, you need to pay an extra fee, usually around 40 EUR per month. Dental care is usually 60 EUR per year but can be increased to 90 EUR per year for an additional fee. Some cheaper check-ups are self-payable, but most medical treatments are covered, especially if medically required.
You must first consult your usual doctor before visiting a specialist, except in emergencies. For non-emergency cases, you can directly visit a specialist. Some types of doctors, such as female health care, teeth, and eyes, are exceptions, and you can go directly to them.
Private Versicherung
Alternatively, you can opt for Private Versicherung, which requires a minimum earning and proof of private insurance to exit the statutory system. You have more choices with private insurance than with statutory insurance, and you pay a flat amount per month. Your employer covers 50% of the costs, and you need to provide an annual paper to your employer to update the payments.
I, for instance, pay 460 EUR per month, with my employer contributing 230 EUR, leaving me to pay only 230 EUR. Private insurance can be more cost-effective for additional coverage, especially for services like dental care (80 EUR) and hospital stays (1-2 beds as default). Medications and smaller check-ups are fully covered, and you can always visit a specialist directly.
Payments and Reimbursements
In Gesetzliche Versicherung, the doctor's invoice goes directly to the insurance, and you do not see the invoice. In Private Versicherung, you receive the invoice, which you send to the insurance. For example, my insurance has a mobile app where I can photograph and submit the invoice. Typically, I receive 90 EUR back, while Gesetzliche pays 100 EUR. If your self-payment reaches 400 EUR over the year, you will get 100 EUR paid back. If you do not submit any invoices for a year, you will receive 3 months of payment back.
If you are unable to work for an extended period due to illness, your employer continues to pay your insurance. After around 6 weeks, this stops, and the insurance begins to pay you a smaller amount, typically between 70–100 EUR, depending on your insurance plan. The longer and more severe the illness, the higher the payments.
Regulations and Benefits
Both types of insurance are heavily regulated to ensure transparency and fairness. Insurance companies cannot raise prices based on preexisting conditions, nor can they deny coverage to any applicant.
Conclusion: Whether you choose Gesetzliche Versicherung or Private Versicherung, the German healthcare system offers robust coverage and benefits. Each system has its advantages, and the choice largely depends on individual needs and preferences. Understanding the nuances of these systems can help you make informed decisions that best suit your health and financial goals.