Getting to grips with health insurance in Germany can be a tough challenge for expats, especially those from the United Kingdom, where everyone can count on the publically funded National Health Service. But taking the time to learn about the different health care options available and how they meet your circumstances is crucially important if you have made Germany your home.

While Germany has one of the best healthcare systems in the world, the ageing demographics of the population is likely to make medical insurance become an increasingly important issue, as the costs of insuring the population inevitably rises. According to statistics from the German Federation of Health Insurance Companies (BKK), the number of employees aged 55 and older in Germany increased by 49 per cent from 2000 to 2010.

For employees of German companies, obtaining health insurance is not too complicated. Workers in Germany who are employed by a company will be automatically covered by a gesetzliche Krankenkasse (statutory health insurer), providing they earn under €4,190 a month. This way the cost of funding a medical insurance plan is shared roughly 50/50 with an employer that sorts out all the paper work on behalf of a worker.

AOK is the largest statutory health insurer in Germany, ensuring about 24 million people under the 13 regional branches, making it responsible for the health of about a third of the German population. Other leading statutory insurers include KKH-Allianz, which insurers about two million people with 114 service centers throughout Germany, and the consistently well-ranked Techniker Krankenkasse.

Those who fall ill can normally expect their employer to pay six weeks’ full salary. After this period, the government statutory health insurer pays a percentage of a sick person’s income, up to approximately €2,250 a month as statutory sick pay (Krankengeld) for up to 78 weeks.

Those who are self employed or out of work can pay voluntary health insurance contributions to a statutory Krankenkasse. This is calculated at a rate of 14.9 percent of a person’s income. However, calculations are made based on a minimum income of €1,916.25 a month, resulting in a monthly charge of €274.02.

For many self-employed people in Germany, taking out private health insurance is an attractive option. The cost of private medical insurance varies, depending on a person’s age, gender and state of health. But private medical insurance is usually only for the self-employed, government officials or salaried workers who have an annual income of above €49,500.

Those looking for a private health insurance policy can consult with an independent agent or compare policies online using a Versicherung-Vergleich service. For example, www.geld.de and www.financescout24.de have an online portals enabling visitors to compare private insurance policies. Those using this service will find that it does not have an English language option, making Google Translator a useful tool for non-German speakers. Unlike statutory schemes, a private health insurance policy does not automatically cover a policyholder’s family. Additional fees will be levied for insuring other family members such as children.

Alternatively, expats living in Germany can take out an international health insurance plan. While these schemes can be less costly that private medical insurance offered by providers in Germany, applicants should scrutinize the small print for caveats and conditions, which may exclude important areas of cover. These could exclude cover to those who have pre-existing conditions, illnesses or injuries.

Those earning a freelance living as an artist or writer can apply to join the Künstlersozialkasse (KSK), a scheme introduced to integrate self-employed freelance artists and writers into the statutory social insurance system. The KSK is not a conventional insurer, operating a model where funds paid into the scheme are redistributed between freelancers. Professions eligible for the scheme include performance artists, musicians, journalists, along with teachers of art, music and journalism.

The scheme pays half of a policyholder’s social security contributions (as a percentage of their income), including pension contributions and Krankenkasse. Those who wish to apply to join the scheme should consider enlisting the help of a consultant to help with the paperwork, which of course has to be completed in German. Those applying will have their chances of success enhanced if they hold a membership of a professional trade body and can provide detailed evidence of their work.

“I had to prove I earned my ‘main income’ from journalism,” recalls a KSK scheme member. “When I asked what that meant on the phone, I was told ‘about €800 to €1,000 a month’. You basically send in your contracts and invoices for the last few months and they assess you.”

One key prerequisite for medical insurance cover under the Künstlersozialkasse scheme is that the creative professional must obtain a minimum income of €3,900 a year from their self employed/freelance work.