Germany is often touted as a model for healthcare – especially since it created the very first universal healthcare system in the late 1800s, under Otto von Bismarck.
Since it is compulsory here, you’ll find it quite hard to be hired as a freelancer or get any kind of visa without it. So here are some of the most important things to know.
Private versus public – there’s a difference
A health insurance card for AOK, one of Germany's statutory health insurance providers. Photo: DPA.
Germany has two different systems of healthcare – the statutory and the private. Statutory health insurance – more often called “sickness funds” – is required for everyone earning less than €4,462.50 per month, or €53,550 per year, and what you pay as a contribution is adjusted for how much you earn. Certain people may opt out, like those making above this threshold or those who are self-employed.
The statutory system is based on the idea that “the cost of healthcare is shouldered primarily by the better-off”, according to the Mannheim Institute of Public Health.
The main difference is this: Statutory insurance contributions are based on income and the benefits you receive are according to need. Private insurance premiums are based on your risk (younger people may pay less, for example), and the benefits you receive are according to what’s in your contract.
Some 90 percent of the German population is covered by statutory sickness funds, according to the German Medical Association.
Private versus public – pros and cons
If you’re self-employed, an older or long-term student or a high-earner, you may be trying to decide between public or private.
The benefit of statutory insurance is that your contributions don’t change as much over time, instead being based on your income. But because private premiums are based on risk, this can sometimes be more favourable for younger people.
Private insurance holders also get certain perks when visiting the doctor. They may get priority in setting up appointments and in consulting the head doctor. But private companies also require you to pay upfront and then will reimburse you, whereas statutory firms receive the bills themselves.
For more detailed information see this report.
Health insurance for freelancers, artists and other creative types
Artist Niklas Klotz. Photo: DPA.
Self-employed artists, writers, journalists and musicians can apply for a very special health insurance group called the Künstlersozialkasse (KSK). The state-funded KSK acts as a sort of employer to pay half the amount of your insurance for pensions, health and even nursing care.
You first have to apply to join and be considered a part of “the artistic and/or publishing” worlds.
The KSK “considers as an artist someone who creates, performs, or teaches music as well as performing arts or visual arts. A publisher… is someone who is working as a writer or journalist, or in a similar manner to a writer or journalist.”
Some of the professions the KSK includes on its application are copywriters, graphic designers, emcees and translators (though this depends on what you’re translating – something more artsy or journalistic is what they’re looking for).
Health insurance for students
Students at the University of Heidelberg. Photo: DPA.
Germany has social insurance agreements with other EU and European Economic Area countries that any student with statutory health insurance in their home country can also get coverage at a statutory insurer in Germany with their European Health Insurance Card.
Some foreign private companies are also recognized in Germany, according to the German Academic Exchange Service (DAAD), so it’s best to contact your local insurance provider to find out.
And for those outside the EU, German statutory insurers are obliged to offer students discounted rates up until the age of 30 and until the end of their 14th semester. These contributions are around €80 per month.
Once you turn 30 or have been studying for longer than 14 semesters, you’ll have to pay a higher rate. If you surpass these thresholds and no longer get the discount, you can also turn to private companies, which sometimes offer student rates themselves.
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