Healthcare in Germany: when do you have to pay extra?

You can be certain of a high level of healthcare in Germany. But you’ll also sometimes face additional medical bills – with both public and private insurance.

Healthcare in Germany: when do you have to pay extra?

Understanding the complexities of the two systems takes time. If you’re not sure about the differences between Zuzahlungen (co-payments) and Selbstbehalt (deductibles) who could blame you? (read on for more …).

From prescriptions to dental work, here’s a handy guide to out-of-pocket healthcare costs – to help you choose the right solution for you.   

Find out about ottonova’s fully digital insurance solutions for expats

Public or private? First, the basics …

Health insurance is compulsory in Germany. For public health insurance (GKV), everyone pays 14.6 percent of their gross income (plus a small supplement) – and can expect a robust level of protection.

If you’re employed and earn more than €62,550 per year or self-employed, you can choose full private health insurance (PKV). This opens up new choices offering broader coverage of drugs and treatment, including policies from ottonova private health insurance that offer up to 100 percent coverage of all such costs. If you prefer a premium policy, you could consider ottonova’s First Class tariff. 

Public co-payments: how you contribute

Perhaps you hoped that having public insurance would mean you only pay your monthly premium? Unfortunately, that’s not the case. Welcome to the world of co-payments – patient contributions that even apply to ambulance transportation costs (although not in emergencies).

After an accident or surgery, you may badly need physiotherapy to get you back to your best. If you’re prescribed a course of treatment with public insurance, you’ll pay 10 percent of the costs – plus a fixed €10 per prescription (which should include multiple sessions).

Private health insurance can offer you much greater coverage – up to 100 percent reimbursement of the charges for physiotherapy.

When you require hospital treatment, you can also expect to pay €10 per day towards this with public insurance (for a maximum of 28 days per year). If you feel in need of extra services or comfort – such as treatment by the head physician or having your own room – you’ll be liable for the full cost, whereas with private insurance you can have such options included in your policy.

Co-payments are limited to a maximum of two percent of annual household income – that’s €1,400 if your gross income is €70,000.

Going private: deciding your deductible

If you go private, you can get the same employer subsidies as with public insurance – up to a maximum of €368 per month – helping to make private coverage more affordable.

You also need to make a choice about your deductible that influences what you pay each month. Your deductible (or excess) is what you pay towards your medical bills before your insurer picks up the remaining amount. Want a lower monthly payment? Just choose a higher deductible. 

Fast health insurance services for expats in English – get a consultation with ottonova 

Pharmacy payments: just what the doctor ordered?

Even if you’re new in Germany, it’s easy to spot the many pharmacies (Apotheken) – with a green cross or a big red ‘A’. While the German pharmaceutical market is worth more than €43 billion per year, you can only get many medicines from pharmacies with a doctor’s prescription.

Public insurance usually covers prescription-only drugs – but the pharmacy must look for the cheapest option. You’ll also need to make a co-payment of between €5 and €10 per prescription before taking your medicine home for some much-needed rest. 

Photo: Getty Images

Some ‘lifestyle’ drugs are excluded altogether from public coverage: if you’re looking for hair loss treatment, your luck’s out. The same is true if you’re fond of herbal remedies; many appear on the Ministry of Health’s list of drugs you can’t claim for – along with treatments you can buy over-the-counter (OTC) like cold medicines, Ibuprofen and nasal sprays.

But some private companies do partly or fully cover OTC drugs. With , it’s easy to get many such medicines reimbursed regardless of the supplier or price of the drug – just scan your receipt and upload it in the app. Need a quick answer on whether a particular drug is covered? Just ask the English-speaking Concierge in the app or by calling while in the pharmacy.

Dental bills: avoiding a kick in the teeth … 

Many people dread a simple trip to the dentist – let alone root canal surgery. But taking out private insurance that covers the costs of complex dental treatment could help you avoid additional financial pain.  

With public insurance, you’ll generally be covered for check-ups and basic dental, gum and orthodontic treatment. You’re less likely to be fully covered for annual dental cleaning, which helps prevent gum disease – as well as keeping your teeth whiter. 

With major dental treatments, relying on public insurance could mean you have to pay up to 80 percent of the cost. If you need dental prosthetics, for example, you must share a treatment and cost plan from your dentist with your insurer – who then decides what it will pay.

As an example, endodontic treatment – involving the soft pulp inside the tooth – could cost around €1,300 with public insurance typically covering around €350. That would leave you with €950 to pay – money that could be covered in full with the right private policy. If you have GKV insurance, you can always take out a private top-up such as those offered by ottonova.

Digital reimbursement: get your money back fast!

Even with many private insurers, you may have to pay up for healthcare costs first and then wait for them to process the claim and transfer the money to your bank account. The paperwork can also be a drag to deal with.

As Germany’s first fully digital private health insurer, ottonova is often able to send the money to your account before the bill becomes due. Bills of up to €500 uploaded to the app will be reimbursed within 48 hours from Monday to Friday. See the infographic below for more details of how ottonova’s health insurance for expats compares with public health insurance.

For members


Living in Germany: Newsreader’s giggles, your go-to German word and German Unity Day

In this week's roundup we talk about a German newsreader's fit of giggles, your 'comfort' German word, Oktoberfest and why German Unity Day could have been scrapped as a weekday public holiday.

Living in Germany: Newsreader's giggles, your go-to German word and German Unity Day

Living in Germany is our weekly look at some of the news and talking points in Germany that you might not have heard about. Members can receive it directly to their inbox on Saturday.

Why we love German newsreaders 

The news is a serious business, but things lightened up this week thanks to German newsreader Susanne Daubner’s laughing outburst. In what was a very relatable moment, Susanne, from ARD’s Tagesschau, was trying to report on a summit being held on the chemical industry in Germany, but found something her colleague Sven Lorig said so funny that she launched into giggles – known as a Lachflash in German – and couldn’t stop. Susanne said after that she “couldn’t really explain” what happened. She said she was engrossed in her news report but heard her colleague in the background talking and thought: “Oh dear I’m already on air.” She added: “And then I just had it to laugh. It felt like it lasted forever.” The moment went viral on social media, with many saying it made them laugh out loud.

It reminded us of the moment last October when another ARD German newsreader Annette Dittert sparked a roar of laughter. When Dittert was reporting on the chaotic incidents that happened in the run up to former British Prime Minister Liz Truss’ resignation, she used strong English swear words – something which would be extremely unusual on anglo TV. While describing the chaotic scenes in the House of Commons, Dittert said that the former PM’s deputy whip Craig Whittaker vented his frustration by saying he was “f**king furious and I don’t f**king care anymore” (without blanking out the swear words). Who said Germans don’t have a sense of humour?

Tweet of the week

What’s your go-to German word to ensure you sound engaged in a conversation?

Where is this?


Photo: picture alliance/dpa | Peter Kneffel

We couldn’t resist sharing another photo of Oktoberfest with you. Revellers at the Wiesn have enjoyed blazing sunshine since the festival started on September 16th. It runs up until October 3rd – and just under a week later, on October 8th – Bavarians will go to the polls to vote on their new state parliament. Our columnist Brian Melican this week reported from the Wiesn and gave a fascinating overview of the uneasy political situation in Bayern. And for all those in Hesse – which is voting on the same day – check out our guide to the elections here.

Did you know?

This Tuesday, October 3rd, marks 33 years since reunification and almost 34 years since the fall of the Berlin Wall. It is a public holiday for people in Germany. Because it falls on a weekday this year, it means most people get the day off work and shops and businesses will be closed while Germans spend time with their loved ones or simply take a day of relaxation. But did you know that former German Chancellor (and the now disgraced) Gerhard Schröder tried to remove the Tag der Deutschen Einheit (German Unity Day) as a national holiday in 2004?

 He wanted to move it to a Sunday to give fewer people the day off. In a letter defending his plan, Schröder wrote: “the holiday should not be abolished, but moved to the first Sunday of October every year.” Citing economic reasons, he explained he was committed to reducing the number of national holidays. Unsurprisingly, this wasn’t a very popular suggestion, and it remained on October 3rd. We wish you a wonderful German Unity Day!