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


How to make the most of Germany’s long summer days

In Germany the sun sets late and rises early in the summer months. The Local's reporters share their favourite activities for taking advantage of the long hours of daylight.

How to make the most of Germany's long summer days

Germany doesn’t quite get to see the “midnight sun” – how’s it going up there Norway? – but it is located far enough north to enjoy rather long days during the late spring and summer seasons.

The summer solstice, called Sommersonnenwende in German, marks the longest day and also the beginning of the summer season in the Northern Hemisphere.

In the town of Flensburg, which is near Germany’s northern border with Denmark, the sun sets at 10:06 pm and rises at 4:41 on the summer solstice, amounting to approximately 17 hours and 24 minutes of daylight.

Central and southern German cities get a little less daylight, but still enjoy late night sunsets and early morning sun rises. Berlin, for example, gets 16 hours and 50 minutes of daylight on the solstice. Munich gets just over 16 hours of light on the longest day.

Especially for people who moved to Germany from more southerly latitudes, watching the sunset at 10 pm or noticing the sky lighten at four in the morning can be a surreal experience.

But of course the flip side of long days in the summer are long nights in the winter, giving you all the more reason to take advantage of all the light while you can.

Here’s a few things to do with your extra daylight hours during the German summer:

Add outdoor sports to your ‘Feierabend’ routine

Germans place a high value on work-life balance, and this is perhaps best seen in the importance placed on the Feierabend, or your after-work time.

READ ALSO: Why every country should get on board with the German Feierabend

During the winter having a dinner date, or more simply a Feierabendbierchen, are the main after-work activities that come to mind. But during Germany’s long summer days, you still have plenty of daylight left to go skating in the park, or enjoy a bicycle tour of the city, even if you work until 6 pm or later.

sunset jog

Jogging, biking and other sports are all possible after work during Germany’s long summer days. Photo: picture alliance/dpa | Peter Kneffel

Some people really take advantage of the extended light – using that extra time for physical activities that they might not otherwise get to do during work days. It’s not uncommon to see people stand-up paddle boarding on the river, or rock climbing, late into the evening in the summer.

Go for an early morning stroll

Germany’s early morning sunrises can be a bit of a controversial topic.

For the early birds, they offer an opportunity to get ahead of the day before your work day or other obligations begin. For the night owls who currently lack shutters, they can be an unwelcome wake-up call.

But with the sky lightening as early as 4:30 am, whether you’ve freshly woken up, or are heading home after a long night out, you may want to consider taking advantage of a unique opportunity for a morning walk. 

Especially for those who tend to sleep in, an early stroll can allow you to see the world anew – complete with birdsongs in the air and the smell of freshly baked bread wafting out of local bakeries.

Enjoy some of Germany’s summer events and festivals

The summer season is a good one for outdoor events and festivals in Germany, and especially in June and July, attendees can add a catching a late evening sunset to a fest day’s itinerary.

There are a number of festivals worth checking out in June in Germany, including some events scheduled for the longest day itself, such as this solstice celebration in Conneforde or Fête de la Musique in Berlin.

A couple others worth mentioning are the Tollwood Summer Festival in Munich or the Rose and Light performance night in Frankfurt’s Palm Garden.

Stay tuned for a list of July events we’ll be sharing soon.

Catch a film at an open air cinema

Germany loves open air cinemas – it’s home to hundreds of them – and a mid-summer eve is really the best time to experience one.

To find an outdoor theatre near you, try searching for ‘Freiluftkino’ + your city name. 

But be sure to keep languages in mind while looking over screening programs. If you don’t yet have the German skills to enjoy a movie auf Deutsche, you’ll want to look out for films marked OV (original version), OmU (original version with German subtitles) or OmeU (orginal version with English subtitles). 

an open air cinema

Spectators watch a film at the open-air cinema in Oranienburg Castle Park at dusk. Photo: picture alliance/dpa | Jens Kalaene

Watch (or play) some football

This year, you have the added option of watching Euro 2024 football games – often late into the evening – until July 14th.

Of course watching football is something you can always enjoy in the comfort of your own home. But this year you can join in the real-world frenzy that is the UEFA Euros Championship outside at one of the official fan zones, or otherwise at your favourite beer garden, späti or sports bar with outdoor seating.

This has the added benefit of allowing you to watch the game, while also taking in a the summer breeze.

And if watching Die Mannschaft score a couple goals is particularly inspiring, you might still have enough light to head to your local park and kick a ball around after.

Take a wild dip in refreshing waters

Summer in Germany is often accompanied by at least a few heatwaves: a string of hot, sticky days when temperatures soar and it’s tempting to just stay indoors.

In warm weather, though, there’s nothing quite like venturing out to a picturesque lake or a beach along Germany’s rugged coastline and taking a wild dip.

Though you can’t expect temperatures as warm as the Mediterranean sea, that’s part of the charm: bathing in cool, refreshing waters is the ideal medicine for lethargy during those sweltering summer afternoons. 

There are a range of studies that show that outdoor swimming is good for the soul – not to mention great for your health. From releasing mood-enhancing endorphins to boosting immunity and improving cardiovascular health, it’s no wonder wild swimming is known as one of the best natural highs around. 

READ ALSO: ‘Go early and stay late’ – Your tips for making the most of Germany’s lakes

With reporting by Imogen Goodman