For members


Could it soon get harder to get private health insurance in Germany?

According to reports in German media, the Social Democrats (SPD) and Greens want to make it harder for high earners to switch to private health insurance. Here's what you need to know.

Health insurance cards from statutory insurer AOK.
Health insurance cards from statutory insurer AOK. German health insurance will pay your medical bills, including sick pay for up to 78 weeks. Photo: picture alliance/dpa | Karl-Josef Hildenbrand

What’s going on?

Germany’s health insurance funds have been struggling with huge deficits recently – especially in the wake of the Covid pandemic that placed an unprecedented burden on the health and care system.

This year, the statutory insurance funds (GKV) could face a historic deficit of €17 billion, while the care insurance funds need an estimated €4.5 just to stabilise the system.

Health Minister Karl Lauterbach (SPD) has recently taken a number of steps to correct the situation, including allowing insurance funds to hike their additional contributions to enforcing pharmaceutical discounts on medicines. But there are signs that his emergency measures may not be enough.

Speaking to Handelsblatt on Monday, Dagmar Schmidt, vice chair of the SPD parliamentary group, called for a discussion on placing a higher financial burden on high earners in order to plug the financial hole in the healthcare system. 

Schmidt said a “significant increase” in the threshold for switching from public insurance to private insurance was needed to ensure that wealthier people in Germany were shouldering their fair share of the costs.

This would likely involve raising the salary threshold for transitioning to private insurance from €4,987.50 gross per month to the same level required to opt out of public pension contributions: €7,300 per month in western states and €7,100 per month in eastern states. 

READ ALSO: Will health insurance costs go up again in Germany?

How does the system work at the moment? 

Currently, regular salaried employees in Germany must have statutory health insurance unless their income exceeds a certain threshold. This threshold increases incrementally each year and currently stands at €66,600 per year for 2023. 

If employees earn over this amount, they have the option to switch into the private system and opt out of statutory insurance contributions. Since private insurance isn’t income-linked and generally provides more attractive benefits than statutory insurance – including lower waiting times – many higher earners choose to make that switch.

In addition to the salary threshold, there are a few other exceptions to obligatory public insurance for certain groups of the population.

A health insurance card.

A health insurance card. Photo: picture alliance/dpa/BKK Mobil Oil | gettyimages/Lothar Drechsel

For example, freelancers can generally choose whether to take private or public insurance, though it can be hard to switch back to statutory insurance after opting for private.

This can be an issue in later life when private insurance contributions can go up significantly, or in circumstances when higher earners end up in a much lower salary bracket.

As of 2020, around 90 percent of the population were paying statutory insurance contributions, while 10 percent had private insurance, according to data published by the Association of Substitute Health Insurance Funds (VDEK).

READ ALSO: German doctors debate added fees to ‘no-show’ appointments

What do each of the parties think of the current system?

Hiking the earnings threshold for entering the private healthcare system has long been a goal of the centre-left SPD – and it seems the largest party in the traffic-light coalition also has support from the Greens.

Maria Klein-Schmeink, vice chair of the Greens’ parliamentary group, told Handelsblatt that her party would also support such a move.

“This would mean significant additional income for the statutory health insurance and – unlike higher contribution rates – would only burden high earners,” she explained.

However, the reignition of the healthcare debate by both the SPD and Greens sets the parties on a collision course with the liberal FDP, who currently control the Finance Ministry within the traffic-light coalition.

Dagmar Schmidt

Dagmar Schmidt, vice chair of the SPD parliamentary party, has been calling for a shake-up of the health insurance system. Photo: picture alliance/dpa | Kay Nietfeld

In their party manifestos back in 2021, both the Greens and SPD had called for an end to the two-tier insurance system of private and public health insurance, arguing that it was unfair for higher earners to opt out of statutory contributions. This idea was branded ‘Citizens’ Insurance’ (Bürgerversicherung).

However, these proposals were blocked by the FDP during coalition negotiations and never made it in to the final coalition pact. 

But Schmidt said the FDP’s insistence on austerity measures had forced the coalition to consider other options financing the healthcare system outside of government subsidies. 

“The question is how the coalition will finance its health policy plans,” she said. 

In the aftermath of the pandemic and Russia’s invasion of Ukraine, Finance Minister Christian Linder (FDP) is keen to regain control of the nation’s finances and dramatically cut government spending.

“The Minister of Finance does not see himself in a position to provide subsidies for (healthcare) at the moment,” Schmidt said. “Because service cuts are not an alternative, we have to improve the revenues of the social security system.”

Could the SPD and Greens force a shake-up of the health system? 

The debate over whether to shake up Germany’s existing healthcare system is likely to come to a head as the coalition parties – and opposition CDU/CSU – debate the forthcoming budget. 

The FDP remains firmly against proposals to make it more difficult for higher earners to switch to private insurance – largely because it would spell a reform of the two-tier health insurance system. 

However, Schmidt hinted in Handelsblatt that the Greens and SPD could potential refuse to support the Finance Ministry’s plans if Linder wasn’t prepared to make concessions.

FDP leader Christian Lindner

FDP leader and Finance Minister Christian Lindner speaks at a press conference in Berlin. Photo: picture alliance/dpa | Sebastian Gollnow

READ ALSO: What to know about Germany’s new health insurance fees for 2023

“After all, the finance minister wants to get a majority for his budget,” she said.

Nevertheless, not everyone is convinced that funnelling more people into the statutory insurance system would solve existing issues.

Speaking to Handelsblatt, economist Martin Werding, slammed the proposals as “citizens’ insurance through the back door”.

If the income threshold were to rise to the level of the pension insurance, only a small minority of workers would be able to opt out of statutory health insurance, meaning the private insurance funds would be “bled dry”, he said. 

Member comments

  1. “This would mean significant additional income for the statutory health insurance and – unlike higher contribution rates – would only burden high earners,” she explained.

    Great. Pay more for crappier care. Socialism is the worst.

  2. So if you earn less than €66,600 per year, you can’t have a private insurance? I don’t think this is accurate

  3. If the objective is to increase the money that the health care system can “spend”, the answer is for those that can afford it (as always) to take out additional insurance to pay for additional perks, such as single bed rooms, bespoke meals, improved bedside views or whatever.

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For members


Do German employees with Covid-19 and no symptoms still have to go to work?

The Covid-19 pandemic may be officially over but the number of reported cases is going up around Germany. If an employee tests positive, but has no symptoms, do they still need to show up at work?

Do German employees with Covid-19 and no symptoms still have to go to work?

During the bulk of the Covid-19 pandemic, anyone with the virus was required to stay home for a certain period of time, whether they showed symptoms or not.

Now the pandemic may officially be over, but “Covid-19 is still with us,” as Germany’s health minister Karl Lauterbach said last week upon announcing the availability of the newest booster vaccine

There are currently three Covid-19 variants circulating around Germany, with the reported number of cases going up.

READ ALSO: Could there be a new wave of Covid-19 in Germany this autumn?

Workers around Germany may get tested – be it because a close contact had the virus or out of curiosity – and find they also have Covid-19, but are completely free of symptoms.

Does this mean they still need to show up at their workplace, if working from home isn’t possible, or should they stay home until they have officially recovered?

Employee must indicate infection

If a person infected with Covid exhibits typical signs of the virus such as a coughing, a cold or a fever, the case is usually crystal clear: they can and should rest at home, as with any sickness. 

In accordance with German law, they’ll need to get a sick note from their GP if those symptoms last for longer than three days. 

However, positive test alone “does not automatically make you unfit for work,” lawyer Alexander Bredereck told Germany’s RND editorial network. “And if you are not on sick leave, you actually have to work. Therefore, the employee is in a difficult situation here.”

He continued: “If the employee simply stays at home without a sick note, in the worst case he can risk a warning or even dismissal for not showing up for work.”

However, if someone goes to work despite the positive test result, they may endanger their colleagues – as they can become more severely infected. 

Furthermore under German labour law, the employee is usually obliged to inform their employer of the Covid-19 infection.

READ ALSO: How sick leave pay in Germany compares to other countries in Europe

Uncertain legal situation

“At the moment, there are no legal requirements that employees and employers have to adhere to,” says Bredereck. 

In February 2023 Germany’s ‘Occupational Health and Safety Ordinance’ on Covid-19 – which would have required those with an infection to stay home at least five days – came to an end.

Since then, Germany’s Ministry of Labour has simply recommended that each employer implement their own hygienic requirements to protect their employees from Covid and other infectious diseases such as the flu, which is soon expected to see a spike in cases as the autumn/winter season takes hold. 

If there is a high incidence of infection in one particular region, the Ministry of Labour recommends that, in addition to the usual hygiene measures, social distancing measures should be implemented again and people should reduce their contacts. 

This suggests that workers should not endanger other workers in this situation.

Stay transparent

To solve the dilemma and avoid conflicts, Bredereck recommended that employees simply stay transparent with their management.

“Don’t take any unnecessary risks or get into trouble with your boss,” he said. “Ask your employer what you should do.”

Alternatively, the employee could also turn to their GP for a sick note, which for regular patients is also available via phone in some cases. 

“Then the doctor has to decide what makes sense, and the employee is on the safe side,” explained Bredereck.