September 21st, 2023 at 05:57 pm
Health Insurance and Healthcare Systems in Germany
Germany is well known for having an excellent healthcare system that prioritizes accessibility and wide coverage for its citizens. Every citizen and resident must have health insurance, which is essential to this system and guarantees that people can obtain high-quality medical care without incurring excessive costs.
It’s crucial to comprehend the nuances and enrollment criteria of Germany’s health insurance system if you intend to relocate there. Health insurance is a basic need of living in Germany and is necessary in order to get healthcare services.
What Is the Function of the German Healthcare System?
The healthcare system in Germany is based on a hybrid model that blends public and private components. It is predicated on the requirement for health insurance, which is supplied by either private health insurance (Private Krankenversicherung) or statutory health insurance (Gesetzliche Krankenversicherung).
Private health insurance is offered to self-employed people and higher-income earners, whereas statutory health insurance is required for employees below a specific income threshold.
Comprehensive coverage for medical services, such as primary care, specialist consultations, hospital stays, prescription drug coverage, and preventative care, is provided by both insurance kinds. Contributions from employers, employees, and the government support the system. People are free to select the healthcare professionals that they want, and patient education and preventive care are given top priority.
Did you know that the German health care system is the second most generous in the EU, after Luxembourg, covering over 80% of its citizens’ prescription costs?
Statutory Health Insurance: What Is It?
In Germany, the majority of people are required to have public health insurance, often known as statutory health insurance (Gesetzliche Krankenversicherung, or GKV).
Solidarity is emphasized by statutory health insurance since each member contributes a certain amount of their income. The employee and the employer usually share the income-dependent contribution amount. This guarantees that healthcare is both inexpensive and available to people of all income levels.
People are entitled to a range of medical treatments under statutory health insurance, such as primary care, specialist consultations, hospitalization, prescription drugs, and preventative care. Long-term care services, rehabilitation, and essential treatments and procedures are all covered.
Nonetheless, some groups of people can choose to forego mandatory health insurance in favor of private health insurance, such as those with higher incomes or those who work for themselves.
Who Qualifies?
Legally, German statutory health insurance must cover the following categories:
- workers whose annual compensation is less than a specific level, which in 2023 is projected to be approximately €66,600. Both full-time and part-time workers are included in this.
- Students enrolled in state-approved schools up to the age of thirty who do not regularly earn more than the allowed amount. After 30 years of age or after completing education, other regulations might be applicable.
- those participating in apprenticeship programs or other forms of vocational training.
- wives and children who are family members of those who are afforded statutory health insurance.
What Is Included?
In Germany, it is legally required for statutory health insurance coverage to provide the following services:
- Initial General Care Practitioner (GP) consultations, examinations, and primary care services.
- Specialist care refers to medical professionals such as dermatologists, cardiologists, and gynecologists who provide consultations and treatments.
- Hospitalization refers to receiving medical care as an inpatient at a hospital, which may involve surgeries, diagnostic tests, and rehabilitation programs.
- Prescription drugs: Drugs that have been recommended by medical practitioners and are governed by rules regarding coverage and reimbursement.
- Preventive care includes immunizations, tests, and initiatives to promote health with the goal of preventing and detecting diseases early on.
- Maternity and childbirth: pregnant women’s prenatal care, delivery, and postpartum care.
- Rehabilitation: Services related to rehabilitation, such as speech, occupational, and physical therapy.
- Mental health: Psychiatric care and therapy are among the inpatient and outpatient therapies available for mental health issues.
- Devices and medical aids: Provides coverage for required devices and medical aids, including hearing aids, mobility aids, orthotics, and prosthetics.
- Dental care: Cleanings, fillings, extractions, and examinations are among the basic dental procedures.
What’s Not Included?
Generally speaking, statutory health insurance does not cover or only partially cover the following medical services:
- Specific dental procedures treatments like orthodontics or cosmetic dentistry might not be fully reimbursed by mandatory health insurance, meaning the patient would have to pay in full or in part for the services.
- Complementary and alternative therapies: Services like naturopathy, homeopathy, and acupuncture might not be completely covered by public health insurance. However, certain insurance funds might only cover a portion of certain alternative therapies.
- Private hospital rooms: Although essential hospital stays are covered by public health insurance, choosing a private room or extra amenities may come with out-of-pocket costs.
- Non-prescription drugs: Public health insurance typically does not cover over-the-counter drugs. That being said, prescription drugs written by medical experts are covered by coverage limitations and reimbursement requirements.
- Specific medical equipment and assistance: Prosthetics, orthotics, and hearing aids are examples of basic medical devices and aids that are covered. However, some high-end or specialty gadgets can need extra coverage or cash outlays.
- Cosmetic procedures: Public health insurance usually does not cover cosmetic surgery or treatments conducted for aesthetic reasons.
What’s the amount?
According to your wage, the cost of public health insurance in Germany will range from 14.6% to 15.6% as of 2023. This is because the cost of insurance is normally based on a person’s income. If you are self-employed, you bear the full expense on your own; otherwise, you and your employer split this percentage.
Private Health Insurance: What Is It?
A substitute for mandated health insurance in Germany is private health insurance, or private Krankenversicherung, or PKV. For those who are exempt from being compelled to enroll in statutory health insurance, such as higher-earning individuals, independent contractors, government employees, and members of specific professional associations, it is an optional kind of coverage.
Individual contracts are the foundation of private health insurance, enabling policyholders to customize their arrangements with certain private insurance companies. The age, health, and requested coverage are the main criteria that affect the premiums for private health insurance; younger people often have cheaper prices. Access to private hospitals or specialist medical professionals, as well as a broad range of supplementary services and alternative therapies, are all provided by private health insurance.
Who Qualifies?
Germany’s private health insurance policies cover the following categories:
- Those who make more money than the legal minimum required to obtain health insurance.
- Individuals working for themselves, whether as independent contractors or business owners, are not limited by their salary.
- Students who have private insurance as dependents of their parents or who are older than the age restriction for mandatory statutory health insurance (usually thirty years old).