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German Health Care Coverage

I wanted to share some of the things I've been thinking about related to life in the US and Germany.

Thumbs up for affordable, comprehensive health care

Thumbs up for affordable, comprehensive health care

Be treated like a Mensch in Germany

The basics of German health care

German health insurance isn’t free but it also doesn’t endanger your freedom as some might have you believe in the US. The system is divided into gesetzlich – satutory and privat – private. What this means is most workers pay into the gesetzliche Krankenversicherung and some into the private Krankenversicherung based on receiving a higher overall income or depending on the kind of work contract you have like some teachers in Germany and freelancers. Both types of insurance are provided by insurance companies and not the government. The only say the government has is in regulating the levels of care that must be provided and the cost at around 15% of earned income.

Anyone employed earning over 451 Euros a month will roughly split the bill for health insurance of approximately 15% with their employer at around half each. It doesn’t matter as much which provider you choose compared to the US because a basic core standard of care must be guaranteed. There aren’t multiple tiers within a provider’s health care coverage either. Any additional insurances beyond those provided by the gesetzliche Krankenversicherung can be bought through additional private insurance from another provider. However, for the majority of people, you won’t need additional insurance.


Two major advantages over American health care

Unlike in the US where health insurance coverage varies greatly depending on your plan, those insured in Germany don’t need additional insurance in case they get cancer or another illness deemed too expensive to cover on a lower insurance premium plan in the US. This is pretty rad and might just save your life and not leave you homeless from the astronomical bills.

Another important aspect is that health insurance isn’t tied to your job. The 15% premium for health insurance remains the same whether you are employed or not. If you lose your job, part of your premium will be covered until you find work again. If you leave contracted employment and work as a freelancer, you can opt to remain in the gesetzliche Krankenkasse and pick up the other half of the 15%. This is a good idea because you can have very affordable health care when you retire as well compared to being privately insured.


Freelancers have a few disadvantages

There is an assumption that freelancers in Germany will earn decent salaries and it would, therefore, be no problem for them to join the high wage earners who already need to have private insurance. That’s not always the case and can be tricky for US Americans looking for insurance in Germany.

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German insurers will only admit someone into the gesetzliche Krankenversicherung who has contracted employment in Germany or who is coming from a job which had them covered with an equivalent type of insurance. This disqualifies many US Americans who seek freelance employment in Germany since most only have access to private health care providers.

There are possibilities to join a co-op that essentially puts you on their payroll and processes your invoices for you for a fee. You are legally considered employed by that co-op even though you are really a freelancer. This is an acceptable solution, but it ultimately could make things difficult financially to pay money just to have access to pay more money for health insurance. Low paid freelancers are one group who doesn’t benefit much from the wonderful health care in Germany.

Many freelancers end up only staying for several years in Germany before returning home. In this case, a BaFin (approval for minimum insurance coverage) accredited travel insurance can possibly suffice the requirement for health insurance in order to be granted a freelance visa. This type of insurance can, however, only be used for a maximum of five years before needing to transfer into a German private insurer, which is much more expensive, or into the gesetzliche Krankenversicherung through taking on contracted employment.


Bürgerversicherung - One health care system for everyone

Over the past several years, German politicians have been debating the concept of a Bürgerversicherung, essentially a rebranding of the gesetzliche Krankenversicherung where everyone would need to be covered. The idea is that there would be more available funds in the overall bucket of those insured by pooling money from higher income earners who would normally not have paid into the gesetzliche Krankenversicherung. My understanding is those higher income earners wouldn’t pay a disproportionately higher rate, but the idea is there would be overall more people insured under the same system, which would hopefully ease any funding shortcomings.

Opponents of the Bürgerversicherung point out that private insurance helps to pay for expensive devices in doctor’s practices through the higher premiums and charges for care. With the pandemic grinding so much to a standstill these past few years, there hasn’t been much development on this proposal.


"Never gonna give you up," until you ask us to in writing

Here’s a quick anecdote that will likely seem strange to most in the US. I returned to the US about seven months ago and forgot to cancel my German health insurance, forgetting that Germany doesn’t kick you out of coverage immediately after your final day of work. I get a letter in the mail explaining that my insurer heard I was no longer at my former employer and that they would automatically switch my status to voluntarily insured with them. The letter was succinct as you would expect from German business contact, but also kind and reassuring that I would still be covered. I had to write an official letter asking them to no longer cover me. Their response was one of thanks and to let them know when I was ready to come back. In the words of the Muskelprotz Austrian Terminator, “I’ll be back” Techniker Krankenkasse and thank you for bringing a smile to my face as I waited a month with no insurance in the US because employers don’t start health care coverage until a month after you start working for them.

This content is accurate and true to the best of the author’s knowledge and is not meant to substitute for formal and individualized advice from a qualified professional.

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