How the Healthcare System works in Germany
Germany’s healthcare system is one of the most advanced in the world – but also one of the most regulated.
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For newcomers, it can seem like a maze of acronyms, paperwork, and rules. Understanding how it works will help you avoid costly mistakes and ensure you get the care you need.
1. A dual system: public and private
Germany has two main types of health insurance:
1) Public health insurance (Gesetzliche Krankenversicherung – GKV)
- Covers about 90% of residents.
- Contributions are income-based (currently around 14–15% of your gross salary, split between you and your employer).
- You can choose among various public providers (Krankenkassen) such as TK (Techniker Krankenkasse) or AOK.
2) Private health insurance (Private Krankenversicherung – PKV)
- Often chosen by higher earners, self-employed people, or civil servants.
- Premiums depend on age, health condition, and coverage level.
- Can offer faster specialist appointments, but switching back to public can be difficult.
More info: German Federal Ministry of Health – Health Insurance
2. Who must have insurance?
Health insurance is mandatory for everyone living in Germany – without it, you cannot get a residence permit.
Employees: Usually registered automatically with a public insurer by the employer.
Self-employed and freelancers: Must choose and register themselves, deciding between public and private.
Students: Can often get reduced rates in public insurance until a certain age.
3. How to choose a doctor
- Hausarzt (general practitioner): Your first point of contact for most health issues. They can treat you directly or refer you to a specialist.
- Specialists (Fachärzte): Often require a referral (Überweisung) from your GP.
- Dentists (Zahnarzt): You can go directly, without a referral.
Tip: In cities, doctors often have long waiting lists – book appointments well in advance.
4. Emergencies
- 112 – Ambulance/fire brigade
- 116 117 – Non-emergency medical service (available 24/7, connects you to out-of-hours doctors)
- Apotheke (pharmacy): For medication and basic health advice. Look for a green cross sign.
5. Common challenges for newcomers
- Language barrier: Not all medical staff speak English. Consider learning basic medical vocabulary or bringing a German-speaking friend.
- Waiting times: Non-urgent specialist appointments can take weeks.
- Understanding bills: Even in public insurance, you may pay small co-payments (Zuzahlungen) for certain medications or treatments.
6. How to make the system work for you
- Register with a Hausarzt as soon as you arrive – don’t wait until you’re sick.
- Keep your insurance card (Gesundheitskarte) with you at all times – you’ll need it for every appointment.
- Learn the basics of booking appointments in German: Ich möchte einen Termin vereinbaren… (I’d like to make an appointment).
