What's it Like to Have German Health Insurance?

A lot of folks in the US ask me what German health insurance is like. As a former resident of Germany (2003 to 2008) and a participant in their public health insurance program (there is also a separate, private system, which I know nothing about) here are 7 differences I noticed:

1. It has a different name.

It’s not “health insurance.” It’s Krankenversicherung, or illness insurance. Krankenversicherung is a protection against financial devastation, it’s no guarantee you’re going to be healthy.

Personally, I refer to my policy payments every month as Illsurance. We have car insurance for our cars, and home insurance for our homes, why not Illsurance for illnesses?

2. Your payments are percentages, not flat fees.

Depending on your Krankenversicherung, you pay roughly 14% of your income towards your policy. Your employer pays a bit less. Thus the monthly payments change depending on and related to your income changes, but there is a cap on how much you pay when you’ve reached EUR 4,350/month gross. Insurance companies can change the percentages, however they are relatively small and they are announced in advance.

3. It’s a lot less paperwork.

During the years I lived in Germany, I had only one extra sheet of paperwork to fill out.

In FIVE YEARS I only had to do extra paperwork ONCE. That includes doctor visits for antibiotics, annual visits, and even an outpatient procedure. (And the Krankenversicherung paid for my taxi to get to the office for the procedure and back.)

Here was what sparked that extra sheet of paper: I had an asthma attack at work, couldn’t breathe, and they called an ambulance. The ambulance staff gave me oxygen and checked me over, and suggested I see a physician the next day. The Krankenversicherung sent me a form to fill out where I had to explain why I needed an ambulance.

Das war alles.

4. Co-pays were very low.

When I moved to Germany they introduced co-pays. It was EUR 10 every quarter–yes, every three months—to see your primary care physician and to go to another doctor, you either had to get a transfer order or pay another EUR 10. At the dentist, you paid EUR 10 but you were refunded the EUR 10 if you didn’t have any cavities.

Echt jetzt.

Patients at this time also had to start paying for their own over-the-counter medications that their doctor recommended. Most of what my doctor recommended to me was between EUR 3 and EUR 8. Not a problem for a young, healthy person who was working, however this did get to be tricky for elderly folks on a fixed income.

Now it looks as if it’s a minimum of EUR 5 and a maximum of EUR 10, based on a percentage of 10% of the cost of the medication, at least at this Krankenversicherung. It looks like there are no more co-pays…

5. die Künstlersozialkasse

Artists and other freelancers in Germany don’t have an employer, however the German government sets aside money every year and has set up the Künstlersozialkasse (KSK, the Artist's Social Fund) to act like an employer to these folks, at least when it comes to their Krankenversicherung.

First you must prove that you are, indeed, a working freelancer and apply to be in the KSK. Then you tell them which Krankenversicherung you want and how much you expect to earn. (This can be adjusted during the year, but you don’t get money back for previous payments made!) Then you send in your money each month and that’s it.

6. Arzneimittel und Massagen

Germans are really into natural products and this includes their medical care. You can be prescribed natural “medications” like Echinacea and other herbs. We call these over-the-counter meds, they call them Arzneimittel. You can even be prescribed massage for psycho-physical conditions like the stress of recovering from a car accident. You pay only a small percentage of these out-of-pocket.

7. Est geht um die Gesundheit.

Herein lies the greatest cultural difference: Germans have a philosophy of health and wellness, not a philosophy of illness and medicine. Most people do something for exercise during the week, there are walking paths everywhere and people regularly ride their bikes to work.

Just off the top of my head, here are some of the Wellness things you can do in Germany: buy wellness clothing, visit a Wellness Hotel, regularly visit a mineral bath, zur Fußpflege gehen, visit the sauna (Achtung! Naked people!), go to Physical Therapy, opt to ride your bike to work, walk and take the subway instead of driving, an die frische Luft gehen, spazieren gehen, wandern gehen, Gesund essen, Gesund kochen…

There is a small percentage of people in Germany who don’t participate in the Krankenversicherung, and I don’t know how that works for them. It is also illegal to be without Krankenversicherung in Germany. So apart from them, no one in Germany could ever be financially destroyed by medical bills.

Given the right circumstances, your doctor can even send you on a Kur, which is a wellness retreat, also paid for by the Krankenversicherung when it’s prescribed by a doctor, for prevention, rehabilitiation, or treatment of chronic ailments.

Although it still costs a serious chunk of change every month, in general I found that I spent little time thinking about the Krankenversicherung while I lived there. That would be the biggest day-to-day difference.

Read more on these German sites:

Krankenkassen. https://www.krankenkassen.de/

Die besten Wellness-Hotels in Deutschland http://www.focus.de/reisen/hotels/tid-34504/wohlfuehlhotel-ranking-2014-das-sind-die-besten-wellnesshotels-in-deutschland_aid_1149378.html

Gesundheitsseiten24.de : http://www.gesundheitsseiten24.de/