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The intricate world of German health insurance


Whether you’re a fleeced American used to paying over the odds or a naïve UK resident who blunders through life without paying anything for their healthcare, the German system will come as something of a revelation. It’s strict, reasonably fair, realistically expensive and is – above all – something you do have to pay for.

German health insurance is compulsory. Salaried workers pay 15% of their income into one of 130 public, not-for-profit “sickness funds” – though generally employers contribute half of the premiums. These “sickness funds” are designed to provide general cover for all citizens. Things get gentler for civil servants – like public servants everywhere they seem to have generally arranged for the tax-paying public to stump up for their cover – but there are areas where individual workers can make serious savings by taking out private health cover. This applies particularly to younger workers, who are far likely to get sick, and for those on higher salaries: if the health tax is 15% then by the time you’re collecting 60,000 Euros a year you can get better healthcare, cheaper, in the private sector.

Salaried employees must have public health insurance; and indeed 89% of Germans do. This had advantages in that the premium is set by the Federal Ministry of Health, covers family members, and is co-funded by the employer. The rate of 15.5% is split between employee and employer. It’s also pay as you go: the rate is the same whatever your age or pre-existing health conditions.

Private health insurance can benefit higher earners, public servants (also often higher earners) and the self-employed. As rates are based on individual agreements the charges depend on the individual’s age, state of health, and the level of services required. Dentistry is one of the obvious negotiable elements.

There are dangers with opting out of the public health insurance system. It can be hard to get back. If you’re under 55 years old and your income drops below a certain level you might be able to slip back into the system. Otherwise you might have to go whistle and put up with rising private premiums and rising costs.

However you choose to arrange your cover you’re likely to get good healthcare in Germany. Unlike the French they have little time for alternative therapies and no passion for suppositories: in Germany you’re a lot more likely to be queued in for surgery – fast. Even the public sector averages a waiting time of 12 weeks and the private operators are quicker.

But blasé Brits, used to the free on-demand health services available in the UK, should bear one thing in mind. In Germany, you do need to be insured to get healthcare. Unless you’re able to drive yourself back to the UK – and possibly quite fast – you might just die.

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