How German health insurance works
Two schemes coexist: the public funds (gesetzliche Krankenkassen), where the vast majority of employees contribute and which cover spouse and children free, and private insurers, reserved for high earners and the self-employed. In both cases, no carte Vitale: one electronic health card per person.
Good to know
- Health insurance is compulsory for anyone working or living in Germany. Employees whose income stays below a yearly threshold are compulsorily in the statutory scheme; above it, they may choose private insurance, but returning to the statutory scheme is then tightly restricted. Source
- In the statutory scheme, family members without work or income (spouse, children) are covered free as dependants (Familienversicherung). You freely choose your fund among the Krankenkassen and can switch. Source
- With a contracted doctor or dentist, the insured person shows the electronic health card (eGK) and pays nothing upfront: the fund pays the practitioner directly. Privately insured patients pay the consultation and then claim it back. Source
- No compulsory gatekeeper: you freely choose a GP (Hausarzt) and, for children, a community paediatrician (Kinderarzt), seen directly. For some specialists, a referral from the GP is still customary. Source
- 116 117 (the out-of-hours doctor) answers 24/7 for anything that cannot wait for surgeries to open; 112 is for life-threatening emergencies. Source