The sentence that takes newcomers longest to believe is this one. Your spouse and your children cost nothing extra.
One contribution, taken as a percentage of one salary, and the whole household is insured. That’s the part of the German system that has no equivalent in most of the world, and it’s worth understanding before anything else.
Health insurance here is compulsory for everybody living in the country. Not encouraged, not tax-advantaged. Required, and organized so that nobody falls out of it.
Everybody Is Covered, Including You
The system has two halves. The public one covers the large majority of the population, and a private sector sits alongside it for a small minority.
Most employees have no choice to make. Below a fairly high salary threshold you’re in the public system automatically. Your contribution is a set share of your gross pay, and your employer covers half of it. Earn above that threshold, or work for yourself, or serve as a civil servant, and the private route opens up.
What you do choose, always, is your Krankenkasse, the particular public fund you belong to. There are dozens of them. The core benefits are the same by law, and they compete on extras and on service. Switching is straightforward and costs nothing.
Think hard before going private, though. It often looks cheaper when you’re thirty, healthy, and single, because private premiums are priced on risk rather than on income. Those premiums climb as you age, and every family member pays their own. The door back into the public system is effectively shut once you’re past middle age.
People who moved here at thirty and reconsidered at fifty-five have written a great deal about that door.
The Family Comes Along at No Extra Cost
In the public system, a spouse without significant income of their own is insured alongside you for nothing. So are your children, right through school, and on through an apprenticeship or a degree until their mid-twenties.
Each of them gets their own insurance card and the same entitlements you have.
For a family of five arriving from a country where every head carries a premium, this is the single biggest financial difference they will notice. It’s also the reason the public system frequently beats the private one for anyone with children, whatever the sales pitch says.
One change is on the way, and it’s fair to know about it. A recent reform will start charging a share for partners who are insured this way without having young children or caring duties at home. Children remain free of charge, as do parents of small children and people caring for a relative.
What You Pay at the Counter
Seeing a doctor costs nothing at the desk. No fee for the appointment, no invoice afterward, no claim to file. You hand over your card and that’s the transaction.
Prescriptions carry a small co-payment, and so does a night in hospital. Both are modest, and both stop entirely once your co-payments for the year pass a set share of your household income. That share is lower again for anyone with a chronic condition, and the fund refunds everything above it.
So there is a ceiling on what a bad year of health can cost you. That ceiling is the thing to hold on to.
Some things sit outside the standard package. Dental crowns and dentures are subsidized rather than covered, and the subsidy is being trimmed. Glasses are on you unless your prescription is severe. Single rooms and treatment by the head of department are private extras, which is what most supplementary policies are actually for.
Getting Seen, in Person or on Screen
You pick your own doctor and you can change at any time. No registration with a practice, no assigned physician, and in most cases no referral needed to see a specialist directly. That freedom is unusual and people here defend it fiercely.
Now the honest part. A family doctor will usually see you within days, and plenty of practices keep walk-in hours. Specialists are the bottleneck, and waits of several weeks are common. Privately insured patients do get seen faster, and nobody here pretends otherwise.
What helps are the tools almost nobody uses. A national appointment service books specialist slots for publicly insured patients, by phone or online. It places well over a million of them a year, mostly within a couple of weeks. Certain specialties are also required to hold open consultation hours where you turn up without an appointment.
Ask your family doctor for a referral code. That’s what unlocks the faster lane in the booking system, and hardly any patient knows to ask.
The digital side has moved quickly after a slow start. Video consultations are a normal part of care now. Prescriptions are issued electronically and collected at any pharmacy with your card or your phone.
Two things go further than most countries manage. Every publicly insured person now has an electronic health record that follows them between practices, unless they opt out. And doctors can prescribe approved health apps the way they prescribe tablets, with the fund paying for them.
For emergencies the number is 112, everywhere in the country and free from any phone. Outside surgery hours but short of an emergency, the on-call service uses 116117, which is the same number as the appointment line.
What happens to your salary while you’re ill is covered on German employment law. How the contribution fits into the rest of your payslip sits on work in Germany. The wider picture is on living in Germany.