Sunday, August 14, 2016

Health Insurance, German Style

Many other bloggers before me have written about the jungle of German bureaucracy they've had to wade through in order to move here, study, get insurance, get a job, extend a stay, and so on. I never wrote about any of that because I had an easy transition. However, just to explain...

In order to remain in Germany longer than the length of a tourist's stay (i.e. to move here), I needed to apply for an (A) Aufenthaltstitel (residency permit).

In order to apply for (A), I needed (B) proof of health insurance. Health insurance is mandatory in Germany.

I could not get (B) public health insurance without having (C) a job.

In order to apply for (C) a job, I needed to have (A) an Aufenthaltstitel.

See how this works?

Truly, I have no idea how people whose husbands don't own a company navigate this nightmare. We solved it thus:
  1. I took out short-term traveler's health insurance through an American company (Sirius International), which covered me for the first month or two of my time in Germany.
  2. My husband's company hired me to teach conversational English classes to their employees once a week (which I am still doing). 
  3. With a note from my employer, I applied for public health insurance.
  4. With proof of a job, sufficient funds to support myself, and health insurance, I was able to apply for my Aufenthaltstitel.

Although I get a salary from the company, it's minimal and the monthly premium I have to pay for health insurance is quite low - less than €50 - and the company puts in the same amount. The company takes taxes, social security, and the premiums for health insurance, old-person-care insurance, joblessness insurance, and retirement insurance out of my check each month. They'd take the 8% church tax out as well if I hadn't officially (at the town hall) divorced myself from the church a few years ago to avoid this.

This year I started teaching German (that thing I was certain I would never do again) as a Dozentin (freelance teacher), and what I earn from teaching has surpassed my salary from the company. This required me to go to my insurance company and switch from Pflichtversicherung (mandatory health insurance) to freiwillige Versicherung (voluntary health insurance).

I was required to do this because the job connected to my Pflichtversicherung is no longer my main source of income. I am not allowed to just change the job that is connected to my Pflichtversicherung to my teaching job, because Pflichtversicherung is not available to freelancers. My options now are private insurance or freiwillige Versicherung. We decided against private insurance because:
  1. once you're in the private system, it's very, very difficult to get back into the public system even if your circumstances change, and
  2. while the initial premium would be less expensive than the freiwillige Versicherung, those premiums increase drastically with age, and in the long run (provided I live long enough), this option would be much more expensive.
Since we are not very good at predicting the future and I am the polar opposite of a risk-taker, we agreed that private insurance would not be the best option for me.

Right, so I applied for freiwillige Versicherung. Unfortunately the monthly premium for this insurance is based on household income, not just my income. To make this long story slightly less long, my premium, which was less than €50 per month, will now be...significantly higher.*

I could whine and bitch about this (and to be perfectly honest, I did a little). I haven't been and won't be teaching full-time, and the premium I'll have to pay is exactly one full week of my work at the VHS, or Volkshochschule (before taxes). If I went back to being a Hausfrau, I could keep paying less than €50 a month for health insurance. But how silly would that be? Teachers are needed in Germany, and I can teach (and actually enjoy it!).

I'm not going to whine, because this is part of living in a social state (or rather a social market economy). Those who can afford to do so pay more into the system so that the less fortunate are taken care of as well. M and I have a fine house, a car, employment, food on the table every night, and we can travel, dine at nice restaurants, and buy want we want and need. Why should I grumble about putting more into the system so that another family can also see a doctor when they need to? If I have what I need, I'm not going to begrudge someone else getting the help they need, especially when it comes to medical care.

I admit, now that we'll be paying more for my insurance, I'm considering actually finding a Hausarzt. So far I've only visited the Frauenarzt and the Zahnarzt because the one is required for certain pills that are wise to take at my age, and the other because I've always taken good care of my teeth. I also received great care when I inexplicably tore a groin muscle, which included an ER visit, x-rays, an MRI, and several visits to an orthopedist - and we never received a single bill. I was amazed, since such things cost thousands of dollars out-of-pocket in the States even when one has health insurance.

I'm sure the system isn't perfect. But it's better than people having to go without medical care in a civilized country because they can't afford it.

*"significantly higher" = I went from what I think was the lowest possible amount one can pay to the highest possible amount.


  1. The German health insurance system is good, but I still miss the NHS!

    To get the cheapest type of health insurance here, you have to have a Hausarzt who then refers you to specialists that he/she works with. With the more expensive types of insurance you can just go directly to a specialist without a referral. Gynaecologists are an exception - you can go to them without a referral no matter what type of insurance you have. So I have a Hausarzt because I had to pick one when I applied for my insurance but I've never actually seen her.

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