Getting health coverage as a foreigner in Germany is trickier and more expensive than you might think. Ausländer have to prove they are insured before they receive an Aufenthaltserlaubnis or residency permit (documents not required for citizens from the EU, Iceland, Norway and Liechtenstein). There are many ways of getting covered.
Get a job
If you score a position with employee (Angestellte) status – not always such a simple thing to do in Berlin – and earn under €4163 a month, you’ll be automatically covered by a gesetzliche Krankenkasse (statutory insurance fund).
Marry someone with a job
If you have little or no income of your own, you’ll be automatically covered by his or her Krankenkasse.
Become a student
Students can get insurance from a Krankenkasse for about €60 a month. Why do you think so many Germans in their late twenties call themselves “students”?
Voluntary Krankenkasse contributions
If you’re self-employed or just not working, you can get private insurance or pay voluntary contributions to a statutory Krankenkasse. This is calculated as 14.9 percent of your income, but for some reason they base this calculation on a minimum income of €1916.25 a month, resulting in a monthly charge of €274.02 – obviously a high sum for the low-income self-employed. People who aren’t working or have any other kind of income can pay the seemingly arbitrary amount of €121.79 per month.
Private health insurance (PKV)
An attractive option at first glance, especially for young, healthy, self-employed males, who might pay less than €100 a month. Rates are based on your age, gender, health record and how much you’re prepared to pay out of your own pocket. But beware: private insurance premiums can go up annually. Some privately insured pensioners pay as much as €1000 a month!
Those who can prove they earn a living through artistic activity or writing of some kind are eligible to join the Künstlersozialkasse, an organization which will pay half of your social security contributions (as a percentage of your income), including pension contributions and your Krankenkasse (you have to belong to one in addition to the KSK) – a great deal compared to the other options. What constitutes ‘artistic activity’ is debatable. Getting into the KSK can be tricky. Most people hire a consultant to help with the paperwork, but it’s worth the effort. www.kuenstlersozialkasse.de
Travel health insurance
For foreigners staying up to three years, travel health insurance is a viable option: it provides sufficient basic coverage including emergency dental care (although not routine check ups). Available for about €2 a day, such a travel health plan is a blessing for those who can’t afford regular German insurance premiums or got kicked out of the system. The Ausländeramt may or may not consider this type of insurance sufficient to qualify for a residency permit for non-EU nationals.
European Health Insurance Card
If you’re from the EU or Switzerland, your European Health Insurance Card (formerly the E111 form) entitles you to treatment in Germany. Go to the local AOK office and fill out the appropriate form, which you’ll have to show the doctor. The catch: it’s not meant for the residents and you have to reapply every two years in your home country – where you’ll have to prove residency and perhaps keep paying insurance fees.
International expat insurance
International health insurance plans are often half the price of German private insurance. Just google ‘expat insurance’ and you’ll find dozens of offers. But, as with any insurance, read the fine print very carefully: what do they really cover? How much do they really reimburse? What are their policies on pre-existing conditions?
Go on welfare
Funnily, it’s a lot easier to get health insurance if you’re on the dole than if you’re self-employed. And it’s free! Impoverished, jobless EU citizens have the same rights to Hartz IV benefits as Germans. Of course, if you just show up from another country and apply for welfare, be prepared for a long ride through cold, hard German bureaucracy, with grumpy women with dyed red hair urging you to go back where you came from.