Public Health Insurance: Which Provider Should I Choose?
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Public Health Insurance: Which Provider Should I Choose?

Summary:

With so many public insurers to choose from in Germany, it can be hard to know which one is right for you. Is there a difference between the public providers? And which one should you choose?

There are more than 100 Krankenkassen (public insurers) in Germany—so which one should you choose? We looked at five Krankenkassen (AOK Nordost, BARMER, DAK, hkk, and TK) and found that the basic level of service was quite similar. But if you have some special health requirements, then certain insurers provide unique advantages over others. Here are our recommendations. 

Price

By law, all Krankenkassen (public insurers) in Germany must charge a base price for their services. For most people, this amounts to 14.6% of pre-tax income. But this doesn’t mean that the cost of coverage is the same across all public insurers.  

Prices can vary by a few hundred euros a year (depending on your income) based on additional contributions, known as Zusatzbeitraege. We dig into the topic of additional contributions in this blog post—but if you’re worried about cost, then you might consider switching to a Krankenkasse with lower additional contributions. 

Of all the public insurers, hkk is best known for having low Zusatzbeitraege, at .39% (which brings the total hkk contribution to 14.99% of pre-tax income). For comparison, TK’s additional contributions are 1.2%, while AOK Nordost, BARMER, and DAK all have additional contributions of 1.5%. So if you’re looking to save a few Euros (or a few hundred, if you’re a high earner), then hkk could be the way to go. 

English-language service

While it’s costs are low, hkk does have one major disadvantage for many expats: service is only available in German. So if you want English-language customer service representatives and online services, then you might be better off with one of the other Krankenkassen. AOK and BARMER both offer a good level of English-language support, but we find that TK really shines in this area. All key TK resources (digital user accounts, customer communications, and the mobile app) are available in English. 

General preventive care

All Krankenkassen are required to provide a basic level of preventive care—this means a limited number of comprehensive health checkups, cancer screenings, and dental checkups. We go into detail on preventive care in this post

If you’re particularly worried about skin cancer, then AOK or TK are good choices: while most insurers do free skin cancer screenings every year starting at age 35, AOK fully covers them from age 14. TK, meanwhile, covers them every two years from age 20. 

Pregnancy & Getting Pregnant 

When it comes to care during pregnancy, DAK provides some particularly appealing advantages. While all public insurers cover a certain number of health checkups for pregnant women, DAK and AOK both give €500 for extra diagnostic tests and ultrasounds. And while all of the insurers surveyed cover appointments with and delivery by a midwife, DAK gives up to  €500 to keep a midwife on call in the weeks leading up to the due date—significantly more than the  €200-270 provided by the other insurers. 

And if you’re having trouble conceiving, then AOK may be the best choice—if both partners are insured by AOK, then it covers 75% of the costs of artificial insemination. The other insurers cover 50% of costs.

Mental health

Mental health services can be difficult to come by in Germany—particularly in bigger cities, there aren’t always enough psychotherapists in the public system to meet high demand. For publicly insured patients, it can take months to get into Krankenkasse-covered therapy. 

We’ll be honest: overall, the public system leaves a lot to be desired when it comes to timely provision of psychological services. But DAK may be the best choice in this regard. DAK’s partnership with the VeoVita clinic network means that you can quickly get professional help for depression, anxiety, and burnout—and be guided through your diagnosis and the necessary follow-up treatments. This system provides quicker access to guaranteed covered mental health care than other Krankenkassen, but there’s no guarantee that therapists will work in English.

Osteopathy

With the COVID-19 pandemic keeping the #StayAtHome sentiment alive and well, many of us find that our backs are hurting more than they used to. You may want to visit an osteopath to help manage your back pain—but osteopathy isn’t recognized as a “medically necessary” intervention by public health experts. Therefore, many Krankenkassen cover osteopathy as an “extra”. 

AOK Nordost outperforms the other four in this regard, providing up to  €180/year for osteopath visits. 

Travel vaccines 

If you’re planning to travel the world (post-COVID, of course!), then you’ll probably need to get some vaccines. But travel vaccination isn’t part of the basic coverage the Krankenkassen provide. However, hkk and BARMER both cover up to 100% of travel vaccination costs for their members.

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