在德国，相比法定医保，参保私人医保有什么优势（二）What are the advantages of having a private health insurance in Germany vs a public health insurance?
2023-04-20 龟兔赛跑 2954 0 1 收藏 纠错&举报
What are the advantages of having a private health insurance in Germany vs a public health insurance?
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In Germany, both private and public health insurances are available, and both have their advantages and disadvantages. Here are some advantages of having private health insurance in Germany compared to public health insurance:
Access to a broader range of medical services: Private health insurance may offer a broader range of medical services and treatments compared to public health insurance. Private insurance plans may cover alternative therapies, elective treatments, and access to specialized medical facilities that may not be available under the public system.
Shorter wait times: Private health insurance plans may offer shorter wait times for medical appointments, procedures, and surgeries compared to the public system, as private insurers may have agreements with private medical providers.
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Greater flexibility: Private health insurance plans may offer greater flexibility in terms of coverage options, deductibles, and copays, allowing policyholders to tailor their coverage to their specific needs.
However, there are also some disadvantages to having private health insurance in Germany. Private health insurance premiums can be more expensive than public health insurance premiums, and private insurers may deny coverage or charge higher premiums based on pre-existing medical conditions. In addition, private health insurance policies may require policyholders to pay for medical services upfront and then file claims for reimbursement, whereas public health insurance typically covers the costs directly. Ultimately, the choice between private and public health insurance in Germany will depend on individual circumstances, including income, health status, and personal preferences.
Is it true, that in Germany, after you once try private health insurance, you cannot switch to the government insurance anymore?
Originally Answered: Is it true, that in Germany, after you once try private insurance, you cannot switch to the government insurance anymore?
The question refers to health insurance.
Yes, if you have opted into private health insurance (as an employee earning more than (as of 2017) 57,600 €/year or as a self-employed person), it is hard or even impossible to switch back.
When younger than 55 years, you can only switch back when you are employed and your wage is lower than the point where you must enroll in statutory insurance (i.e. there are cases where you must ask your employer to lower your wage)
When 55 years or older, it is almost impossible - except when you are married to a person insured in the statutory insurance, then you can rejoin the statutory insurance by becoming unemployed and being covered as a dependent by your partner’s statutory insurance.
A different way of calculating the Premium. For public it is based on a percentage of your income (not a tax though), for private it is a fixed amount. So for people with higher income private is cheaper, for people with lower/medium income public is cheaper. That is the biggest thing about what this is. Payment amount.
You get 1–2 bed room in hospital, chief doctor treatment and a higher percentage of coverage for dental care (dental care is one of the few regions where in Germany you have a Copay, public only pays 60% of Dental Care usually). People with public can take this sort of stuff as an optional addon insurance though (my wife - on public - for example raised her dental coverage from 60% to 90% by a price of 35 EUR per month, the 1–2 bed room and chief doctor treatment for her cost us 40 EUR per month - it is still cheaper than private for her - for me it is the other way round).
A few examinations are not covered by public. But they are rare .
You might have to wait less in the waiting room
Acupuncture, etc. is usually included by default for private. For public you have to request it (does not cost extra though - but some public insurances might not offer it)
Massages covered by insurance are a few minutes shorter if you are insured public
You need no referral to go to a specialist (public insured need this unless it is an emergency, also some fields are excepted from the referral even if no emergency, like male/female medicine, dental care, eye care)
Private also has disadvantages though:
When you get older the price raises
Kids also cost, while for public insurance they are free (their insurance does not cost the same like for an adult though)
Once you have been in private for some time, you cannot switch back to public (to avoid people going for private when young and public when old)
Remember it is the SAME doctors to whom you go. There are no special “for private only” doctors
So yeah - mostly it is a decision based on what is cheaper for you.
What is the difference in quality between private and state health insurance in Germany?
We refer not to ‘state’ but to ‘statutory’ health insurance in Germany because the carriers of statutory insurance are not agencies of the state but highly regulated non-profit institutions.
The main incentive to choose private insurance is that with statutory insurance your premium is a percentage of your wage, while with private insurance it is a fixed amount, depending on your age/health. So, a young, healthy person who earns a very high wage pays less in premiums in private than in statutory insurance. The catch is that once you are in private you cannot change back when your age, or having children (covered under statutory insurance at no extra cost) or income would make statutory insurance a better deal.
Quality pros of private health insurance
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Some but not all private health insurance schemes pay for a better ‘hotel’ component of a hospital stay, e.g. a single room where someone in statutory insurance would share a larger room with another patient.
Quality cons of private health insurance
Hospitals are a bit more likely to subject you to unneccessary procedures (as they can bill a higher rate with private insurance).
You pay out of pocket for your doctor visits and must file with the insurance for reimbursement - more paperwork compared with statutory insurance where the doctor directly bills the statutory insurance.
Germany has a mixture of private and public health insurance, how does that system work?
All residents of Germany must have health insurance. There are two systems – the public and the private health insurance. These are the main differences:
Public health insurance:
Your contribution depends on your salary: the more you earn, the more you have to pay.
Premiums can reach up to € 977.55 a month which you share with your employer. As a self-employed person, you must cover the full costs yourself.
Coverage is quite limited and benefits can be cancelled at any time.
Your monthly premium does not depend on your salary.
Premiums depend on your health status, the desired scope of benefits and your age of entry: the earlier you decide to switch to private health insurance, the lower your monthly premiums will be.
Coverage is much more extensive and benefits are guaranteed for the entire duration of your contract.
Eligible for private health insurance are these persons: employees with a salary above the annual income threshold of €66,600, self-employed persons and civil servants
What is the most affordable private health insurance in Germany?
What for? Unless you are really in the upper levels of the income range, as an employee you will be automatically insured through the public system (though you can pick among about 200 insurance providers. The premiums are similar, a percentage of your gross income, with your boss paying half). Even as self employed or student you can join them.
Compared to private insurance (where the premiums are calculated based on age, sex and previous diseases and might be cheaper for a young, healthy male, but become very expensive once you get older) the public system is quite hassle free.
With the private insurance you will usually have to forward the payment of the medical bills, but will get re-imbursed later.
I’m an employee with an income well above average and I decided that I will stay in the public system.
The main difference is that the cost of insurance is dependant on income when you are insured publicy and is dependant on age when you are insured privately. The catch is, once you are insured privately it is very hard to switch back. You might want to if are getting old.
The consequence is, when you are young and you have a high income private insurance is very competetive compared to public insurance for the moment. This is why private healthcare insurance is sold almost exclusively to young people. For elder people private insurance is much more expensive than public insurance. No one tries to sell private health insurance to someone who is over 50. It’s not even a contest.
Because there is no switching back you should think very thoroughly if you will be able to afford private insurance when you get old. If you are 80, for example, you can expect costs of 20k Euros or more per year just for private health insurance. Which is somewhere around the cheapest rate as per now, but expect much more in 50 years. With public health insurance the cost for the 80 year old person would be a percentage of your income.
Let’s say you have the average income for a 80 year old (you plan to become old, do you?). This means your income would be around 30k Euros per year. 30k - 20k = 10k which is what you would have left if you are privately insured. This puts you well below the official poverty threshold. Yuck! With public health insurance you would have left roughly 25k Euros which is more than twice you would have left if privately insured.
Of course you will have better and more healthcare if you are insured privately. Still you better plan to get rich and have a good chance at it otherwise you won’t be able to afford your healthcare if you are getting old. Better, switch to private healthcare after you have got rich, because just in case. However you may find that when you finally are rich private healthcare has become unattractive because you are getting old.
Another thing I know personally because my brother has private healthcare: if you are privately insured there is a tendency for doctors to get you over treatment. Doesn’t sound bad? Well, expect to get unnecessary treatment because you are the one that get’s the doctor his next Porsche. You will stay longer than necessary at the hospital because you are the gold mine.
There are definitely differences in waiting times to get to see a doctor. This is the huge drawback when insured publicly. Two episodes that happened:
To me (public healthcare): I was in need to see a specialist to exclude a certain cause for high blood pressure. This is nothing life threatening and there is only one specialist in the particular field in my city of 350.000 inhabitants. My waiting time to get an appointment was 13 months. More than a year! That’s an extreme case but when you need to see a specialist expect to have waiting times for more than a month on average.
To my brother (privately insured): “I have a certain health condition and I would like to see a specialist. When can I have an appointment?” - “How about right now?” - “No, it’s short before noon and I’m hungry. I have to eat something.” - “Well, then come after you are finished, no problem.”
This is the difference between having a platin class private health insurance and public healthcare. But when he goes to the hospital because of a fever at a Friday evening he is invited to stay at the hospital for the weekend because the head physician would want to have a look at his new Porsche patient but is back only Monday while the public healthcare patient would get two Paracetamol and being sent home (also happened).
So if you are rich, get what fits you best. If you are not, think twice.