Benefits overview: Public vs. private insurance in Germany

In the event of sickness all patients want to receive the best treatment under optimal conditions and in the best facilities. However, what are the differences for publicly or privately insured patients when one needs medical care?

Choice of doctors

    German Public insurance (GKV)

    Publicly insured patients have a limited choice which doctor they may visit on an outpatient basis. Only those physicians which are licensed to treat publicly insured patients are covered by public insurance.

    Appointments to see specialist doctors generally require a referral from a general practitioner. Seeing a specialist doctor can be difficult and will likely mean waiting a few weeks for the appointment. On average members of the public insurance scheme had to wait at least 20 days to see a specialist doctor in 2017 according to a study by the Ruhr University Bochum.

    German Private Insurance (PKV)

    Privately insured patients have access to all physicians immediately. Seeing experts immediately and even those which only see private patients is easier.

     

    Some very affordable tariffs will require the referral from a general practitioner to see a specialist doctor but they will always be able to choose which expert they may visit even if the doctor only treats privately insured patients. Wait times to see specialist doctors are on average significantly shorter for privately insured patients.

    Dental coverage

      German Public insurance (GKV)

      Publicly insured patients will notice a severe medical care gap when it comes to dental care. High co-payments ranging from a few hundred to several thousand Euros are the norm. Only the most basic forms of treatment are covered without a co-pay. If the patient decides for a more advanced and better form of treatment he or she can expect a significant co-pay.


      If dentures or implants are required the publicly insured patient is faced with very high co-payments. And if the patient (like most) cannot prove to have visited a dentist annually for the last ten years for check-ups even higher out of pocket payments can be expected. Even for the most basic form of dentures (bridges, crowns, inlays, implants) a co-pay of at least 35% (assuming annual check-ups have been done for the last ten years) is required. For the more advanced forms of dentures co-payments of more than 70% are common.

      German Private Insurance (PKV)

      Privately insured patients benefit from extensive dental coverage. Even the most basic policies will regularly cover far more benefits than public insurance.

       

      Advanced forms of dentures like implants are usually covered at 70-90% depending on the tariff. This also includes quality filling materials like gold and ceramic. Preventive care measures like dental cleanings are also almost always covered. 

      Hospital treatments

        German Public insurance (GKV)

        Some illnesses may require the stationary treatment at a hospital. In those cases, publicly insured patients are required to seek treatment at the closest clinic to their living address and which is part of the public insurance hospital network. The patient will usually be placed in a multi-bedroom with other patients.

        The choice of doctor is limited to the doctor on duty at the hospital and the adult patient is required to pay 10 Euro for each day spent at the hospital (for a max. of 28 days per year, 280 Euro).

        German Private Insurance (PKV)

        Privately insured patients may choose freely which hospital they use for treatment. Treatments at specialized or private clinics are covered (with few exceptions based on the chosen tariff).

        Depending on the tariff the private patient will also benefit from the treatment of a head physician or specialist and stay in a private room or two bed-room.

        Complementary medicine

          German Public insurance (GKV)

          Not everyone wants to rely exclusively on conventional forms of medical treatment and medicine. A large number of patients will also want to make use of complementary forms of treatment such as acupuncture, Chinese medicine, and homeopathy.

          Although public insurers have recognized this need only a small number of treatments are covered and those that are covered will require special approval. The aforementioned treatments also have to be performed by a licensed medical doctor. Treatments from natural health professionals are usually excluded from coverage and have to be paid out of pocket.

          German Private Insurance (PKV)

          Most tariffs offered by private insurers will cover complementary medicine and treatments.

          Those treatments can be performed either by a medical doctor or a natural health professional. If a patient does not believe the benefits of complementary medicine he may choose a tariff which does not cover these forms of treatment to reduce cost.

          Medicines, Remedies, and aids

            German Public insurance (GKV)

            Prescription medicines are covered with limitations and only up to fixed amounts with a 10% co-payment (max. 10 Euro per prescription). Some very expensive but useful cancer medicines may only be available to a limited number of patients under special conditions. Prescription free medicines are not covered, vision aids (glasses, Lasik) are only covered under exceptional circumstances (very severe vision impairment).

            Coverage for hearing aids is also limited and will likely result in large co-payments. Remedies (such as physiotherapy, radiation, etc.) are covered with a 10% co-pay per treatment + 10 Euro per prescription.

            German Private Insurance (PKV)

            Prescription medicines are covered with few limitations and a varying co-pay depending on the chosen tariff.

            Prescription medicines may also be covered depending on the tariff. Glasses/Lasik are covered up to a set amount under most tariffs. Remedies and aids are also covered, sometimes with a co-pay.

            Even very expensive medicines may be covered given there effectiveness has been scientifically proven depending on the chosen tariff.

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