Private health insurance: hidden costs and German paperwork

Discover what TK can offer young professionals

Extra costs for each family member

Choosing private health insurance as a single person often overlooks the potential additional costs associated with family planning and aging. Even if you are not planning a family, life can be full of surprises!
Statutory health insurance allows married and civil partners without their own income or with low income to be insured free of charge. It also covers children without additional costs. In contrast, private health insurance requires a separate premium for each family member. This can become expensive for families with several children.

Health cover? It's a family affair

Start saving now: low premiums are not guaranteed

With statutory health insurance, the contribution rate goes down if your income is reduced. This is not the case with private cover. Even if you lose your job or receive social benefits, you still have to pay the same premiums for private health insurance.

Those who choose private health insurance need to be aware of the potential risks due to changes in circumstances. They should plan ahead to manage the increasing costs.

Higher premiums in older age

The biggest disadvantage of the private system compared to statutory cover becomes apparent in old age. Private insurance premiums are often significantly higher in later years than in the statutory system. This is especially true when self-employed individuals have less money due to declining income sources (e.g., low pension or insufficient private provision). Moreover, as we age, we generally require more medical treatments. Therefore, many older people choose more comprehensive plans, which are much more expensive.

Upon retirement, as a TK member with statutory insurance your contributions are calculated based on your pension income and not your salary. This means you are likely to pay considerably less.

Not all costs are covered

Private health insurers don't always reimburse every submitted bill. They first check if the treatment is necessary. Depending on your plan and contract, some services are excluded or only partially covered. You need to be well-informed and be able to communicate well with the doctor to ensure you are not left with expensive bills.

The review period usually takes up to 14 days. You might transfer costs after the insurance has paid. If this doesn't meet the insurance's payment terms, you might have to pay reminder fees yourself. Medications must be paid for directly at the pharmacy. Private health insurance reimburses these costs only after the bill and prescription are submitted and reviewed.

Paperwork headache

Insurees who opt for private health insurance also take on a lot of paperwork - in German! Moreover, the actual billing of private medical treatments can often be complicated requiring mediation between the insurance company and the doctor. Therefore, it is important to have a good understanding of how the system works before making the switch.

Billing

With statutory health insurance, medical treatments and medications are billed directly through the

eHealth card

. All you have to do is present the card at the doctor’s practice and the rest is handled between the insurance fund and the doctor. In contrast, privately insured individuals enter into a direct contractual relationship with the treating doctor. This means:

Private insurees receive the bill directly after the treatment in the practice or by post.

As a private insuree, you often have to pay the costs for medical services yourself and then submit these to the private health insurer for reimbursement. This requires sufficient financial reserves. What’s more, the processing time can vary.

This can be cumbersome and time-consuming, especially if you are unfamiliar with the reimbursement process.