Not one plan. Not two hundred.The private health plans that actually fit you

The short version

• Public premiums follow your income. Private premiums do not — they stay the same if your salary drops, and they carry on through unemployment and parental leave.
• Public cover includes a non-working spouse and children for free. Private cover needs a separate policy, and a separate premium, for every person.
• Private cover buys faster specialist appointments, a say in who treats you in hospital, and far better dental cover than the public system.
• What your private contract promises is fixed when you sign it. The public system can change its benefits by law; your private insurer cannot take away what your tariff already covers.
• Going back to public insurance is hard, and after 55 it is close to impossible for most people. Treat the decision as permanent.

The short version

• Employees may only leave the public system once their salary passes a set annual threshold. Regular pay and recurring bonuses count towards it; one-off payments do not.
• Self-employed people and freelancers may choose freely, whatever they earn — with one exception, artists and journalists covered by the Künstlersozialkasse (KSK).
• Civil servants (Beamte) have 50–80% of their medical costs paid by the state through Beihilfe and insure the rest privately. For them it is usually the cheaper route, and the support continues into retirement.
• Students choose once at enrolment and cannot change during their studies. The next opportunity is a first job after graduating, or turning 30.
• Children need their own policy if both parents are privately insured. Where one parent is in the public system, free family cover may still be possible.

The short version

• Never trim cover to bring the premium down. A cheap tariff with a hole in it is the expensive option the first time you need it.
• Read the deductible (Selbstbeteiligung) carefully — what you pay yourself before the insurer pays anything. A high one looks attractive right up until the year you are actually ill.
• Check whether you may switch tariff later without new health questions. That is how you bring costs down as you age without losing the provisions you have built up.
• Answer the health questions completely and honestly. An insurer that finds an omission later can void the contract, and you will have paid years of premiums for nothing.
• Have a broker make an anonymous pre-enquiry before you apply anywhere. An application you make yourself and that gets rejected can be recorded in the industry's HIS system and follow you to every other insurer.
• If you might start a family, price it as a family. Private cover has no free family insurance, and that changes the real monthly cost far more than the headline premium does.

The short version

• Your premium is fixed by your entry age rather than recalculated as you get older. It still rises as medical costs rise, for everyone in the tariff at once.
• German law only lets an insurer raise premiums once costs have moved past a threshold, so increases arrive rarely and in large steps rather than gently each year.
• Getting ill after you have signed does not raise your premium. That is the core of the bargain.
• Employees get roughly half their premium from their employer, up to a legal cap. The self-employed pay all of it, and that is most of the gap between the two.
• Ask what the premium looks like at 65 and at 80 before you sign, not just what it is today.

The short version

• Staying on expat or incoming insurance too long. It is temporary cover, it is often refused when you renew a residence permit, and the longer you stay on it the harder full cover becomes to get.
• Choosing a tariff alone from a comparison table. A table cannot tell you which insurer will accept you, and applying to the wrong one leaves a trace.
• Taking private cover in your twenties without ever asking what it costs at 60.
• Forgetting that a partner who does not work is free in the public system and a second full premium in the private one.
• Buying dental add-on cover on top of a good private plan that already covers most of what the add-on is selling.
• Taking legal expenses insurance from the same company that holds your health cover — the one you may one day need to argue with.