GKV vs. PKV - the advantages and disadvantages

There are many ways to come to Germany as a foreigner. For example, possible groups of people include students, scholarship holders or scientific employees. These groups of people usually have the choice between German statutory health insurance (Gesetzliche Krankenversicherung GKV) or substitutive private health insurance (Private Krankenversicherung PKV).

Substitutive private health insurance (PKV) is comprehensive health insurance that is equivalent in coverage to the statutory minimum and is thus considered an alternative to statutory health insurance (GKV).

Only a few people in Germany have this choice. Those who can choose between GKV and PKV should take advantage of this opportunity and inform themselves about various criteria, such as the premiums and the scope of benefits, before taking out the policy. What are the advantages and disadvantages of the two systems? We'll explain that to you here.

Who is allowed to insure themselves and how?

Most people in Germany (approx. 90%) have statutory health insurance. These groups of people include, for example, trainees, salaried employees, pensioners, co-insured spouses and children, and people without income.
 
In order to become a member of a substitutive private comprehensive health insurance in Germany, certain requirements must be met. Salaried employees with a high salary (above the compulsory insurance limit) are allowed to take out private health insurance. In addition, self-employed persons, freelancers, and students may become members of a substitutive private comprehensive health insurance.
 
Private, but not substitutive private health insurance also includes foreign health insurance or so-called incoming insurance.

These are good for foreign guests who are staying temporarily in Germany but are not obliged to become a member of a statutory health insurance, or substitutive comprehensive health insurance.

But beware, these foreign health or incoming insurances often only offer you protection for the acute treatment of new illnesses. Pre-existing conditions such as diabetes are usually not covered.

What are the advantages of statutory health insurance?

Premium-free family insurance

Statutory health insurance offers families, in particular, a great advantage, because spouses, as well as children up to the age of 25 with no or very low income (approx. 470 EUR per month), can be co-insured free of charge. This is an advantage over substitutive comprehensive health insurance, where each family member is insured independently and pays his or her own contribution.

The regulations of non-contributory family insurance also apply to students. So if you come to Germany with your spouse and maybe even with your children, the statutory health insurance is the cheaper insurance solution for you. You will save a lot of money compared to the substitutive private health insurance!

Favorable premiums for low-income earners and students

In the case of statutory health insurance, contributions are based on income. Therefore, people who earn little pay a lower contribution than people who earn well. Students also benefit from this. The health insurance contribution for students consists of a uniform basic amount and an individual additional contribution depending on the health insurance company.

The basic contribution is the same for every statutory health insurance and depends on the BAföG requirement rate. This is independent of whether you receive BAföG yourself or not. The additional contribution is determined by each statutory health insurance company. This means that students pay a different contribution depending on the additional contribution of their health insurance. So don't be surprised if, for example, your acquaintance who is insured with a different statutory health insurance pays a different contribution as a student than you do. 

No health examination

The statutory health insurance companies are obliged to accept every person as a member, regardless of his or her personal health situation. This is a crucial point in comparison to health insurance companies that offer substitutive private comprehensive health insurance. These insurance companies can refuse people as members due to their age or health condition. 

What are the advantages of substitutive private comprehensive health insurance?

Wider range of services

The range of benefits is defined by law for statutory health insurance (approx. 95%). The situation is different with private health insurance, where the insured person can determine his or her benefits individually according to his or her wishes and needs. 

Therefore, PKV-insured persons get more and better services compared to the GKV-insured persons, e.g. at the family doctor, dentist and in the hospital. Thus, privately insured persons get to enjoy better treatment methods, e.g. in preventive examinations.

Faster appointments with the doctor

People with private health insurance often receive appointments with specialists (e.g. dermatologists) more quickly than people with statutory health insurance. In addition, there are medical practices and hospitals that treat only those insured under private health insurance. If the doctor prescribes medication, GKV-insured persons usually have to pay part of the cost of the medication themselves (€5.00 - €10.00). There are no such co-payments for those with PKV insurance.

Contributions

In contrast to statutory health insurance, the premiums for private health insurance do not depend on income or status, but on the age at which the insured person joins, the state of health and the desired benefits. Therefore, PKV is worthwhile for people with a high income, but also for young people such as students or scholarship holders. They benefit from particularly favorable premiums with PKV.

Protection even when traveling

PKV includes worldwide insurance coverage for a period of up to one month, which is particularly beneficial for foreign students or scholarship holders. This means that you are also covered during a visit to your home country. 

What are the disadvantages of statutory health insurance?

Services defined

With statutory health insurance, you cannot put together your own range of benefits. You are bound to the statutory standard benefits.

Limited protection abroad

Statutory health insurance companies pay fixed standard rates for medical treatment. If you get sick abroad and the treatment is more expensive than the fixed standard rate, you have to pay the difference out of your own pocket, because the health insurance companies only pay for treatments up to the maximum sum of what they would cost in Germany.

And that only applies to travel within Europe. As a rule, a German health insurance company does not pay at all.

What are the disadvantages of private health insurance?

Health examination

To be eligible for substitutive private health insurance, you must answer questions about your health. The insurance company has the right to reject your application, in contrast to a statutory health insurance. Therefore, it may be more difficult for people who suffer from a pre-existing condition (e.g. diabetes) to be accepted into a substitutive private comprehensive health insurance.

No free family insurance

In private health insurance, there is no free family insurance as in statutory health insurance. Each family member must be insured separately.

Waiting times

There is often a general waiting period of three months in private health insurance before the insurer pays the bill. For special services such as childbirth, dental treatment, dentures or psychotherapy, there is often a special waiting period of eight months.

For outpatient treatments

People with private health insurance often pay in advance for outpatient treatment. This means that you receive the doctor's bill, pay it and then submit it to the insurance company for reimbursement. However, statutory insurance companies will reimburse you as soon as possible (about 14 days). 

Conclusion

The question "is GKV or PKV better for me?" cannot be answered universally. There are advantages that favor both types of insurance. Which insurance is right for you depends, among other things, on your age, the duration of your planned stay in Germany, and whether you are traveling alone or with your family.