Public vs. private health insurance

106 posts in this topic

Off topic as usual for this (probably ) narcissist! But I remember in the UK a doctor saying  " you have a kidney stone and I will cut it out on 14th February." He was also showing off to two young trainee docs.

I ended up in hospital in London for two weeks and it was painful. AND my then Italian girlfriend left me instead of visiting me in hospital! Tiziana was her name! Tiziana!!! What a name!

The good news..in those days (c.1983 ), you were still allowed to drink beer in hospital...my mum brought a crate of beer.

( Don´t tell anyone but my French friend Jean-Louis even brought me a rolled up joint, which I (unlike Bill Clinton ) inhaled!! )

:D

 

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2 hours ago, john g. said:

it just IS that way...no doubts at all.

 

but it is also just true that whenever I've had a serious problem in Munich, I'm seen right away too, even on public cover.  Even if it's iffy, I get in right away.  Unusual stomach pain->same day ultrasound -> mri within a week.  Yeah on private cover without ultrasound evidence to show a serious problem, maybe I'd get the mri same day, but in the US for example, even with severe pain and serious effects you could wait months.  Maybe this is why I think it's so great here :)  My mom's cancer went from maybe operable to absolute 100% lost cause in the time it took for her to get her scans, and they KNEW she had cancer.  Her doctor was reduced to tears because of the whole fiasco but that's american health care (THE BEST!  not).  Based on my experience so far I have zero reason to believe that if I had a serious issue, let a broken bone of all things, that I'd have to wait for treatment at all.  In the worst case my doc would send me to the nearest hospital and that would be that.  sorted (insofar as any urgent issue can be sorted...final outcomes vary but at least you do get evaluated and on the road to treatment)

 

For a routine checkup, yes, appointments need to be booked rather far out, but not usually more than 6 weeks.  Even my FA, who has a very strong private racket, doesn't need more than 6 weeks to book a checkup.  If there is even a hint of pain or infection I can go in same day, always.  I might have to wait but I do get checked.  Routine checks are routine, non urgent, not an issue if I have to wait.  To me this isn't really relevant when comparing public/private.

 

Anyway, I really suspect this difference in experience with public vs private is a regional thing, which is why I asked if engelchen had any insight into what the factors might be.  If anyone else has any explanations of course that's welcome too.

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37 minutes ago, john g. said:

The good news..in those days (c.1983 ), you were still allowed to drink beer in hospital

 

oh you still can!  they sell it in the house imbiss :) 

 

at least round these parts

 

god I think I'm going to be stuck in munich for life.  how I will pay for it when I can't work anymore, I have no clue...

 

 

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14 minutes ago, lisa13 said:

 

but it is also just true that whenever I've had a serious problem in Munich, I'm seen right away too, even on public cover.  Even if it's iffy, I get in right away.  Unusual stomach pain->same day ultrasound -> mri within a week.  Yeah on private cover without ultrasound evidence to show a serious problem, maybe I'd get the mri same day, but in the US for example, even with severe pain and serious effects you could wait months.  Maybe this is why I think it's so great here :)  My mom's cancer went from maybe operable to absolute 100% lost cause in the time it took for her to get her scans, and they KNEW she had cancer.  Her doctor was reduced to tears because of the whole fiasco but that's american health care (THE BEST!  not).  Based on my experience so far I have zero reason to believe that if I had a serious issue, let a broken bone of all things, that I'd have to wait for treatment at all.  In the worst case my doc would send me to the nearest hospital and that would be that.  sorted (insofar as any urgent issue can be sorted...final outcomes vary but at least you do get evaluated and on the road to treatment)

 

For a routine checkup, yes, appointments need to be booked rather far out, but not usually more than 6 weeks.  Even my FA, who has a very strong private racket, doesn't need more than 6 weeks to book a checkup.  If there is even a hint of pain or infection I can go in same day, always.  I might have to wait but I do get checked.  Routine checks are routine, non urgent, not an issue if I have to wait.  To me this isn't really relevant when comparing public/private.

 

Anyway, I really suspect this difference in experience with public vs private is a regional thing, which is why I asked if engelchen had any insight into what the factors might be.  If anyone else has any explanations of course that's welcome too.

Evening, lisa! When I  first arrived in Germany as an English teacher c 1990 , I thought/presumed I was automatically covered by the public system. Famous German social security etc. I ended up from the beginning kipping in a spare room of a German  guy who travelled a lot. Whilst he was away, I cut a finger washing up and went to  a doc.

German guy back from his business trip- " letter for you, John."

 

" What´s in it?"

" A doc bill "

 

" Why? "

" Don´t you have health insurance? "

" Dunno."

 

So he arranged for a friend of his to come round...friend was a rep for a private insurance company and sold me a useless private plan. It turned out it was only valid in the new Bundesländer. He didn´t tell me I had options eg public or another company.

 

Long, long story..but that´s how I became an independent insurance broker!

 

:rolleyes:

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3 hours ago, lisa13 said:

Munich has, on par I'd guess, far more residents who have the option to go private

 

Not necessarily. Don't forget all the Beamte in Berlin both at the state and federal level who are mostly privately insured. It would be interesting to look at the stats.

 

Quote

So what do you think - is it just a lack of docs in Berlin?  Why would that gap swing in your direction but not ours? If you have any hypotheses or info I'm interested :)

 

I don't know. However, there are many doctors who are not taking new patients and those that do tend to have long waiting times (rarely less than 3 months).

 

14 minutes ago, lisa13 said:

For a routine checkup, yes, appointments need to be booked rather far out, but not usually more than 6 weeks.  Even my FA, who has a very strong private racket, doesn't need more than 6 weeks to book a checkup. 

 

 

I think I should start coming to Munich to see specialists.

 

Just finding a new ophthalmologist here who was taking new patients was a nightmare and then I had to wait 5 months for the appointment. Endocrinologist is about 4 months and the lung doctor 3 months.

 

 

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Dunno either, lisa, but England have just scored a fifth goal against Kosovo..bin abgelenkt worden!

:P

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13 minutes ago, engelchen said:

Beamte in Berlin both at the state and federal level who are mostly privately insured. It would be interesting to look at the stats.

 

good point - I always forget you guys have the political cash going on.  that is an interesting angle.

13 minutes ago, engelchen said:

I think I should start coming to Munich to see specialists.

me too.  If for no other reason than I'd love to buy you a drink/dinner. no exaggeration, you have helped me immeasurably both directly and vicariously over the years it's the least I could do (and I think you're just cool).

 

But less selfishly, it does sound like healthcare here IS better for us commoners, though I've been hard pressed to find real endocrinologists (not just specialists in diabetes) who aren't fully private.  No idea about lung specialists.  My current opthamologist is terrible, but he has a fabulous moustache, and he'll see you same day for complaints.  Meh...prolly not worth the trip, I can send you a pic of the moustache if you are curious ;)

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9 minutes ago, john g. said:

Dunno either, lisa, but England have just scored a fifth goal against Kosovo..bin abgelenkt worden!

:P

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oh jeez - that explains it!

 

victory is yours :):):)

 

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12 hours ago, engelchen said:

On the other hand if you suffer from a chronic but not life threatening illness, you sometimes have to wait months for an appointment with a specialist as a Kassenpatient.

Don´t you know about the Terminservicestellen?

They´re supposed to find you an appointment within a month. If they fail to do so you can go private and your public insurance will have to pay.

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The mere fact that it is a topic that comes up again and again in politics in parliament and government in Germany that privately insured patients receive preferential access to specialist and in hospitals is proof enough that this kind of problem or two-tier-system actually exists in Germany.

On the other hand, as many have pointed out above, being publicly insured in Germany is not exactly making you a second or third-class patient. The German health system is quite good and no-one will be left behind or not treated well because he or she is with public health insurance. 80-90 % of people in Germany are in public health insurance anyway.

 

There are a couple of areas of coverage where most (but not all, especially not the very cheap private plans) private health insurances offer superior coverage. Starting with coverage when travelling outside the EU, followed especially by dental coverage in the line of major dental work and dental replacements (where public coverage has deteriorated to become a sad joke at best) and also with the free choice of hospitals etc. But all of the above can be also obtained as a private add-on, i.e. supplementary coverage for those who either can't get out of public insurance (due to occupation/income or health conditions) or where it simply does not make sense at all to switch to private fully comprehensive health insurance. 

 

In the end, private health insurance should not be selected and obtained to "save money". That is usually a plan that won't really work out well in the long run (of course, for those who definitely will only stay for a few years in Germany, these savings can make a lot of sense, too).

 

A really good and dedicated broker like John Gunn and us will always look at the full situation of a client, at the short and long-term perspective and fully disclose the pros and cons of both sides of the equations before offering a recommendation. Just like John, we are signing up a lot of clients to public health insurance every year because it is the best solution for them. Those we recommend to take on private health insurance are the same, it is the best solution for them based on their preferences, wishes and goals. 

 

The way this intermediary is trying to "sell" you into private health insurance does not really sound like a truly unbiased advisor who has your best interest in mind. Therefore some caution may be recommended towards this kind of advice.

 

Cheerio

 

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On 9/10/2019, 9:57:56, PandaMunich said:

 

engelchen, did you check the websites that allow you to book an appointment?

 

 

There is also doctena.de. Interestingly, if you use Doctolib to find a doctor in Berlin, almost all of them show this message:

 

Dies ist eine reine Privatpraxis für privat versicherte Patienten. Sie können auch als gesetzlich versicherter Patient einen Termin buchen. In diesem Fall müssen Sie die Behandlungskosten selbst tragen (Selbstzahlerleistung).

 

If I understand correctly, you'll have to pay for the visit yourself, if you're publicly insured.

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We were talking about Augenärzte (Fachärzte für Augeheilkunde = ophthalmologists).

If you follow that Doctolib link, you will see that the results have already been filtered to show only ophthalmologists who offer appointments for publicly insured people (Kasse = publicly insured), i.e. you don't have to pay there:

 

5d796e2417016_2019-09-1123_54_34-Augenar

 

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What happens if you retire in Germany with regard to the public and private system. Lets say one partner has public and one has private insurance. The public one is based on a percentage of your salary. So when you retire it's based on a percentage of your pension? How does it work? Does the private one just cost the same amount as when you are working, even though your income drops substantially? What happens if it becomes too expensive to continue to pay? Can the private insurers simply start rapidly increasing the price to the point the patient can no longer afford to pay the insurance?

 

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35 minutes ago, scook17 said:

So when you retire it's based on a percentage of your pension?


Yes, if you:

  • spent at least 90% of the second half of your worklife in an EU public health insurance, and
  • draw a German DRV (Deutsche Rentenversicherung) public pension

you are made a mandatory member of the KVdR (= Krankenversicherung der Rentner) as soon as you reach pension age, details in here:

If you didn't, you become a voluntary member of your public health insurance and suddenly have to pay the 18.x% (or how much it will be then) public health&nursing contribution on all your worldwide income, with the DRV just subsidising you to the tune of:

  • (7.3% + 0.5*Zusatzbeitrag)*your_public_pension

Details in here:

 

35 minutes ago, scook17 said:

Does the private one just cost the same amount as when you are working, even though your income drops substantially

 

Yes, though most times it will rise, since you will be older and therefore pose a higher risk to the private health insurance.

 

35 minutes ago, scook17 said:

What happens if it becomes too expensive to continue to pay?

 

You first have to sell all your assets, and when you no longer have any assets, you become bankrupt.

You can also be moved to the Notlagentarif (which costs around 125€ a month but offers nearly no cover): 

 

35 minutes ago, scook17 said:

Can the private insurers simply start rapidly increasing the price to the point the patient can no longer afford to pay the insurance?

 

Yes, they frequently do.

For an article in the quality newspaper Süddeutsche Zeitung on this topic, please see here (machine-translated into English).

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11 hours ago, PandaMunich said:

Yes, though most times it will rise, since you will be older and therefore pose a higher risk to the private health insurance.

Doesn´t that reason apply to new customers only? AFAIK in Germany once you entered into a contract with a private health insurance your premium will only rise because of "medical inflation". That´s why "Altersrückstellungen" are baked into the premium you´re paying.

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5 hours ago, jeba said:

Doesn´t that reason apply to new customers only? AFAIK in Germany once you entered into a contract with a private health insurance your premium will only rise because of "medical inflation". 

 

Why do you think Stiftung Warentest warned about them (see the above linked Süddeutsche article)?

 

The problem is that in private health insurance, not all of an insurance's customers form one big pot like they do in public health insurance, i.e. that you do not have a healthy spread of young to old customers, which can compensate each other.

 

What private health insurances do, in order to offer cheap insurance to young people to attract them into their insurance, is to always open new pots, where these new people are grouped together with other young people who do not cause high costs - which is why they can offer these cheap rates to young people.

Then these pots get closed and all these young people get older and older and cause more costs, with no influx of young healthy people to offset them.

And the insurance tariff in that pot rises.

And people can't get out of that pot, i.e. they're trapped.

 

5 hours ago, jeba said:

That´s why "Altersrückstellungen" are baked into the premium you´re paying.

  

The Alterrückstellung, i.e. the part of your contribution that's saved with the intent to lower your contributions when you get older in no way compensates the rise in costs because of the higher medical needs of the ageing members of that specific "pot".

 

Look here for a graph published by the private health insurance Signal, where you can bet they used the "ideal" candidate, i.e. someone who entered private health insurance at age 20 and who would have therefore contributed a maximum in Altersrückstellungen (and please show me the person who fulfills that condition, people at that age just don't earn over the Versicherungspflichtgrenze of over 60,000€ to be allowed to be leave public health insurance for private health insurance, nor do people become self-employed at such a tender age).

 

You will see that even in their own skewed statistic someone over 50 pays 2.5 times the rate of someone young:

5d7df543acb13_Beitragsentwicklung-PKV-SI

 

Stiftung Warentest said in its test of 23.04.2014:  https://www.test.de/Private-Krankenversicherung-im-Test-5-von-107-Tarifen-sind-sehr-gut-4692658-0/

that someone who entered public health insurance at the more realistic age of 35 will have to pay at least over 3 times the contribution they paid at age 35 when they finally retire.

This test is old, from 2014, yet strangely enough Stiftung Warentest never dared to do another test. Well, the insurance industry has a big lobby...

 

If you look for an example from the real world, the Central private health insurance raised its rates by the factor 2.98 (= 517.49/173.69) in just 10 years between 2006 and 2016 (source), not in the 32 years (age 35 to pension age 67) that Stiftung Warentest had stipulated for a threefold rise:

 

5d7dfeb2a699c_CentralBeitragserhhung2006

 

 

The conclusions Stiftung Warentest reached are still valid, in fact it's even worse now, because of the following additional wrinkle:

 

Now add the additional problem these private health insurances have with the enduring low/negative interest rate period we have been having.

They had planned to invest the money from these Altersrückstellungen and to have it grow.

Well, now that calculation no longer works, which is why a lot of private health insurance had unprecedented rises in contributions to compensate the less money they make from their investments.

 

However, the private health insurances are not stupid, they raise the rates disproportionally, i.e. they increase the contributions for the "older" pots more than for the "younger" pots (see the above screen shot, that's also how the Central private health insurance did it).

They do that because these older people would lose all their saved Altersrückstellungen if they protest and move to another insurance, so they're basically a trapped audience. So these older customers will pay and pay. 

And if they do happen to leave, the insurance wins because they now get these members' Altersrückstellungen (you cannot take them with you to another insurance company) and because they got rid of older customers who cause high medical costs.

Win-win for them.

 

There are supposed to be independent auditors (Treuhänder) to keep the insurance companies honest, but as several court cases have shown, these auditors (who often do that job for decades at an insurance) are not as independent as customers would wish for: https://www.haufe.de/recht/weitere-rechtsgebiete/wirtschaftsrecht/bgh-zur-rechtmaessigkeit-einer-beitragserhoehung-in-der-pkv_210_481090.html

 

Please also read:  https://www.finanztip.de/pkv/pkv-beitragssteigerung/

 

****************************************************************************************************

 

Summary:

Stiftung Warentest came to the conclusion that the only people for whom private health insurance was a good idea were civil servants, since when they reach pension age, the state will pay 70% of their medical costs (source), so they only need a health insurance that covers the missing 30%.

 

Stiftung Warentest also say in their test (which you would have to buy at 4.49€ or just read its summary for free in the Süddeutsche article) that a retired employee or self-employed would have to pay over 1,000€ for their private health insurance, i.e. for 100% cover.

So a retired civil servant would "only" have to pay 300€ for 30%, which I agree is a much more manageable figure than over 1,000€ a month.

But that conclusion doesn't help you if you're not a civil servant...

 

The Stiftung Warentest's conclusions are from 5 years ago, now we have had 5 additional years of low/negative interest rates, so by now the estimated private health insurance contribution at pension age will be even higher than the "more than 1,000€" they had estimated in 2014.

And if insurance companies can't get the planned return on their investments from the market, there's only place left to get it from: from their customers.

 

 

So what's my conclusion?

If you do want to go private, weigh these advantages and disadvantages beforehand, to come to an informed decision.

Someone who will only be in Germany a few years won't care that the contributions will be astronomical at pension age, so for these people, going private would be a good decision, since they won't be around when the pendulum swings back.


And since public health insurance lowered the minimum contributions for self-employed to around 156€ a month (before they were around 360€), i.e. they lowered the minimum assumed monthly income from 2,283.75€ to 1,038.33€ on 1. January 2019 (source), public health insurance has become much more affordable even for low-income self-employed.

 

Anyone who intends to stay in Germany, or who thinks it even remotely possible to have a family one day (non-working spouses and children are covered for free in public health insurance, while in private health insurance you have to buy cover for each person), should enter public health insurance - if they can.

Yes, contributions in public health insurance will also go up, no way to avoid that with an ageing population, but at least these increases will be "fairer" since they will be based on all contributors, be they young or old, being put in the same pot.

And public health insurance contributions go by income, so unlike private health insurance where the high contributions hit you exactly when you can least afford it, at pension age when your income sinks, at least in public health insurance you can be sure that you will only have to give up a (hopefully) affordable part of your income for health insurance. 

 

For some people, e.g. people who come from a non-EU/EEA country and who cannot enter public health insurance because:

  • they won't be employees who are less than 55 years old, or
  • they won't be self-employed members of the Künstlersozialkasse (artists, journalists, authors), or
  • they're not returnees to Germany or German citizens,

there won't be any choice, they have to go private.

 

But everybody else: think long and hard before choosing private health insurance.

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Fine post, Panda!

Just to add to your list at the end: as a general rule, self-employed EU citizens who have been registered in Germany for over three months and currently have NO health insurance in Germany ( lots of people🙏🏻) cannot get into public insurance. In many such cases, it can often be difficult even to get into private German insurance.

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