Co-payments in Public Health Insurance in Germany [2024 Guide]

Key takeaways

• Public health insurance covers all medically necessary treatments that are also economical.
• You usually pay a small amount for medical services, such as hospital stays, medication, etc. This is called co-payment.
• The co-payment in public health insurance is limited to 2% of your gross annual family income and 1% for chronically ill individuals. This is called the individual burden limit.

This is how you do it

• If you exceed your individual burden limit, you must apply to your public health insurance provider for a co-payment exemption.
• You must keep the invoices for all your medical services. Public health insurance companies require them as proof.

Table of Contents

What is covered in public health insurance?

German public health insurance, also known as statutory health insurance, is rated one of the best in the world. It covers all medically necessary and economical treatments. 

You usually pay nothing to access healthcare in Germany. However, you pay a small amount for certain services, such as hospital stays, medical aids, and medications. 

The maximum amount you pay for accessing medical services is limited to 2 percent of your annual gross family income. Furthermore, this limit is reduced to 1 percent for chronically ill people. You’ll learn more about it later in this guide.

What is not covered in public health insurance?

• Cosmetic treatments: Plastic surgery, laser operation of the eye, etc.
• Limited dental coverage: Don’t cover high-quality fillings. Partial coverage for other dental treatments.
• Only economical medical procedures are covered. For example, it covers only basic chemotherapy. If you want immune system adaptive chemo, you must pay for it yourself. The same applies to other surgeries and inpatient treatments.
• Alternative medicine: Public insurance covers only part of the costs of alternative medicines like homeopath, osteopathy, nature therapy, etc.
• Travel vaccinations: This covers the vaccination recommended by STIKO. For other vaccinations, you must pay yourself.

What is co-payment in public health insurance?

You usually pay nothing to access healthcare in Germany. However, you pay a small amount for certain services, such as hospital stays, medical aids, and medications. This is called co-payment.

How much is the co-payment in statutory health insurance?

Despite having the same active ingredient, medications’ prices are often very different. This is why public health insurance companies have set the maximum amount they will pay for a group of comparable medications.

Suppose the medication your doctor prescribed is more expensive than the maximum amount set by the insurer. In this case, you must pay the difference plus a co-payment.

The co-payment amount depends on the medical service. The table below summarizes the medical services and co-payments publicly insured individuals must pay.

Area	Co-payment / Additional payment	Exceptions
Medicines and dressings	For prescribed medicines, you pay 10% of the price, but at least 5€ and a maximum of 10€ per pack. However, you never pay more than the actual cost of the drug.	Example: – The medicine costs 7€. You pay a co-payment of 5€. – The medicine costs 75€. You pay a co-payment of 7.5€.  – The medicine costs 120€. You pay a co-payment of 10€. NOTE: Medicines to “improve the quality of life,” such as Viagra or medication to help you quit smoking, are not covered. It doesn’t matter if you have a doctor’s prescription.
	Non-prescription and over-the-counter medicines are not covered by public health insurance.	The health insurer makes an exception in the following scenarios and covers the medication costs. – Children up to the age of 12. – Adolescents with developmental disorders up to the age of 18. – Insured persons aged 12 and over for the treatment of serious illnesses. However, the medicines should be part of the standard therapy for serious illnesses.
Travel costs	Inpatient treatments, rescue trips to the hospital, and ambulance transport: 10% of the cost per trip, at least 5€ and a maximum of 10€ per trip. You don’t pay more than the actual trip cost.	The same copayment amount must also be paid for children.
	Outpatient treatments: Health insurance doesn’t cover the travel costs for outpatient treatments.	Exception: – The costs for medically necessary trips for outpatient treatment, such as dialysis and chemotherapy, are covered.  – Disabled people can also claim the travel costs even if they don’t have a disability card.
Home Nursing	10% of the costs for a maximum of 28 days, plus an additional 10€ per prescription.	After 28 days, you don’t pay the co-payment; the health insurer covers 100% of the costs.
Household help	10% of the daily costs, at least 5€, and a maximum of 10€ for each day the assistance was used. You don’t pay more than the actual costs per day.
Remedies (e.g. physiotherapy, occupational therapy, voice-speech, podiatry, etc.)	10% of the cost of the product plus 10€ per prescription	Example: Your doctor prescribed you four physiotherapy sessions in a prescription. You pay 10€ for the prescription and 10% of the cost of each physiotherapy session.
Medical aids (Hearing aids, walking aids, prostheses, incontinence pads)	10% of the costs, but at least 5€ and a maximum of 10€ per aid. You don’t pay more than the actual costs.	Exception for consumables, such as feeding tubes or diapers for incontinence: you pay a co-payment of 10% per pack, but a maximum of 10€ per month.
Outpatient intensive care	Copayment depends on where the outpatient care is done.  e.g. in full-time care facilities, you pay 10€ per day e.g. in your home, you pay 10% of the costs plus 10€ per prescription You pay for a maximum of 28 days per calendar year.
Hospital treatment	10€ per calendar day for a maximum of 28 days per year.
Medical rehabilitation (outpatient and inpatient)	10€ per calendar day
Follow-up rehabilitation after hospital stay	10€ per calendar day	You pay a co-payment for a maximum of 28 days per calendar year, taking into account the co-payment for hospital treatment
Sociotherapy	10% of the daily costs, at least 5€, and a maximum of 10€ per treatment day. You don’t pay more than the cost of the therapy.
Dentures	Health insurance companies pay fixed subsidies for dental treatment. The fixed subsidy increases if you keep the bonus booklet for five or ten years. The same applies to children.
Artificial insemination	You pay a co-payment of 50%

When can you be exempt from the co-payment?

You are exempt from co-payment once you reach the individual burden limit ( Section 62 SGB V ).

• The individual burden limit is 2% of your annual gross family income. 
• The burden limit is 1% of gross family income for chronically ill people.

Once your total co-payment exceeds the individual burden limit, you stop paying the co-payment. There are three ways to stop paying co-payment.

• Once you reach the limit, apply for a co-payment exemption letter from your health insurer. You must provide the receipts as proof. If the insurer approves your application, you’ll recieve a co-payment exemption letter. You can show this letter when accessing medical services and don’t have to pay a co-payment in that calendar year.
• You can calculate the individual burden limit at the start of the year. Pay the whole co-payment in one go to your health insurer and get the exemption letter. This way, you don’t have to save the invoices.
• Collect the receipts throughout the year. Check if you surpass the individual burden limit. If yes, submit the receipts to the public health insurer for reimbursement at the end of the year. The insurer will reimburse the amount that exceeds the limit.

NOTE: You can submit the co-payment application retroactively for up to four years. 

How do you calculate the individual burden limit?

The individual burden limit that public health insurers consider for co-payment exemption

• The individual burden limit is 2% of your annual gross family income. 
• The individual burden limit is 1% of gross family income for chronically ill people.

How is family income calculated? 

The sum of the gross income of all the family members who live in the same household is considered for calculating the burden limit. This means

• Your income,
• Your spouse’s or registered partner’s income
• Income of your underage children
• Income of children over 18 and covered by family insurance

Here are some scenarios where the income of your children or partner is not considered when calculating individual burden limits.

• If the children have their own health insurance while studying or in training, their income is not considered. It doesn’t matter whether they live with you in the same household.
• If you are unmarried, your partner’s income is not considered. It doesn’t matter whether you and your partner live in the same household.

What counts as income?

Public health insurance companies consider all types of earnings when calculating the co-payment limit. Here are some of the incomes that insurers consider.

• Wages and severance payments
• Pensions and benefits
• Income from self-employment or business
• Income from capital assets
• Rental and leasing income
• Unemployment benefits I
• Citizen’s allowance
• Sick pay

Public health insurance providers don’t consider the following earnings when calculating the co-payment limit.

• Child benefit
• Child allowance
• Housing benefit
• Student loans
• Care allowance
• Parental allowance up to 300€
• Integration assistance for disabled people

What allowances are deducted from the income when calculating the co-payment limit?

	2021	2022	2023	2024
For spouses	5,922 €	5,922 €	6,111 €	6,363 €
For each child	8,388 €	8,548 €	8,952 €	9,312€

Example

The table below calculates the co-payment burden limit for a married couple with two children.

Wife’s annual gross income	50,000 €
Husband’s annual gross income	50,000 €
Total annual gross income	100,000 €
– Spouse allowance	– 6,363 €
– Allowance for 2 children	-18,624 € (9312 x 2)
= family income to be taken into account	75,013 €
Load limit 2%	1500€

In this example, you pay a maximum of around 1500€ in co-payments in 2024. If a family member is chronically ill, the maximum contribution is half, i.e., 750€.

How do you get public health insurance?

You can register with any of Germany’s 96 public health insurers. Almost every company offers online registration.

Registration is simple: fill out the form and submit it. You usually receive the confirmation within 14 business days.

We find TK the best public health insurance provider for expats. It offers its website, mobile app, and customer support in English.

You can register with TK online here.