Key takeaways

• A deductible is the amount you pay, and the health insurance company covers the rest. 
• You set the deductible amount when signing the health insurance contract. 
• Private health insurance plans with a deductible are more prevalent in Germany.
• A deductible can help you save on private health insurance costs. However, you must not take a plan with a very high deductible, as you can reduce the deductible only after a health check. 

This is how you do it

• Calculate carefully how much you save in health insurance premiums and how much you pay in deductibles. If you pay more than you save, deductibles aren’t worth it.
• Remember, taking private health insurance is a lifelong decision. So, consider a long-term view when deciding on the deductible amount.
• Employees don’t benefit much from private health insurance plans with deductibles. This is because the employer contributes to the health insurance premium but not to the deductible.

Table of Contents

What is a health insurance deductible in Germany (Selbstbehalt)?

Deductible is the amount you pay on your own. The insurance company pays the rest. It is called Selbstbehalt or Selbstbeteiligung in German.

You must be familiar with the deductibles for other types of insurance like car insurance, liability insurance, etc. Health insurance companies also offer tariffs with a deductible.

How do health insurance deductibles work in Germany?

In health insurance deductibles, you pay part of the medical bill, and the insurer covers the rest. So, during doctor’s visits or medications, you pay the deductible first.

Example: Suppose you opt for a health insurance plan with a deductible of 300 € per year. Your medical bill is 500 €.

In this case, you will pay 300 € (the deductible amount) yourself, and the health insurer will cover the rest, 200 €.

You don’t pay deductibles every time you visit a doctor or buy medication. The deductible amount is set for the year.

Continuing with the above example, suppose you visit another doctor in the same year. This time, the medical bill is 400 €. 

You don’t have to pay the deductible again, as you already paid it on your first medical invoice. Thus, the insurance company will reimburse the whole invoice, i.e., 400 €. 

What are the benefits of health insurance deductibles?

• Health insurance plans with a deductible are cheaper than those with no deductible. 
• Tariffs with a deductible also benefit the health insurance company. If the insured only receives money after they have paid the deductible, they no longer submit small invoices. This reduces the administrative effort and costs of the health insurer. 
• Patients often think more carefully about which medical services they want to use if they have to cover part of the costs themselves.

Private health insurance deductible

Tariffs with deductibles are more prevalent in private health insurance. The higher the deductible, the more you save on health insurance premiums.

Private health insurance companies offer different types of deductibles to their customers.

Types of deductibles

Absolute deductible

In absolute deductible, the private health insurance provider specifies a yearly fixed amount you pay yourself. 

For example, the deductible set in the contract is 400 € per year. In this case, the insurance would step in once you paid the deductible amount, i.e., 400 €. 

An absolute deductible often applies to all health insurance service areas, including outpatient and inpatient treatment and dental services.

Many insurers waive the deductible for preventive examinations. For example, if you go for professional teeth cleaning, you don’t have to pay a deductible. The insurer will cover the costs.

Percentage deductible

In percentage deductible, you pay a percentage of the medical costs yourself, but up to a set maximum limit.

The percentage deductible mode is the most advantageous for the following reasons.

• The private health insurer contributes to the medical costs from the start. In the “absolute deductible,” you must pay the whole deductible before the insurance kicks in.
• You save more in percentage deductibles, as shown in the example below.

Example: You opt for a deductible of 10% with a maximum limit of 500 € per year. Let’s assume you had the following medical expenses in the year.

	Total medical cost	Deductible amount you must pay	Amount paid by the insurer
Doctor’s visit	400 €	40 € (10% of 400)	360 €
Medication	200 €	20 € (10% of 200)	180 €
Dentist’s visit	300 €	30 € (10% of 300)	270 €
Total	900 €	90 €	810 €

In the above example, you only paid 90 € in deductibles, and the insurer paid 810 €. However, if you had an absolute deductible insurance plan, you would have paid 500 €, and the insurer would have paid 400 € (900 € – 500 €) only.

Deductible only in one insurance area

Privat health insurance tariffs with deductibles applicable in one insurance area mean the personal contribution is limited to only that service area.

So, you don’t have to pay any deductible if you avail of medical services in other areas.

For whom is the deductible worthwhile?

Self-employed

Private health insurance plans with a deductible benefit self-employed or freelancers in Germany because they pay the whole insurance premium themselves.

You can learn about private health insurance for self-employed in our guide.

Employed

For employed people, the advantages of a deductible are significantly less for the following reasons.

• The employer pays 50% of their health insurance premiums.
• The employer doesn’t contribute to the deductible. You pay the whole deductible yourself.

Worse, you pay more in deductibles than you save on insurance costs. Thus, you should carefully calculate the savings in a health insurance plan with a deductible.

Civil servants

Private health insurance tariffs for civil servants generally do not contain any deductible.

The state covers up to 50% or 70% of the medical costs for civil servants. So, the private health insurance premiums are already very low.

Calculate the benefits from deductibles carefully

You are young and rarely go to the doctor. In this case, getting a private health insurance plan with a deductible benefits you.

But the state of your health can change quickly – due to an accident or illness. Moreover, with age, visits to the doctor become more frequent. You may need regular medication or physiotherapy.

So, you should calculate how much you save in health insurance costs versus how much deductible you pay. If the savings are less than the deductible, it isn’t worth it.

Don’t be tempted by the high deductible tariffs. You can increase the deductible anytime without a problem. However, you can reduce it only after a health check. 

So, in the long term, paying higher deductibles while unemployed or retired would be tough. You can read our guide to learn other ways to reduce private health insurance costs. 

How does a deductible affect taxation?

Private health insurance contributions are tax-deductible in Germany. You can enter them as special expenses on your income tax return.

As private health insurance plans with deductibles are cheaper, they reduce your tax savings. At the same time, you cannot deduct health insurance deductible from your income tax return (Federal Finance Court ruling of June 1, 2016, Ref. XR 43/14 ).

You can only deduct your medical expenses as an extraordinary expense. However, only if they exceed your reasonable burden. 

Can you reduce private health insurance deductible?

Reducing the private health insurance deductible is not easy. The health insurer demands a new health check. 

So, if your health has deteriorated since you took out private health insurance, you may have to pay high premiums for low deductible tariffs. In the worst case, the health insurer may deny you a plan with a lower deductible.

Public health insurance deductibles

You can also get public health insurance plans with a deductible. However, they are often not as attractive as private health insurance.

Who can take a statutory health insurance tariff with a deductible?

You can take a public insurance plan with a deductible if you meet the following requirements.

• You are a member of statutory health insurance.
• You pay at least part of the health insurance contributions.

NOTE: Once you opt for a tariff with a deductible, you cannot change it for the next three years. Additionally, you cannot change your public health insurance company for the next 3 years.

References

• https://www.finanztip.de/pkv/pkv-selbstbehalt/
• https://www.tk.de/techniker/aktionen/praemieflex/praemie-flex-selbtsbeteiligung-2149914