How to Navigate the German Healthcare in Aachen

Health insurance is one of the first and most important errands you should run when moving to a different country. Let’s see the ins and outs of German health insurance and take a peek into the German healthcare system as an expat!

Public vs. Private Health Insurance

Germany has made health care compulsory for all citizens and residents, which means that each resident must subscribe to either public (gesetzliche Krankenversicherung, GKV) or private (private Krankenversicherung, PKV) health insurance.

Public Insurance (GKV)

• This system covers most people, including students, those employed and whose income is below a certain threshold (€66,600 annually in 2023), and unemployed people.

• Employers in Germany’s public health insurance system (GKV) pay exactly 50% of the standard contribution rate, which is 7.3% of the employee's gross income. They also share 50% of the supplementary contribution (Zusatzbeitrag), which varies by insurer.

• Some larger public insurers in Aachen are AOK Rheinland/Hamburg TK (Techniker Krankenkasse) and Barmer GEK.

Private Insurance (PKV)

• This type of insurance is available to self-employed persons with high incomes and some selected professions.

• These premiums are not determined by income; they are calculated based on an individual’s age, health condition, and desired coverage amount.

• Usually, it allows for faster appointments, access to private hospitals, and other bonuses such as dental work.

• Allianz, Debeka, and DKV Deutsche Krankenversicherung are some of the most renowned private firms.

Getting Health Insurance

Generally, foreigners choose public insurance as their primary coverage unless they qualify for private coverage. The universities or workplaces assist in dealing with health insurance. For students, universities typically require proof of health insurance before enrollment and may have agreements with specific insurers to facilitate coverage. Employers handle employee insurance enrollment by deducting contributions directly from salaries and registering them with a public or private insurer, depending on eligibility.

To register for health insurance, individuals must submit documents such as a passport, proof of residence, employment contract or university enrollment confirmation, and, in some cases, previous health insurance records from their home country. Once registered, they receive a health insurance card (Gesundheitskarte), which is required for medical appointments and treatments.

Public insurance for students is the most accessible due to it being subsidized to a flat value of about 120 Euros a month.

Using the Healthcare Systems in Aachen

How To Find A Doctor (Hausartz)

How To Find A Doctor (Hausartz) For any medical condition, your first contact should be a general practitioner known as Hausartz. On your behalf, they will give referrals to other practicing doctors. There are various online directories available that can assist you in locating doctors who speak English in the city such as Doctolib.

Surgical Clinics And Emergency Care

The largest medical field in Aachen is Uniklinik Rwth Aachen, which provides highly specialized medicine for specialties and research. Additionally, for more minor injuries, you can go to smaller clinics or urgent care centers.

Tip: Ensure you point to your health insurance card as it is a mandatory requirement for any type of appointment or in an emergency.

Time Spent Waiting

Access to public health care services is great but the waiting times for anything that does need attention but is considered to be less urgent can take quite a bit of time. This is particularly true for those who require consultation with specialists. Appointments can take weeks or even months apart. Waiting periods in the consultation are shorter for those with private insurance, and they tend to go to exclusive private practice areas.

Pharmacies & Getting Prescriptions

In Germany, pharmacies (Apotheken) are the only places where prescription medications can be legally dispensed. Unlike in some countries where you can buy medicine at supermarkets or drugstores, German pharmacies handle both prescription and over-the-counter (OTC) medications.

How to Get Prescription Medication

If you receive a prescription (Rezept) from a doctor, you need to take it to a pharmacy. Prescriptions can be electronic (eRezept) or on paper, depending on your doctor. Most prescriptions require a co-payment, which varies depending on your insurance and medication. Some medications may require prior approval from your health insurer before being dispensed.

Differences Between OTC and Prescription Drugs

• Prescription Drugs (Verschreibungspflichtige Medikamente): Only available with a doctor's prescription.
• OTC Medications (Freiverkäufliche Medikamente): Common painkillers, cold medicine, and vitamins can be purchased without a prescription.
• Some medications that are OTC in other countries may still require a prescription in Germany.

24-Hour & Late-Night Pharmacies in Aachen

Most pharmacies operate Monday to Saturday, 9 AM – 6 PM. Outside of normal hours, emergency pharmacies (Notdienstapotheken) rotate coverage. You can find the nearest open pharmacy using the [following website] (https://www.aponet.de/apotheke/notdienstsuche) or by checking pharmacy windows for schedules.

Mental Health Services

Accessing Therapists, Psychologists, and Psychiatrists

Mental Health services are available throughout Germany, although the waiting times for therapy and other forms of counseling tend to be rather lengthy. However, Psychotherapy is practiced extensively, and one can select a provider according to the language spoken and insurance accepted. Therapists can be located on websites of health insurance providers or portals like therapie.de. Psychiatrists (Psychiater) hold medical degrees and are trained to prescribe drugs while psychologists concentrate on psychotherapy.

Insurance Coverage for Mental Health

Public health insurance typically covers outpatient psychotherapy when deemed medically necessary, with minimal co-payments. Private health insurance plans also cover mental health services, including consultations with psychiatrists, psychologists, and therapists. However, coverage details can differ between insurers and plans. Some private insurers may require pre-approval for certain treatments or limit the number of covered therapy sessions. It's essential to review the terms of your private insurance plan to understand the level of mental health care provided and any associated co-payments.

Support Groups & Expat-Friendly Services

Many other supportive resources are present in the area for additional help. Some therapists offer their services in other languages such as English or French, which greatly helps those people who do not speak German to receive the necessary attention. Counseling services for students and employees are common in universities and workplaces so there are other alternatives for the help needed for mental wellness.

Health Insurance for Family Members & Dependents

Coverage for Spouses and Children

In Germany, there is the option of having family members or dependents on a primary policyholder’s health insurance plan, though this solely depends on whether the health insurance is public or private. Under the public insurance system (GKV), non-working spouses and children can benefit from a family insurance plan (Familienversicherung) free of charge. On the other hand, within a multi-member private health insurance policy (PKV), every insured person is obliged to have their own plan, thus making it more expensive.

Special Considerations

Certain circumstances play an important role in coverage. If one spouse holds a private policy, the other spouse may not have the option of remaining in public insurance. Also, children must be insured with one parent's plan which is a matter of costs and available benefits balance. Expats should also be informed about how their former insurance conditions affect their enrollment possibilities in Germany.

Dealing with Bureaucracy & Paperwork

Registering for Health Insurance

In Germany, the process of enrolling into a health insurance plan is simple and mostly automated. First, you have to pick one out of the two types of health insurance. If you are already employed, your employer may be able to help you register. Supporting documents that need to be submitted include the passport, a residence permit, an employment contract, and proof of income.

Documents Needed for Doctor Visits

The health insurance card is the most important document. Ensure that you always have it with you at all times. A general practitioner may sometimes issue a referral for specialists. Prior tests done for persistent illness complaints or while the patient was undergoing treatment could also serve as good proof.

Handling Insurance Claims and Payments

Based on the insurance policy, the claiming and payment processes for the insurance benefits differ. Small private practitioners can bill the government, and German public health insurance pays the bills. With private insurance, patients have to pay the doctors and later submit a reimbursement claim to the insurance company. When claiming, copies of the prescription and receipt must be saved for quick payment. That's how patients will be paid back.

Cultural Differences in Healthcare

In Germany, as in many countries, expats can find notable differences from other regions in their approach to healthcare. Most doctors’ offices do not accept walk-ins, so appointments are a must. Doctors in Germany are known to be quite blunt, so expect straightforwardness and little beating around the bush when it comes to receiving treatment and examination. You can get checkups done, but your Hausarzt will not book the specialist appointment for you. Unlike in some other countries where the referral comes with a scheduled appointment, you’ll need to arrange the appointment yourself after receiving the referral.

The German healthcare system follows evidence-based medicine, which means fewer unnecessary tests and prescriptions. Alternative medicine, such as homeopathy, is sometimes covered by private insurance but is rarely included in public insurance plans.

For those unfamiliar with the system, advocating for oneself as a patient is important. Asking for clarification, seeking second opinions, and researching providers can help ensure quality care. Learning basic German medical phrases can be beneficial, particularly if a doctor does not speak English. Online reviews and expat forums can also be useful in finding well-recommended healthcare providers.