Going to the Doctor Abroad: Germany

Welcome to my new Going to the Doctor Abroad series—a series of interviews with expats living abroad about how healthcare differs in their adopted country. Love it? Hate it? Find it useful? Let me know.

Today, my wonderful friend Ali from Aliadventures.com has agreed to tell us about healthcare in Germany.

First, tell us about you. What do you do? Where are you from? What’s your story in a nutshell?

I’m originally from the US. I lived in New Jersey until I was 15, then Atlanta until just after my 31st birthday. When I was 30, I met (via Twitter!) an American named Andy who was living in Freiburg, Germany. We fell in love, got married, and I moved to Germany. We recently moved to Berlin because it’s an amazing city.

In my previous life, I was an aviation insurance underwriter, but now I am a freelance writer and travel blogger. Travel is one of my biggest passions, and I reached all seven continents before my 30th birthday.

Talk to us about average run-of-the-mill doctor visits. How do they work in Germany? How are they different from the US?

I haven’t yet been to the doctor here in Berlin, but I lived in Freiburg in the Black Forest for almost four years, so my experience is based on that location. My normal doctor visits were really easy. I almost never had to wait more than a few minutes past my appointment time (though I often did wait about 30 minutes at a specialist’s office) and I could usually get an appointment within a couple of days if I really needed to get in.

In the US, I was used to a nurse always taking my temperature and blood pressure no matter what the reason was for my appointment, but that has not been my experience here. One time I went in because I had a fever and they still didn’t take my temperature. It doesn’t bother me, but it’s one of those little things that seems strange at first.

Let’s talk about specialists. How do you get in to see a specialist if you need to?

Any time I need an appointment with a specialist, I just call and make the appointment. Like in the US, they are sometimes a little more booked up, but if I’m having an urgent issue, they can usually squeeze me in.

Are there any other ways visiting a specialist is different in Germany?

For the ladies, visiting the OB/GYN can be a little different. They don’t give you those paper gowns, which makes sense since they’re going to see all the vital parts anyway, but it can feel strange at first. My doctor had a little curtain in the corner where I had to take off my top before she did a breast exam, and then I’d go back in, put my top back on and take off my bottoms for that part of the exam. It feels really strange to walk across the room half-naked, but it’s really no big deal. Though I have heard of some doctors who make you completely undress, so it varies. In general, Europeans are less concerned with nudity, especially when it comes to medical situations.

Any tips for finding English-speaking doctors in Germany? How usual is it for doctors to speak English?

The easiest way to find English-speaking doctors is to ask other expats in the area. Friends, English-speaking groups, and online expat groups are all helpful. In my experience, most doctors in Germany speak at least some English, and I haven’t had any problems with it. You’ll have better luck with this in big cities than in smaller towns.

Let’s talk about pharmacies and prescriptions. Are they any different from the US?

Pharmacies here are stand-alone shops, as opposed to the pharmacy section of a drug store or grocery store in the US. Usually they have my prescriptions right away, but occasionally they have to order something and then it’s ready by the end of the day or the next morning depending on when I drop off my prescription. Things like paracetamol and ibuprofen (the generic equivalent of Tylenol and Advil) are only available at pharmacies, but you don’t need a prescription. You just ask for it from the pharmacist. In general, they’re a little more cautious about medications here, but I’ve never had a problem getting what I needed.

In an emergency situation, what is the protocol in Germany?

It’s pretty much the same. Either get yourself to the emergency room or call 112, which is the equivalent to 911 in the US.

How is a hospital visit different than in the US?

I’ve never had a hospital stay in the US, but a few years ago I did end up in the hospital in Germany. I was not given any sort of hospital gown, which was nice because it meant I could hang out in my own clothes or pajamas. But since I didn’t expect to be admitted, my husband had to rush home and grab a few things for me so I wouldn’t have to go to sleep in my jeans. There wasn’t as much privacy as I’d expect, like no curtain to separate my bed from my roommate’s. But I guess you never really get privacy in a hospital.

There were some challenges with the food that I didn’t expect. No one expects good food at a hospital, but I kept telling them not to give me dairy or big piles of raw vegetables because I was there for a digestive disease that affects my colon. They didn’t seem to understand why eating these things would be a problem. I should have just told them I had lactose intolerance, even though I didn’t.

The doctors spoke English, so I didn’t have problems there, but most of the nurses did not, so that was challenging. Knowing some basic German (I had just finished an intensive eight-month course) did help, but it was a little stressful.

What about homeopathic practitioners, acupuncture, and other non-medical treatment options? Are they accessible? How do you go about finding them? How are they different from the US?

This isn’t something I had any experience with in the US, but it is much more acceptable here in Germany. My western doctors seem to understand that alternative medicine can be helpful too, and they’ve even encouraged me to go to those types of doctors. I went to an acupuncturist in Freiburg on and off for three years, and I really liked it. I didn’t know anyone who had recommendations at that time, so I just searched online for an acupuncturist. My husband called a few until we found one who said he could handle some English, though he did ask that Andy (who speaks fluent German) come in for my first appointment when there was more to discuss.

I’ve only been to two appointments with an alternative practitioner in Berlin who spoke near-perfect English, but there are a lot more to choose from in bigger cities like this.

What about health insurance? What kind of insurance is available to expats in Germany? Would you recommend it? What’s the cost?

Health insurance is mandatory in Germany, so yes I recommend it. The type of health insurance you get depends on your situation, but if you get a job with a German employer, you can generally get on the public plan. If you go to Germany on a freelance visa, you’ll have to get private insurance. I don’t exactly know how the private plans work, but if you qualify for one, they can sometimes be cheaper depending on your age and health conditions. (I know a German who couldn’t get private health insurance because he has a digestive disease that is similar to what I have, but I don’t know how this works if you don’t qualify for the public plan.)

The premium you pay on a public plan is based on how much you earn, within a minimum and maximum. If you’re earning at or above the maximum level (which I think is around 50,000 euros annual), your premium is around 700 euros or so a month. If you’re employed, your employer pays half, but if you’re self-employed, you pay the full amount.

I am on an artist plan, which is for freelancers in a creative field (writers, painters, musicians, etc.). The plan is called KSK (Künstlersozialkasse) and they sort of act like an employer. I’m technically still insured through a public plan with another company, and KSK isn’t actually a health insurance company. I pay roughly half of the monthly premium, plus a small amount for the German equivalent of social security and medicare/medicaid. My premium ends up being about 18% to 19% of my gross earnings.

Does health insurance cover everything or is it a co-pay system? If so, how much are you generally paying for things?

Health insurance here pays for virtually everything, which makes the expensive premiums more worthwhile. Doctors visits are completely covered, no co-pays or deductibles. When I was in the hospital, I had to pay 10 euros per day. I can’t even imagine what it would’ve been in the US. Alternative practitioners, like my acupuncturist, are not covered, and they can cost anywhere from 40 to 100 euros per session. There are some plans you can add onto your normal health insurance to cover some of that, depending on which health insurance company you choose.

If you’re on a private plan, you have to pay for things up front and get reimbursed. I’m not sure how this would work for a hospital stay.

What about the cost of pharmaceuticals? How does it compare to the US?

Prescriptions are generally five euros, sometimes 10. The pills I take every day to manage my ulcerative colitis are 10 euros for a three-month supply. This is so much cheaper than in the US! The same medication in the US cost me $1,400 for a three-month supply until I hit my yearly deductible, and even then I had to pay about $100.

I’ve ordered six months at a time here, which is 20 euros, and several times the pharmacist has said to me, “You know this is expensive, right?” It makes me laugh every time.

Anything else people should know about going to the doctor in Germany?

The medical system in Germany is really good, even when there are differences that might seem strange to you. They are more cautious then US doctors (as a generalization), so they don’t prescribe drugs as often and you might end up with a hospital stay for something that would be outpatient in the US.

Dental visits are typically once a year here, not twice a year like in the US. The annual cleaning that insurance covers isn’t nearly as extensive as what I’m used to in the US either, so we often pay a little extra for the polishing part. Dental care is also covered in your health insurance and pays for virtually everything. I had to go to a dental specialist last year to have a tooth pulled, and it didn’t cost me anything.

Even though I go to English-speaking doctors, I find it helpful to type out the things I want to tell the doctor, especially for a first visit. It reduces the chances of misunderstanding, and I won’t forget to mention anything.

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Huge thank you to Ali for sharing her experiences with German healthcare. Any questions still on your mind? Anything you wish I had asked that I didn’t? Let me know in the comments.

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