Can I become a private patient with statutory health insurance?
In short
Partly. With statutory health insurance (gesetzliche Krankenversicherung) you can choose cost reimbursement (Kostenerstattung): the doctor bills you privately, but your fund pays only its own rate, often less than half. You become a private patient in hospital with a top up from about 31 euros a month, and at the doctor's with an outpatient plan. You never become fully private this way.
Published premiums and guide values for people with statutory health insurance, October 2026.
Example
Typical range
Hospital top up, age 32, good plan with ageing reserves
from about 31 euros a month
Hospital top up, age 52
from about 49 euros a month
Outpatient top up, mid range, age 26 to 39
about 12 to 18 euros a month
Paying for a two bed room yourself
about 65 euros a day
Premiums from published examples, October 2026.
The share in the worked example is a guide value from quoting practice.
Your premium depends on age and health; we obtain the exact quote.
Worked example
Dermatologist visit with cost reimbursement
Someone with statutory health insurance chooses cost reimbursement and sees a dermatologist who bills privately.
Private bill
about 120 euros
Fund's rate for the same service
about 35 to 50 euros
Admin deduction up to 5 percent
about 2 euros
You pay about 70 to 85 euros per visit. Guide values from quoting practice; your fund tells you its rate on request.
Option 1: cost reimbursement with your fund
Instead of using your health card, you get a private invoice and send it to your fund (Krankenkasse). You must tell the fund in advance and stay with this choice for at least one calendar quarter.
The fund refunds no more than it would have paid the doctor, and may deduct up to 5 percent for admin. The doctor, however, bills under the private fee scale (GOÄ). With statutory health insurance alone, you pay that gap yourself.
Option
What you get
Cost
Cost reimbursement without top up
private bill, free choice of doctor
often more than half the bill yourself
Hospital top up (Krankenhauszusatz)
senior doctor, one or two bed room
from about 31 euros a month at 32
Outpatient top up (ambulante Zusatzversicherung)
money towards glasses, naturopath, check ups
about 5 to 35 euros a month
Paying privately
single treatment, no contract
full bill
Option 2: private patient in hospital
Hospital is where becoming a private patient is easiest. A hospital top up pays for the chosen senior doctor and the better room. Good plans cover doctors' fees up to 3.5 times the fee scale.
If you only want a quieter room, you can pay it yourself when needed: about 65 euros a day for a two bed room, about 124 euros for a single room.
Option 3: private patient at the doctor's
Outpatient care is harder. Most outpatient plans pay fixed budgets for glasses, naturopaths or check ups, not the gap between a private bill and the fund's rate. Plans that pay that gap exist but are rarer and cost more.
Decide first whether you want faster appointments, a specific doctor or services the fund does not pay at all. Each goal needs a different plan.
When it is not worth it
If you rarely see doctors and are happy with them, private status adds little. It does not guarantee better medicine, only more choice.
Cost reimbursement without cover is risky: larger tests can leave you with several hundred euros to pay, and you cannot switch back before the quarter ends.
Step by step
Decide whether you mean hospital, appointments or extra services.
For hospital, compare hospital top ups.
Before choosing cost reimbursement, ask your fund for its rate and admin deduction.
Check whether an outpatient plan pays the gap to a private bill.
Answer health questions honestly.
Checklist
Goal clear: senior doctor, appointments or extras
Hospital plan pays up to 3.5 times the fee scale
Cost reimbursement only with a plan for your share
Waiting periods known
Premium in later years considered
Common mistakes
Choosing cost reimbursement and being surprised by the bill
Thinking a top up makes you fully private
Choosing a hospital plan without ageing reserves and facing steep rises later
Questions and answers
Frequently asked
Can a top up make me a private patient?
In hospital largely yes, at the doctor's only as far as the outpatient plan pays.
How long am I bound to cost reimbursement?
At least one calendar quarter.
Must the doctor warn me?
Yes.
Before treatment the doctor must tell you that costs the fund does not refund are yours.
Will I get faster appointments?
Often, but there is no right to it.
Should I switch to full private insurance instead?
That depends on income limits and long term costs.
For most people with statutory health insurance a top up is the realistic route.
