Health Insurance and Home Birth — What’s Covered
One of the most common questions about home birth in Germany: who pays for it? The short answer is that your health insurance covers the midwife and her care. The longer answer involves an on-call fee, a few things that aren’t covered, and an optional supplementary insurance that may or may not be worth it.
What statutory health insurance covers
German statutory health insurance — gesetzliche Krankenversicherung, or GKV — covers midwife-attended home birth as standard maternity care. This is not a special benefit. The midwife bills the Krankenkasse directly for her services.
What is covered: all antenatal care provided by the midwife (Vorsorge), the birth itself — the midwife’s attendance during labour and delivery, postnatal care (Nachsorge) with home visits for up to 8 weeks plus further visits if needed for breastfeeding support, and materials and supplies used during the birth.
This is comprehensive care from pregnancy through the postpartum period, fully covered.
What is not covered
The birthpool hire is a private expense. The Krankenkasse does not cover pool rental. Doula services are not covered. Additional comfort items — anything you buy to set up your birth environment — are your own cost.
And then there is the on-call fee.
Find out about renting a birth pool for your home water birth
The Rufbereitschaftspauschale
The Rufbereitschaftspauschale is the on-call fee your midwife charges for being available around the clock in the weeks surrounding your due date. She keeps her schedule open, carries her phone, and is ready to attend your birth at any time. This compensation is separate from the fee for the birth itself.
The GKV pays a portion of the Rufbereitschaftspauschale, but it typically does not cover the full amount. The midwife may charge the difference to you directly. The out-of-pocket cost varies — anywhere from 0 to over 500 euros, depending on the midwife’s fee structure and what the Krankenkasse reimburses.
Since 2015, following political pressure from midwifery organisations and parent groups, the GKV contribution has increased. But it remains a point of contention. Midwives argue the reimbursement still does not reflect the true burden of being on call for weeks.
When you speak to your midwife, ask specifically: how much is her Rufbereitschaftspauschale? How much does the Krankenkasse cover? What is the out-of-pocket balance, and when is it due?
Private health insurance
Private health insurance — private Krankenversicherung, or PKV — varies by provider and plan. Some PKV plans cover home birth, others explicitly exclude it or require pre-approval. If you have private insurance, check with your insurer before assuming coverage. Get the answer in writing.
Supplementary insurance
Several German insurers offer Zusatzversicherungen — supplementary insurance policies — that cover costs not fully reimbursed by the GKV. The most relevant for home birth include coverage of the Rufbereitschaftspauschale (partial or full), coverage for a Beleghebamme in hospital if transfer is needed, and a private or semi-private room if a hospital stay follows transfer.
The catch: most supplementary maternity insurance must be taken out before becoming pregnant, or very early in pregnancy, with a waiting period of typically 8 months. It cannot be purchased after the pregnancy is well established.
Providers to research include ARAG, DKV, Barmenia, and HanseMerkur, among others. Coverage, premiums, and exclusions vary considerably — compare carefully, and read the fine print on home birth and midwife fees specifically.
Is it worth it? That depends on how much the Rufbereitschaftspauschale gap bothers you and whether you value the hospital room upgrade in case of transfer. Many women plan home births without supplementary insurance and cover the on-call fee gap out of pocket. It is optional, not essential.