Germany offers an excellent healthcare system for its citizens. Since healthcare reforms in 2009, health insurance became a legal requirement, i.e., anyone who lives in Germany must have some form of health insurance. This requirement does not exclude foreigners, which means all expats who want to live in Germany must know how the healthcare system works and how they can sign up for health insurance.
The German Healthcare System in a Nutshell
Germany’s public healthcare system offers its residents coverage with either statutory public health insurance (Gesetzliche Krankenversicherung-GKV) or private insurance (Private Krankenversicherung-PKV). Statutory health insurance is obligatory for the majority of residents, and only a few specific categories can opt out of the public health insurance scheme and sign up with a private provider.
Unlike in France or Belgium, when residents visit a doctor or a healthcare provider, they don’t have to pay for the service and wait for their health insurance to reimburse them later. It’s the healthcare provider who is compensated by the health insurance fund. However, patients still have to pay some service fees on their own.
Expats who move to Germany are also included in the healthcare system and must be holders of health insurance. Depending on their income situation, they may be eligible for only public health insurance, or they may have the option to get coverage from both systems.
Is Health Insurance Mandatory in Germany?
Health insurance in Germany is mandatory for every single legal resident as well as expats. However, according to the German government, the following categories are subject to only public compulsory public health insurance:
- Employees whose income does not exceed the annual salary limit, i.e., those who earn less than €69,300 per year (as of 2024).
- Individuals who benefit from unemployment or alimony.
- Students, interns, and apprentices, who are engaged in professional activities without pay.
- Pensioners.
- Individuals with disabilities.
- Artists and publicists (even self-employed artists).
- Individuals who have no other entitlement to health insurance and were last insured under statutory health insurance.
- Individuals who receive an orphan’s pension.
- Agricultural and forestry entrepreneurs.
In simpler words, if you earn more than the annual income threshold €69,300 per year (as of 2024) or are a self-employed/freelancer, you can choose between statutory health insurance or private insurance. The only exception to the self-employed category are artists who must pay social contributions to the artists’ social security fund (KSK).
If you are travelling to Germany for a holiday, a business trip, or another type of short-term visit which lasts less than 181 days, then you should get travel insurance for Germany.
German Health Insurance for Foreigners
Foreigners who are living and earning an income in Germany have to obtain health insurance in one of the following ways:
- Public health insurance. Public health insurance is obligatory for most people in Germany, except for those that exceed the annual income threshold and have the option to choose to join either the public insurance scheme or buy private insurance.
- Private health insurance. Private health insurance mostly plays a supplementary or complementary role in Germany. However, those who can choose between private and public plans can make private insurers their main health insurance providers.
- A combination of both. Those who have the option to choose between public or private insurance can also do a combination of the two. For example, individuals who have a high income can remain insured by the public scheme and also purchase private insurance to supplement the areas that are not covered by public insurance.
Public Health Insurance in Germany for Expats
Public health insurance in Germany (Gesetzliche Krankenversicherung-GKV) is mostly funded by social contributions. All expats who are employed are automatically insured by the public health system. You’ll notice a small portion of your salary is deducted for tax purposes which goes towards your social contributions. Your employer also pays for half of your contributions. In turn, you are included in the public healthcare scheme and are eligible for medical services when you need them— your insurance will cover your medical expenses.
To get enrolled in the German public health insurance system you need to choose between the public health insurance companies. Feather Insurance will guide you through comparing and choosing between public insurance companies in Germany.
Self-employed people who can opt-out of the public health scheme are not automatically included in the plan since their employer does not pay contributions on their behalf. However, if they want to benefit from the public scheme, they have to apply to register with the GKV.
For both cases, once registration has been completed, you receive a health insurance card (Krankenversichertenkarte). You need to bring this card whenever you visit a doctor in Germany since it shows that you are entitled to public health insurance.
What Does Public Health Insurance Cover in Germany?
Public health insurance covers most of the medical services, which include doctor’s visits with a GP, out-patient and in-patient costs, surgeries, maternity and basic dental needs. There are some medical services that are not covered by the GKV, in which case you have to pay for the services by yourself or opt for additional insurance.
Is Healthcare Free in Germany?
Health care costs are covered by the public insurance system, which is funded by taxes or social contributions. So, while a part of your wages every month goes towards this payment when you need to visit a doctor or hospital, you won’t be charged for the services with the exception of a €10 fee for the first doctor visit once a quarter and hospital stay fees.
Does Germany Have Universal Healthcare?
Healthcare in Germany is universal, and everyone is entitled to healthcare regardless of their employment or social status.
Private Health Insurance for Expats in Germany
Private health insurance (Private Krankenversicherung – PKV) in Germany covers around 10% of the population, and it’s available to you if:
- You make more than €69,300 per year (as of 2024)
- You are self-employed or a freelancer
- You are a civil servant.
- You are an international student.
Click here to see whether you qualify for private health insurance in Germany.
But, you have to remember that if you opt for private insurance instead of the public insurance scheme, you have to let your employer know beforehand so you don’t get registered with the GKV. You also have to keep in mind that, unlike the public health plan, the premium for private insurance is not only dependent on salary but also on your age, your medical condition, your occupation, and the level of coverage you want.
When you register with a private insurance company in Germany, you receive a private health card (Card für Privatversicherte). Unlike the Krankenversichertenkarte, you don’t need to bring your private health insurance card with you to medical appointments, but it expedites the process of reimbursement and insurance claims.
Health Insurance in Germany by Purpose of Stay
Depending on the reason for your stay in Germany and your employment status, there are several ways how you can benefit from the healthcare system in Germany:
- Foreign students — can choose between enrolling in the statutory health insurance plan or private health insurance; both options come with discounted rates for students.
- Self-employed/freelancers — are able to enrol with the GKV or opt for private coverage instead.
- Retired expats — retired expats who are not working in Germany, can voluntarily register with the public health scheme or purchase private insurance.
>> Read more about Health Insurance for International Students in Germany
Germany Health Insurance for Self-Employed/Freelancer Expats
Self-employed expats in Germany can voluntarily take out statutory health insurance or purchase private health insurance in Germany. As a self-employed individual, since you’re not under a German employer, you have to make sure you pay the required social contributions to be eligible for the public health insurance scheme in Germany. The cost of health insurance, in this case, largely depends on your income. The minimum amount required is somewhere between 160€ to 190€ per month.
On the other hand, if you opt for private health insurance, the price is affected by several other factors, such as your age, the provider you choose, what kind of insurance policy you want, etc. With private health insurance, you’ll have the advantage of customizing your plan according to your medical needs, and if you opt for an international plan, you get coverage in other countries as well. Click here to see whether you qualify for private health insurance in Germany.
Both of these options come with their advantages and disadvantages, and there are several factors that come into play, such as the duration of your stay in Germany.
Germany Health Insurance for Foreign Retirees
If you work for over five years in Germany, you’re eligible for the German state pension, which allows you to benefit from the public healthcare insurance scheme. However, if you haven’t lived or worked in Germany but you simply want to move there to spend your golden years, you have to go through a complicated process.
Firstly, to retire in Germany, you need to have a residence permit — getting a residence permit in Germany without the purpose of work can be quite difficult. But, if you do manage to get a residence permit, you can then look into health insurance options. Just like self-employed individuals, you can also voluntarily sign up for the public healthcare scheme for which you have to pay the contributions on your own. Additionally, you can opt for only private coverage— though you have to keep in mind that the older you are, the more costly your insurance can be.
You can find health insurance for retired expats in Germany at Feather Insurance.
Do EU Expats Need Health Insurance in Germany?
If you’re an EU citizen who will be staying in Germany temporarily, you can be covered by your country’s health insurance scheme. Of course, when you need treatment, you must present your European Health Insurance Card, so make sure you retrieve that before entering the country.
However, if you’re planning on working and living long-term in Germany, then you need to enrol with the statutory health insurance plan.
How Much Does Expat Insurance Cost in Germany?
Expat insurance prices change depending on which path you go, i.e., public or private insurance. For example, if you are included in the statutory health insurance scheme, then the social contributions rate is set at 14.6%, half of which is paid by your employer.
Whereas, for private insurance, the price varies on several factors. For example, a basic coverage plan for a 30-year-old healthy individual can go between €200-€300 per month. The price increases with the age of the policyholder and with pre-existing conditions.
Can I Live in Germany Without Insurance?
No, every single resident in Germany is legally required to have health insurance. If you stay in the country without proper health insurance, you will face penalties, and you may be required to pay back payments to cover your entire stay in Germany.
Health Insurance Companies in Germany
Depending on whether you qualify for public or private insurance in Germany, you have a variety of options when it comes to health insurance providers:
Public health insurance funds
- TK – Techniker Krankenkasse
- DAK
- Barmer
- AOK Baden Württemberg
- KKH – Kaufmännische Krankenkasse
Private insurance companies
- Allianz
- DR-WALTER
- Mawista
- AXA
- DKV
- HanseMerkur
What to Do in Case of Emergency in Germany?
If you have a medical emergency while in Germany, first try to remain calm and remember that no matter what your health insurance status, you are still eligible for treatment. Secondly, keep in mind the following emergency numbers and have them ready on speed dial in case you might need them:
- Ambulance services and fire brigade: 112
- Police: 110
- Emergency doctor: 19 242