Health Insurance in Germany Explained: A Guide for Expats

Germany’s Health Insurance System: What Every Newcomer Needs to Know

If you’re planning to live in Germany — even for a short time — there’s one thing you cannot skip: health insurance.

In fact, in Germany, health insurance isn’t just recommended. It’s mandatory by law. No insurance, no residency, no registration. But don’t worry — while the system can seem overwhelming at first, once you understand the basics, you’ll find that German healthcare is one of the most reliable and respected systems in the world.

This 2025 guide is designed to walk expats, students, and freelancers through the essentials — from costs and providers to public vs private plans.

Why Is Health Insurance Compulsory in Germany?

Unlike many countries where health insurance is optional or employer-based, Germany’s healthcare model ensures that everyone is covered. This has been a legal requirement since 2009, and applies to:

• Employees (part-time and full-time)

• Self-employed professionals

• Students and interns

• Spouses and children (with specific rules)

• Pensioners and long-term residents

If you live in Germany for more than three months, you must have a valid insurance policy that meets German standards — or your visa/residency may be denied.

Public vs Private Health Insurance: What’s the Difference?

Germany has a dual system:

Public Health Insurance (Gesetzliche Krankenversicherung – GKV)

This is the default option for most people. Around 90% of the population is enrolled in the public system.

Key points:

• Contributions are income-based: ~14.6% of your gross salary, split between you and your employer

• Coverage includes doctor visits, hospital stays, medications, dental care, maternity, mental health

• Free for children and spouses (if they have no income — Familienversicherung)

• You can choose from over 100 public providers, including TK (Techniker Krankenkasse), AOK, Barmer, and DAK

✅ Best for: employees earning under €69,300/year, families, students

Private Health Insurance (Private Krankenversicherung – PKV)

Available for:

• Self-employed freelancers

• Civil servants

• High earners (2025 threshold: €69,300/year gross)

• Some students

Key points:

• Premiums are not income-based, but depend on age, health, and coverage level

• Often offers faster access to specialists, private rooms, and higher-end treatment

• Children are not automatically covered — each person must be insured separately

• Switching back to public insurance later can be difficult

✅ Best for: young, healthy professionals or high-income earners looking for premium care.

How Much Does Health Insurance Cost?

Here’s what you can expect to pay in 2025:

Category	Monthly Cost (Est.)
Employee (GKV)	~€350–€450 (split with employer)
Self-employed (GKV)	~€200–€850 (based on income)
Private (PKV)	€300–€800+ (age/coverage dependent)
Students (GKV)	~€120 (fixed rate)

Note: All plans include long-term nursing care insurance (Pflegeversicherung) as a mandatory add-on.

How to Register for Health Insurance in Germany

Step 1: Determine your eligibility.

Are you employed, self-employed, studying? Your status decides which system you can or must join.

Step 2: Choose a provider.

For public insurance, popular choices include TK, AOK, and Barmer. For private, comparison platforms or brokers can help you find the right fit.

Step 3: Submit your documents.

This usually includes your passport, proof of address (Anmeldung), employment contract or university enrollment, and banking details.

Step 4: Receive your health insurance certificate and card.

You’ll get an electronic health card (eGK) that you present at every doctor or pharmacy visit.

Switching Providers: Can You Change Insurers Later?

Yes — but with conditions.

• In public insurance, you can switch after 12 months of membership

• Private insurers usually offer longer contract periods, so switching can be harder

• If you're going from private back to public, it’s usually only allowed under strict rules, such as loss of income or job status

What’s Covered — and What’s Not?

Both public and private plans offer comprehensive healthcare coverage, but there are limits.

Included:

• GP and specialist visits

• Emergency care and hospitalization

• Medications

• Mental health treatment

• Pregnancy and maternity care

• Preventive screenings and vaccinations

Not usually included (without extra coverage):

• Glasses or contact lenses

• High-end dental prosthetics

• Cosmetic surgery

• Alternative treatments (e.g., homeopathy in some public plans)

Healthcare for Children and Families

In public insurance, children under 18 and non-working spouses can be insured for free under family coverage. In private insurance, each family member needs their own policy — which can become costly.

What If You’re Not Insured?

If you’re caught without valid health insurance, you may:

• Face denied residency or visa extensions

• Be required to back-pay all missed premiums

• Be denied non-emergency treatment

Germany does not forgive gaps in coverage, so it’s critical to register immediately after arrival.

Final Thoughts: Health Insurance Isn’t Optional — It’s Protection

Germany’s health insurance system can be a bit complex at first — but once you’re covered, you’ll quickly see why it’s considered one of the best in Europe.

Whether you choose public or private, being insured means access to high-quality, affordable care, with peace of mind that your health is protected — no matter what happens.