Health Insurance in Germany for Expats: Complete Guide
Health insurance in Germany is mandatory by law from the moment you arrive—whether you’re an employee, student, freelancer, or dependent. Without valid health coverage, you can’t enroll at a university, get a residence permit, or start a job.
Germany operates a dual public-private system: most residents are covered by public insurance (GKV), while certain groups like high-earning employees, freelancers, and students under 30 may qualify for private insurance (PKV). Choosing the right provider depends on your visa type, income, family situation, and long-term plans.
This complete guide explains everything expats need to know—how to register, compare costs, understand legal requirements, and avoid costly mistakes.
What Foreigners Must Know About Health Insurance in Germany
Germany has a dual public-private healthcare system. Whether you’re an employee, student, freelancer, or dependent, you’re required by law to have valid health insurance from day one. This applies to:
- EU and non-EU citizens
- Temporary residents
- Students, researchers, and interns
- Spouses and children of insured individuals
Without health insurance, you cannot enroll at a university, sign a job contract, or renew your visa.
Types of Health Insurance in Germany
Public Health Insurance (Gesetzliche Krankenversicherung or GKV)
The public health insurance system covers around 90% of Germany’s population. Contributions are income-based and regulated by law. The government sets minimum service levels, and all public providers must offer them.
Key public providers include:
- TK (Techniker Krankenkasse)
- AOK
- Barmer
- DAK
- HEK
What’s covered:
- Doctor visits and hospital care
- Prescription medications
- Preventive checkups
- Maternity care
- Dental checkups (basic)
- Vaccinations
Private Health Insurance (Private Krankenversicherung or PKV)
Private insurance is available to certain groups:
- Employees earning over €69,300/year (2025 threshold)
- Freelancers and self-employed individuals
- Students under 30
- Civil servants
Private insurance often offers:
- Faster appointments
- Private hospital rooms
- More English-speaking doctors
- Better dental and vision coverage
Providers include:
- Allianz
- Ottonova (digital and expat-focused)
- AXA
- Debeka
Public vs. Private Health Insurance: Key Differences
| Feature | Public Insurance (GKV) | Private Insurance (PKV) |
|---|---|---|
| Eligibility | All residents | Only select groups |
| Costs | % of salary (14.6%–15.6%) | Based on age, health, coverage |
| Dependents | Free for family (non-earning) | Each member pays individually |
| Access | Standard | Faster, more flexibility |
| Switching | Easy to join | Difficult to rejoin public once private |
| English Support | Varies | Often better with private plans |
Disadvantages of Public and Private Health Insurance in Germany
When choosing between public and private health insurance in Germany, it’s essential for expats to understand the limitations of both systems. While both offer access to excellent care, each comes with specific drawbacks that can affect long-term affordability and coverage flexibility.
Disadvantages of Public Health Insurance in Germany
One major disadvantage of public health insurance (GKV) is that contributions are based on income. The more you earn, the more you pay—up to the statutory cap. This makes it less appealing for high earners and freelancers, who must cover the full monthly amount without employer support.
Another issue is longer wait times for specialist appointmentsand limited access to private clinics, which may prioritize privately insured patients. Although non-working spouses and children are included at no extra cost, single individuals often feel they are paying more without additional benefits. For freelancers and students over 30, public insurance can also become costly.
Disadvantages of Private Health Insurance in Germany
Private health insurance (PKV) is attractive for its premium services and fast-track appointments, but expats should consider its long-term risks. Premiums increase with age and are based on personal health history, making it potentially unaffordable in the future.
Each family member must be insured separately, significantly raising costs for couples or families. Once you leave the public system, returning is extremely difficult unless your income drops or you re-enter full-time education. Some private plans also require add-ons for dental or vision coverage, and not all services are reimbursed automatically.
For expats in Germany, choosing the right health insurance means weighing short-term advantages against long-term stability and financial predictability.
How Much Does Health Insurance Cost in Germany?
Public Health Insurance Costs
Public insurance costs are salary-based, and contributions are split between employer and employee:
- Standard rate: 14.6% of gross salary
- Average additional contribution (Zusatzbeitrag): ~1.6%
- Nursing care insurance (Pflegeversicherung): 3.05%–3.3%
For most full-time employees:
- Monthly total (employee side): €300–€450
- Cap limit (2025): Salaries above €5,175/month are not charged extra
Student Public Insurance Costs
- Flat rate: €122.77 to €126.02/month (aged under 30 or first 14 semesters)
Students aged 30+ must choose private insurance or voluntary public insurance, which is much higher.
Private Insurance Costs
Private premiums are based on:
- Age
- Health history
- Selected coverage level
- Optional add-ons (e.g. dental, hospitalization)
Average monthly premium:
- Young professionals: €300–€500
- Freelancers over 40: €500–€800
- Students under 30: From €35/month (basic plan)
Health Insurance for Students in Germany
Foreign students must have valid health insurance before enrolling. Options depend on age and origin:
EU/EEA Students
- European Health Insurance Card (EHIC) may suffice
- Optional to switch to German public insurance
Non-EU Students
- Must choose between public and private
- Under 30: public student plan (~€125/month)
- Over 30: private insurance only
Tip: Choose providers that offer English support and guarantee a certificate for university enrollment.
Health Insurance for Employees in Germany
Once hired full-time, your employer automatically registers you with a public insurer unless you choose a private one (if eligible).
Registration Process
- Choose a provider (e.g. TK, AOK)
- Employer submits your details
- Coverage begins on your start date
Employer covers 50% of monthly contributions.
Employees earning above €69,300/year (2025) may opt out of GKV and switch to private—but this decision has long-term implications and is often irreversible.
Health Insurance for Freelancers and Self-Employed Expats
Freelancers are responsible for their own insurance. You can choose between public (voluntary) or private plans.
Public Option:
- Submit proof of income to calculate rate
- Contribution can exceed €800/month for high earners
Private Option:
- More affordable for young freelancers with no preexisting conditions
- Faster service, more personalized plans
Künstlersozialkasse (KSK): If you’re a freelancer in a creative field, KSK may subsidize half of your public or private insurance.
Health Insurance for Families and Dependents
Public System:
- Covers spouses and children for free if:
- They earn less than €485/month (minijob)
- They reside in Germany with you
Private System:
- Each family member must be insured separately
- Total cost increases with more dependents
Recommendation: For families with one breadwinner, public insurance is often more cost-effective.
How to Choose a Health Insurance Provider in Germany
Factors to Consider:
- Do you qualify for private insurance?
- Do you need English-speaking support?
- Are you covering dependents?
- Do you plan to stay in Germany long-term?
Key Tips:
- TK is popular among expats for its balance of service and affordability.
- Ottonova is a fully digital private insurer with English-speaking service.
- Compare benefits like dental, mental health, and international coverage.
- Use comparison platforms like Check24 or consult an independent advisor.
How to Register for Health Insurance in Germany
- Choose a provider (TK, AOK, Allianz, etc.)
- Submit application (online or via form)
- Receive insurance certificate (Versicherungsnachweis)
- Provide certificate to employer or university
- Receive electronic health card (eGK)
Your eGK (health insurance card) will be needed at every doctor visit or hospital appointment.
Health Insurance During the Visa Process
When applying for a visa or residence permit in Germany, health insurance is mandatory. Without valid coverage, your application will be rejected.
Accepted Insurance Types:
- For long-term visas: only certified public or private German insurance
- Travel insurance is not valid for long stays
Important: If you use private insurance, ensure it meets legal minimum coverage requirements (gesetzlicher Leistungsumfang).
Common Problems Expats Face with Health Insurance
1. Language Barriers
Most documents and doctor interactions are in German. Choose a provider with English customer service.
2. Unexpected Costs
Not all services are covered (e.g. cosmetic dental work). Always ask your provider before booking treatments.
3. Switching from Private to Public
It’s nearly impossible unless:
- You become a salaried employee earning under the threshold
- You lose your self-employed status
- You return to student status under age 30
Read our guide to learn how to switch from private to public insurance.
4. Overpaying as a Freelancer
Voluntary public insurance is expensive without subsidies. Consider KSK or well-reviewed private plans instead.
Useful Add-Ons and Special Coverage
Consider adding supplemental policies for:
- Dental insurance (Zahnzusatzversicherung): Covers crowns, implants, and professional cleanings
- Vision insurance: Covers glasses and lenses
- Travel health insurance: For short trips abroad
- Hospital coverage: Private room, chief physician treatment
Public insurance may cover only basic levels for these areas.
Emergency Medical Services in Germany
In case of emergency:
- Dial 112 for ambulance and medical help
- Carry your health card at all times
- Most emergencies are fully covered by both public and private plans
Can You Use Foreign Health Insurance in Germany?
Only in specific cases:
- EU citizens with EHIC for short stays
- Private travel insurance accepted for tourist visas (up to 90 days)
For long-term stays or residence permits, foreign insurance is usually not accepted. You must register with a certified German provider.
How Expats Should Approach Health Insurance in Germany
Health insurance in Germany is not just a formality—it’s a foundational part of legal residency, job contracts, and access to care. While the system can feel bureaucratic and overly complex at first, it provides one of the most secure healthcare environments in the world.
For expats, the key is to choose a plan that fits your status, budget, and long-term goals:
- Employees: public insurance is usually the most stable and affordable
- Freelancers: weigh KSK or private options carefully
- Students: go for public student plans under 30
- Families: public GKV is more cost-effective for multiple dependents
Take the time to compare providers, understand your eligibility, and plan ahead—because in Germany, health insurance is not optional, it’s essential.
