Health Insurance for Expats in Germany

Overview

Germany has one of the world's most comprehensive healthcare systems—and one of the most complex. Unlike many countries where insurance is optional, Germany legally requires all residents to have health coverage.

The German system offers a choice between public statutory insurance (Gesetzliche Krankenversicherung/GKV) and private insurance (Private Krankenversicherung/PKV). Your eligibility depends on your employment status, income level, and visa type. Understanding this choice is crucial because switching between systems later can be difficult or impossible.

German Healthcare System

Germany's healthcare system is known for excellent quality, minimal wait times, and comprehensive coverage. The system operates on the principle of solidarity—everyone contributes based on their means.

How German Healthcare Works

The system is built on two parallel tracks:

• GKV (Gesetzliche Krankenversicherung): Public statutory insurance covering ~90% of the population
• PKV (Private Krankenversicherung): Private insurance for those who qualify

Key Features

• Krankenversicherungskarte: Insurance card for accessing care
• Hausarzt: Your general practitioner (not mandatory but recommended)
• Krankenkasse: Health insurance fund (for GKV)
• Free choice of doctors: No referral needed for specialists

Healthcare Quality

Germany offers world-class healthcare with modern facilities throughout the country. Wait times for specialists are generally short compared to other European systems. English-speaking doctors are common in major cities like Berlin, Munich, Frankfurt, and Hamburg.

Public vs Private Insurance

This is one of the most important decisions expats face in Germany. The choice affects your costs, coverage, and flexibility for years to come.

Public Insurance (GKV)

Public insurance is mandatory for employees earning below the threshold (€69,300/year in 2024). Key characteristics:

• Cost: ~14.6% of gross salary (half paid by employer) plus ~1.7% supplementary
• Family: Non-working spouse and children covered free
• Coverage: Standardized benefits set by law
• Providers: TK, AOK, Barmer, DAK, and many others

Private Insurance (PKV)

Available to employees earning above the threshold, self-employed, freelancers, and civil servants:

• Cost: Based on age, health, and chosen coverage (not income)
• Family: Each person needs their own policy
• Coverage: Customizable, often includes private rooms, chief physician
• Warning: Premiums increase significantly with age

Who Should Choose What

• Choose GKV if: You have a family, value stability, plan to stay long-term, or earn variable income
• Choose PKV if: You're young and healthy, high-earning, single, or value premium service
• International insurance: Good for initial period, digital nomads, or those who may relocate

Visa Requirements

Health insurance is mandatory for all German visa applications. Requirements vary by visa type.

EU Blue Card / Work Visa

For skilled workers with job offers:

• Employer typically enrolls you in GKV automatically
• High earners (above threshold) can opt for PKV
• Coverage starts with employment start date
• Initial visa application may need travel insurance proof

Freelancer Visa (Freiberufler)

For self-employed professionals and freelancers:

• Must prove health insurance coverage
• Can choose GKV (voluntary) or PKV
• International insurance may work for visa but need German system long-term
• GKV costs ~€200-220/month minimum for freelancers

Job Seeker Visa

• Travel health insurance required for application
• Must cover entire 6-month visa period
• International plans typically accepted
• Transition to German system once employed

Student Visa

• Public insurance available at reduced rate (~€120/month)
• Under 30: Can use GKV or private
• Over 30: Must use private insurance
• Travel insurance not sufficient for student visa

Family Reunion Visa

• Proof of insurance required
• If spouse is in GKV, dependents often covered free
• Otherwise need separate coverage

Recommended Plans

The right choice depends on your visa type, employment situation, and long-term plans.

For Visa Applications (Initial Period)

• Cigna Global: Meets visa requirements, English support, easy transition
• Allianz Care: Good for those who want flexibility
• IMG Global: Budget-friendly visa compliance

For Employees

• Under threshold: You'll be enrolled in GKV—choose provider (TK and Barmer popular with expats)
• Above threshold: Consider GKV voluntary enrollment for family coverage and stability
• PKV consideration: Only if young, healthy, single, and comfortable with long-term commitment

For Freelancers

• GKV (voluntary): Stable costs, ~€200-220/month minimum
• German PKV: Lower initial costs but increase with age
• International (short-term): Cigna or Allianz for first year while establishing

For Digital Nomads / Short-Term

• SafetyWing: Affordable, designed for nomads (but may not meet all visa requirements)
• Cigna Global: More comprehensive, portable worldwide

Expected Costs

Public Insurance (GKV)

• Employees: ~7.3% of salary (employer pays other half) + ~0.85% supplementary
• Freelancers (voluntary): Full ~14.6% + supplementary = ~€200-220/month minimum
• Students under 30: ~€120/month
• Maximum contribution: Capped at income ceiling (~€58,050 for 2024)

Private German Insurance (PKV)

• Young professional (30): €250-400/month
• Middle-aged (45): €400-600/month
• Senior (60+): €600-1000+/month

PKV costs vary significantly based on chosen coverage, health status, and provider.

International Insurance

• Basic (IMG, SafetyWing): €80-150/month
• Comprehensive (Cigna Gold, BUPA): €200-350/month

Out-of-Pocket Costs (With Insurance)

• Prescription co-pay: €5-10 per medication
• Hospital co-pay: €10/day (max 28 days/year)
• Most other care: Fully covered

Common Questions

What happens if I don't have insurance?

It's illegal. You'll accumulate back-payments, face fines, and have difficulty accessing care. If you've been uninsured, you may owe premiums for the entire uninsured period when you eventually enroll.

Can I use my EHIC/GHIC card in Germany?

EU citizens can use EHIC/GHIC for temporary stays. For residency, you must enroll in the German system. The EHIC is not valid for planned medical treatment or as your primary insurance.

Is international insurance enough for a freelancer visa?

For the initial visa application, often yes. But German authorities increasingly expect freelancers to enroll in GKV or German PKV within their first year. International insurance is a bridge, not a long-term solution.

Can I switch from PKV to GKV?

It's difficult. You must meet specific criteria: become employed under the income threshold, become unemployed, or reduce work hours. After age 55, switching is nearly impossible. This is why the PKV decision should be made carefully.

What about expat insurance like Cigna?

International insurance works well for the initial period and for those who may relocate. For long-term Germany residents, transitioning to the German system (GKV or German PKV) is usually expected and often more appropriate.

Do I need supplementary insurance with GKV?

GKV provides comprehensive coverage. Optional supplements (Zusatzversicherung) can add dental, single hospital rooms, or alternative medicine. Many expats find GKV sufficient without supplements.