German healthcare

A guide to German health insurance

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Health insurance in Germany is mandatory, and conditions apply whether residents must choose state German health insurance or private health insurance. Find health insurance companies in Germany and costs involved.

The German healthcare system is one of the best healthcare systems in Europe, and all foreigners living and working in Germany are eligible to access subsidised German healthcare services. However, to access German healthcare it is mandatory for all residents to have some form of health insurance in Germany.

By law, all official residents need to be insured for hospital and outpatient medical treatment through state or private health insurance in Germany. It is also mandatory to show proof of health insurance to apply for a German visa or residence permit, so visitors to Germany also typically need to be covered.

Once you are a resident in Germany, it is compulsory to register with either a statutory German health insurance scheme (gesetzliche Krankenkasse, GVK) or a private insurance scheme (private Krankenversicherung, PVK); which insurance you are eligible to claim is largely dependent on your employment situation, explained below. Some exemptions can apply, for example, health insurance for students in Germany.

This guide explains which German health insurance you must apply for to access healthcare in Germany and how to compare German health insurance policies:

Health insurance in Germany for foreign visitors

Citizens from the EU (Europe Union), EEA (European Economic Area – EU plus Iceland, Liechtenstein, and Norway) or Switzerland are allowed healthcare on the same basis as German nationals if they are travelling to Germany or are temporary visitors. To be eligible for state healthcare, you’ll need to get an EHIC (European Health Insurance Card), typically before you arrive. However, residents planning to stay longer than a year or those working in Germany should arrange either German health insurance or join a private insurer.

Temporary visitors from outside the EU member area may also be able to claim state healthcare under reciprocal agreements with their home country, otherwise will have to pay for healthcare services or take out travel insurance in Germany. Your local government or the German consulate in your home country can advise you. You can also find explanations of required insurance in Germany.

German insurance companies

Who must apply for German health insurance?

Around 90 percent of residents are covered by the German state healthcare scheme. Both EU and non-EU nationals working in Germany will also typically be subject to compulsory state German health insurance (known as statutory sickness insurance, or gesetzliche Krankenversicherung, GKV) if they are:

  • in paid employment or in vocational training, including trainees and apprentices, and earn less than €57,600 per year (2017 figures);
  • pensioners who have been insured for a sufficient period of time;
  • receiving unemployment benefits or assistance;
  • in some form of youth assistance (Jugendhilfe);
  • students in an approved higher education institution;
  • farmers or assisting family members;
  • artists, writers and those in publishing professions (under the Artists Social Welfare Act);
  • have no other access to healthcare services (under certain conditions).

Spouses, civil partners and children (up to age 23, or 25 if studying) of someone covered by state healthcare insurance are eligible for family co-insurance in certain conditions, without having to pay contributions, provided their income does not exceed €415–450 each month, depending on the situation (casual or regular, respectively).

The vast majority of German workers remain on the state German health insurance system, but it is possible to take out more extensive private health insurance in some circumstances. German health insurance contributions are split between employers and employees, regardless of whether you use a private or public scheme.

Whether you are eligible to switch from a state to private health insurance fund is largely dependant on your employment status. If you earn less than €57,600 per year (or around €4,800 per month), it is compulsory for you to stay on the statutory system.

However, you are granted the option to choose either state or private insurance if you:

  • are self-employed
  • are a civil servant
  • earn above the salary threshold
  • have no basis to join a state insurance scheme
  • are a student who renounces their state insurance.

Private health insurance in Germany typically offers more extensive services and quicker waiting times, plus you can have a better chance of finding English-speaking providers. In some cases, it can work out about the same cost as state healthcare. However, unlike the state health insurance, German private insurance does not typically cover children and partners for free.

However, it is not always advised to switch to a private fund, as premiums are based on personal factors and prices increase with age, health risks and added family members. If you are young with few health issues and have sufficient income to pay the premiums, then switching to private insurance can be a viable option.

If you have serious health issues and have trouble being accepted into a private scheme in Germany, you can opt for a ‘Basistarif’, which obliges insurers to accept all cases under the same conditions as the government system.

If you move to Germany to live and work, you’ll need to register with a German health insurance fund before you can use the state healthcare system. If you have a salaried job, your employer will usually register you automatically with a German health insurance company, although you are free to choose your own. Membership typically runs for 18 months; you can typically change health insurance company in Germany by giving two months' notice before the 18-month expiry date, or whenever a supplemental increase has been announced or increased (typically reviewed annually).

List of German health insurance companies

Some of the largest health insurance companies in Germany include:

You can compare private health insurance providers in Germany and get free quotes on our special Expatica health insurance page, and with the following tools, GKV, PVK (in German). 

See Expatica's listing of health insurance companies in Germany, and our guide for more information on other mandatory German insurance and German insurance companies.

Health insurance in Germany

Health insurance costs in Germany

Payment for the German healthcare system is covered by German social security, while around 120 insurers are responsible for administering state healthcare access. In January 2015, the state healthcare contribution was reduced from 15.5% to 14.6% of net income, which was continued in 2017. Generally, you’ll pay around half of this amount (around 7.3% up to a maximum monthly income of €4,350) which is automatically deducted from your salary. You employer covers the remaining fee, at a cap of 7.3%.

In addition, state German health insurers charge an additional ‘contribution rate’, which can fluctuate year-to-year depending on healthcare expenditure. The contribution rate varies between insurers (from around 0.3–1.%) and is only payable by the employee based on a percentage of their income. Your insurance fund is required to send notification of any changes to their contribution charges, in case you want to find a cheaper alternative.

You need to stay with a German health insurance company for at least 18 months, after which you can switch health providers at any time with two months’ notice. While some insurers have millions of members and others only have a few thousand, their service is unlikely to differ greatly, as each insurer must meet the government’s minimum regulations for healthcare. The additional contribution rate, however, is one factor to consider when choosing a German health insurance company.

The German health insurance system, however, has come under pressure in recent years to cut healthcare costs, and co-payments have been increasing for certain medical treatments and medicines and are likely to increase in future. Now in some areas such as dental, orthodontic treatment and glasses, state health insurance only covers a small portion of the cost.

Away from the more specialist areas, state healthcare policies cover most types of medical treatment, including GP visits, hospital care (inpatient and outpatient), medical treatment, x-rays, sick leave, mental health care, rehabilitation, prescription drugs and giving birth in Germany. In some cases you may be subject to a co-payment (Zusatzzahlungen) towards the costs of treatment and prescription drugs.

For each quarter of the year you seek medical help, you’ll need to pay a one-off charge of €10. If you don’t require medical assistance, you won’t have to pay this charge, while if you require assistance several times in a three-month period, you only have to pay it once.

In some instances, it’s possible to purchase add-ons from private insurers – supplementary insurance (Zusatzversicherung) – to top up your state coverage for better hospital choice and treatment, more extensive dental coverage, no co-payment for prescription charges, no quarterly fee, treatment abroad and repatriation costs. 

German health insurance companies

Usually, your employer will take care of registering you with a regional German health insurance company. However, you are free to choose the insurer of your choice, and can do so by informing your employer within two weeks of starting work. If you’re self-employed you’ll need to arrange your own registration with a German health insurer. It’s usually a fairly straightforward process taking your passport and residence permit to a regional office and filling out the forms.

There are many German health insurance companies, with the most common being Aetna, AOK, AllianzAXA, Techniker Krankenkasse, Barmer GEK, BKK, DAK Gesundheit and KKH, as well as international health insurers. Factors that might influence your decision are the insurer’s contribution rate, additional services they provide, ease of contact or, in some cases, you might find a provider with English-language information.

Once you’ve become a member, your health insurer will issue you a card (Krankenversichertenkarte), which you’ll need to show each time you visit a doctor or specialist. GKV Central Organisation maintains an updated list of all state German insurance companies, where you can compare German health insurance rates.

Health insurance cost in Germany

Private health insurance in Germany

Around one-in-10 residents opt for private health insurance in Germany. Some 40 companies oversee the private medical insurance market and there are lots of packages and combinations available to suit different budgets.

While contributions to state health insurance are based on your income, private health insurance contributions are based on your risk profile, which includes your age and medical history.

If you choose to take the private route, you’ll typically pay doctor’s fees upfront and then ask for reimbursement from your private insurance company. Unlike state healthcare services, it’s important to remember there is the prospect of being out-of-pocket for a while after any treatment, although you’ll typically get a full reimbursement unlike in state healthcare where you normally pay part of the medical costs.

In general, private health insurance in Germany offers more extensive cover. In addition to the prospect of more specialist treatments and better accommodation, you’ll also have access to some doctors who restrict their practices to private patients, resulting in shorter waiting times, and you won’t need to pay any additional co-payments for medicine. It’s also much easier to find a doctor who speaks your native language if you’re a member of a private health insurer in Germany.

Typically, you can choose the level of your excess or deduction fee, where you opt to pay up to a certain amount each year for your treatments. This is called a Selbstbehalt, and choosing a higher excess for private health insurance in Germany is one way to reduce your lower monthly contributions. There is also no obligation to stay with a company for 18-months, although the insurance company may have conditions. Find a list of private German health insurance companies here.

Health insurance for students in Germany

If you’re studying in Germany at a state-approved university or education institution, you’ll need to pay a premium for health and nursing care, which currently stands at around €80 per month if you’re over 25 and don’t have any children; until age 25, children in education can be covered for free under their family’s health insurance.

After you turn 30 or complete your 14th semester, the premiums increase by around €50 per month. International students who are not covered by their country’s healthcare system and can’t join the state system (such as overseas graduate students) can access health insurance from around €25–30 per month.

Students will first be assigned to the compulsory state German health insurance but can opt for private insurance if they request an exemption within three months of enrolment. Whichever system the student chooses, it is binding for the entire period of study.

Travel insurance in Germany

Vistors coming to Germany are typically mandated to show proof of health or travel insurance in Germany before being granted a visa. It is possible to purchase Schengen travel insurance to cover you anywhere within the Schengen zone, with many companies offering online registration and prices around €20 or less per month.

For residents in Germany, your Krankenkasse (health insurance plan) will not typically cover you in non-EU countries or for travel-related issues, such as flight cancellations or lost luggage. For travel health insurance inside the EU, residents who pay Krankenkasse can claim an European Health Insurance Card (EHIC), which allows you to access state healthcare services on the same basis as local residents in any EU member state.

It is possible to take out short-term travel insurance in Germany, otherwise an annual travel insurance policy (Reiseversicherung) offers coverage without needing to purchase a new policy each trip. There are generally no limitations on how often you can travel but you may need to check the permitted maximum trip duration, which varies from around 30–45 days depending on the company and package.

Travel insurance in Germany covers the usual benefits, such as travel cancellation insurance, trip curtailment insurance, travel health insurance, and luggage insurance.

Dental insurance in Germany

If you have state German health insurance, simple routine dental procedures (filling, dental hygiene) or dental emergencies are more likely to be covered, although recent pressure on the healthcare system has seen increases in co-payment amounts. Major dental work (crowns, dentures) are more likely to be only partially covered by the state. Privately insured residents should check their plan to see what dental treatments are included.

Otherwise, dental insurance in Germany can be taken out as a supplement to your health insurance plan, or as a stand-alone insurance. Dental insurance in Germany is typically low-cost, at around €10–20 per month, although better coverage or lower co-payments will incur higher premiums.

You can ask your dentist for a detailed overview or quote (Heil- und Kostenplan) before agreeing to any treatment, as well as what will be covered by your dental insurance in Germany.

Sick leave in Germany

State health insurance includes sickness benefit, with your employer paying your wages and salary for up to six weeks if you’re unable to work, and your health insurer paying 70% of your regular salary for a maximum of 78 weeks (over a three-year period) thereafter.

Statutory sick pay (Krankengeld) is paid up to the value of €3,045 per month (around €2,670 after tax), so if you earn more than that you might consider purchasing additional sick pay insurance.

Nursing costs

In addition to the 14.6% premiums paid for state healthcare, you must also become a member of the government’s nursing care scheme (Pflegeplichtversicherung), which covers the costs of meeting any necessary nursing needs (eg. bathing or feeding if disabled). After a major reform implemented in 2017, costs are from 2.55–2.8% of your gross salary (up to a maximum of around €121 month, with no children), of which your employer pays around €55.

German health insurance information

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1 Comment To This Article

  • Sigel posted:

    on 28th June 2017, 12:28:13 - Reply

    I am having a huge problem with obtaining new healthcare coverage. Please let me know if you have any advice. I have lived in Germany 5 years and have had travelers insurance, but this has a 5 year limit. I cannot switch to public insurance since I am over 54. For private insurance, I am 71 and have a new hip and prosthesis. Most companies will not cover me; those who will have yearly deductibles higher than the E300 limit the Ausl%uFFFDnderbeh%uFFFDrde will accept. This leaves the Basistarif. I applied to Allianz, and they denied me, stating I need a residence permit good for more than 12 months first. This of course creates a Teufelskrise. Other companies have given me the same denial. All private insurance companies are required to provide the Basistarif, plus Germany guarantees coverage to all residents. But I am being denied coverage. What can I do?

    [Moderator's note: You can also post questions on our Ask the Expert free service.]