Germany’s healthcare system is renowned for its high standards of care. Although premium and accessible, it can also be unexpectedly expensive, and a lot of expats and internationals often underestimate just how much is deducted from their monthly paycheck in social security costs. 

If you’re planning a move to Germany or have recently relocated, navigating its health insurance landscape can be daunting and a little complex, especially if you’re still learning the language. This guide simplifies the essentials of German health insurance, helping you make informed decisions and avoid unexpected costs or coverage gaps. Let’s go! 

Is it mandatory to get health insurance in Germany as a Foreigner?

In Germany, health insurance is mandatory for all residents, including foreigners. If you don’t secure health insurance upon arrival it can lead to visa complications, back charges to insurance providers, and even salary issues from your employer – you won’t be able to receive your first paycheck without it! 

German law also doesn’t recognize international expat health insurance plans, travel health insurance plans, or any plans that don’t include the obligatory long-term nurse care insurance (Pflegepflichtversicherung) for those looking to stay longer than a couple of months. So be sure to purchase comprehensive health insurance with Pflegepflichtversicherung from a German health insurance provider.

The German Health Insurance System Explained

Germany’s health insurance system comprises two main types: Public Health Insurance (Gesetzliche Krankenversicherung or GKV) and Private Health Insurance (Private Krankenversicherung or PKV).

Choosing between public and private health insurance should be a carefully considered decision. The system that is the best fit for you will depend on factors such as:

• Your income and current employment status
• Your age and health at application (your medical history and the presence of any pre-existing conditions ranging from mild to severe may impact private health insurance eligibility and costs)
• Number of dependents 
• Your intended duration of stay in Germany
• Whether you have held statutory insurance in Europe previously

TIP: Consulting a neutral health insurance broker and advisor can help you navigate these options if you’re unsure which system makes the most sense for you and your unique circumstances. Brokers in Germany offer a free service – they provide quotes from different insurers so you can shop around and offer expert advice to help you choose the best plan without any obligation to purchase. So even if you decide not to buy any insurance from a broker, there’s nothing to lose as they are a great resource to help you research and get a second opinion on your health insurance!

What are the key differences between public and private health insurance?

Here’s an easy-to-understand explanation of both ⬇️

Public Health Insurance (GKV)

Who is eligible: Employees earning below the government-set income threshold (currently €69,300 in 2024*) must join the statutory health insurance system upon starting work in Germany. Those previously insured in Europe without a gap in their insurance and can prove this with an E104 membership certificate can apply for voluntary membership if this is done within 3 months of entering Germany. The form for the certificate can be downloaded here.

Coverage offered: GKV offers comprehensive coverage for essential services, including doctor visits, hospital stays, prescription drugs, preventive care, and maternity care. Care is standardized, meaning everyone receives the same benefits and plans cannot be tailored to suit individual preferences regardless of how much they pay in premiums.

Monthly premiums: Employers and employees share the contribution costs, each paying approximately half. Self-employed and unemployed individuals pay their full contributions. Contributions are income-based, with a cap on the highest possible monthly contribution, currently around €1,040 in 2024* for high earners.

Advantages:

• Cost-effective for families since each dependent can be covered under the same plan
• Accepts all individuals without an upfront medical assessment which means those with pre-existing health conditions are welcomed

Disadvantages:

• Expensive for high-earners since contribution is calculated based on salary
• Limited customization of coverage without adding private supplementary insurance which increases the monthly cost even more

Private Health Insurance (PKV)

Who is eligible: Employees with incomes above €69,300 gross (as of the 2024 threshold*) or self-employed individuals can opt for private health insurance. Eligibility also depends on whether pre-existing conditions are accepted by the provider. 

Coverage offered: PKV offers more customizable plans, with additional benefits like faster appointments, specialist access, and private hospital rooms. You pay only for the benefits you choose.

Monthly premiums: Premiums are based on age, health status, and selected coverage options at the start of the contract and do not increase with age or illness due to the “aging reserves” built into the system. Prices will only increase along with inflation and medical progress, equally occurring in the statutory public system.  Premiums will increase with any dependents that need to be added to the coverage. Contributions are also subsidized by 50% for employees by an employer.

Advantages:

• Cost-effective for high earners without dependents
• Customizable benefits
• Attractive for those who want superior medical care and additional perks

Disadvantages:

• Higher costs for families with multiple dependents since each family member must be insured separately 
• Additional surcharges for pre-existing health conditions or ineligibility 

How to Apply for Health Insurance in Germany

1. Explore Options: Research and compare public and private insurance providers. Utilizing platforms like Quickity and free broker services such as KLforExpats can simplify this process. It should be noted that there is no need to limit yourself to English-speaking providers if you do not speak German when you work with an independent broker who offers service and follow-up support in English and empowers and educates you on how to navigate all your health insurance concerns.
2. Gather Documentation: Prepare necessary documents such as your passport, residence permit, prior insurance proof, employment contract, and medical reports.
3. Apply: Submit applications directly to insurers or with the help of a health insurance broker.
4. Register: Once approved, register with your provider’s app or online portal to activate your insurance and receive your health insurance card by mail.

Common Health Insurance Pitfalls to Avoid in Germany

• Relying on inadequate insurance: Travel insurance or cheap international expat plans do not meet German legal requirements for permanent residents. Ensure your insurance is provided by a German insurance provider and covers essential services like doctor visits and hospital stays to avoid future visa issues.Tip: if your insurance is less than €200 as an employee, you have likely purchased a plan that is not categorized as comprehensive health insurance and likely not recognized by German law. 
• Procrastination: Delaying health insurance enrollment can lead to complications. You may face difficulties joining the public system if you wait more than three months after arrival leaving you left with no coverage during your stay if you are not eligible for private health insurance, or you may incur hefty back payments for the entirety of the months you missed.

Navigating Germany’s health insurance system requires careful planning and understanding. By meeting mandatory insurance requirements, applying for suitable coverage, and avoiding common pitfalls, you can enjoy peace of mind and a smooth start in Germany.

Need more support? Have more questions?

For hassle-free health insurance upon your arrival in Germany, consider contacting our partner health insurance expert, Mirja Lundehn from KLforExpats. KLforExpats is an experienced, English-speaking German health insurance brokerage with over 25 years of experience. The team offers free, bespoke advice that helps you weigh the pros and cons of public and private health insurance and help you find the right insurance provider for your needs. Working with a health insurance broker in Germany is free so don’t hesitate to get in touch so that you have one less thing to worry about when it comes to your move!

PS: If you’re looking into other types of insurance too, we have a guide for that as well – Na, Klar! 😉

*Numbers and stats always subject to change (increasing/decreasing every year)