Health insurance in Germany for foreign expats

The German healthcare system is considered to be one of the best in Europe. It’s a dual system, with both public and private sectors, and the standard of medical care is excellent at all levels.  

Both public and private healthcare facilities have highly trained doctors and medical professionals; modern and well-equipped hospitals; well-managed emergency care services, and high-quality clinics, support services, pharmacies, and rehabilitation facilities.  

Germany’s high standard of healthcare is also designed to be fair and accessible to all. 

It’s mandatory for anyone living or working in Germany to have some form of health insurance. This can either be the government-regulated public health insurance scheme, the gesetzliche krankenversicherung (GKV)², or private healthcare cover. For German residents, the local private health insurance is called PKV (private Krankenversicherung) but, as an expat, you can opt for global healthcare cover instead if you wish. 

Public health insurance in Germany (GKV) 

The public GKV (Gesetzliche krankenversicherung) scheme is the most common and potentially the most cost-effective option. Around 90% of the German population is covered through this system. You’ll choose from approximately 100 different health insurance companies, or Krankenkasse, each of which offers a standardised level of healthcare cover, as well as optional extra benefits and services.  

The amount you pay is directly linked to your income. This cost is usually split 50/50 with your employer, and they’ll handle all the paperwork for you too. The system is designed to give you access to Germany’s healthcare system for a reasonable price. What makes it even more appealing is that spouses, civil partners and children are also covered under this plan. 

Private health insurance in Germany (PKV) 

You can choose to sign up for Germany’s private health insurance (PKV) if your salary is over a certain threshold. In 2023, the threshold is €66,600, but it’s subject to change. You can also sign up for this private healthcare option if you’re self-employed or over 55 and retired. Germany’s private healthcare cover offers a similar standard of care as the public system, but it provides a wider choice of medical and dental options, shorter waiting times and often a higher level of service. 

While the cost of the public GKV is determined by your salary, the cost of private PKV is based on medical risk. This means you may need to undergo medical examinations before you can enroll, and the amount you pay could be significantly more and is likely to increase as you get older. PKV is also usually taken out on an individual basis and won’t cover your family members.  Another important note is that even after you meet the requirements of the PKV, they are not obligated to accept you. Therefore you do have the possibility of being rejected. 

Global health insurance in Germany 

The third option open to you is to purchase private medical insurance from a global healthcare provider. One of the key benefits of doing this is that it’ll cover you both in Germany and anywhere else in the world; a great option if you travel home regularly or are taking the opportunity to explore other countries. Private global health insurance will usually provide you with comprehensive access to Germany’s private healthcare services, offering you a wide variety of options. You also have the option of using global healthcare coverage to supplement your local GKV cover. 

Be aware, however, that Germany has very strict requirements when it comes to non-German healthcare providers. Certain policies may not be recognised if they don’t adhere to local rules around reimbursement limits or out-of-pocket deductibles. It’s therefore worth speaking to an advisor to ensure the plan you’re taking out will meet German standards and requirements. 

Long-term care insurance in Germany 

In addition to the above options, all German residents are required to have long-term care insurance. This ensures everyone is covered if they ever need ongoing nursing care due to an accident, illness, or old age. It’s a separate scheme, additional to your GKV or PKV arrangements.  

If you have public health insurance (GKV), you can add statutory long-term care insurance (Pflegepflichtversicherung) to your contract. It’s paid for through salary contributions and, if you’re employed in Germany, your employer will cover half. If you have private health insurance, you’ll need to add supplemental long-term care insurance (Pflegezusatzversicherung) to your plan.  

The public insurance scheme includes outpatient care with registered doctors (Kassenärzte). They’re able to provide treatment, write prescriptions, assess your condition, and refer you to a specialist if necessary. The GKV (Gesetzliche krankenversicherung) also covers inpatient care at a hospital, in the general ward, as well as basic dental care. Your spouse, and any dependents that live at your address in Germany, will receive the same level of cover for no additional cost as long as they’re registered with the same Krankenkasse. 

There’s no coverage for appointments or treatment from private healthcare specialists, alternative medical care (such as homeopathy) or for any kind of private hospital room. Routine eye care, with an optometrist or optician, and any additional dental care beyond the very basics are also not covered.  

The process for accessing the German healthcare system will differ based on individual circumstances, such as employment status or nationality. It’s always worth doing plenty of research before you move, but here are a few things to be aware of and keep in mind when moving to Germany: 

As an employee  

If you’re going to be working for a German company, you may find your employer automatically enrolls you with a Krankenkasse and sets you up on the government’s public healthcare scheme. If you want to choose your own private healthcare cover, or if your salary will be over the €66,600 threshold and you’d prefer to be registered onto Germany’s private healthcare scheme, you’ll need to inform your employer as early as you can as it’s not a simple process to switch once registered. 

If you’re on the public Gesetzliche krankenversicherung scheme (GKV), it’s your employer’s responsibility to ensure your health insurance contributions are paid each month. Remember, 50% of the cost will be deducted from your salary and your employer will cover the rest. 

Self-employed 

If you’re a freelancer or self-employed in Germany, you’re free to choose between Germany’s statutory public health insurance or a private health insurance scheme. Either way, you’ll need to register with a provider, and it’ll be your responsibility to fill out the necessary paperwork and make monthly contributions. 

For statutory public health insurance, your contribution is calculated as a percentage of your self-employed income. This is usually between 14.5% and 15.5% of your income, but it varies depending on the provider and there are minimum and maximum assessment limits. If you choose to go for private health insurance, your contributions will be based on your health, age, and medical risk. 

Students 

All German universities require proof that international students have health insurance before they can enroll. If you’re a student under the age of 30, you qualify for public health insurance, but you’ll need to register yourself – the university won’t take care of it for you. In lieu of salary contributions, students usually pay a fixed monthly fee, which varies depending on the provider. 

Students over the age of 30 are no longer eligible for the low-cost student health insurance. Instead, you can choose between voluntary statutory public health insurance, or private health insurance. The cost for voluntary public health insurance is, like GKV, calculated based on income. So, if you’re not earning anything as a student, your contributions will be a percentage (usually between 14% and 16%) of the fixed minimum salary threshold. You’ll need to find a provider and fill out paperwork yourself, and you’ll have to cover the full amount. 

Retirees 

Having health insurance is a requirement for all German residents, including retirees. If you’re eligible to claim a German pension, you’ll start paying compulsory pension health insurance (Krankenversicherung der Rentner). Your contributions will be deducted directly from your pension and calculated based on the amount you receive. 

If you don’t receive a German pension or you’re a new resident, you’ll need to seek alternative cover. If you’re an EU or EEA national, you may be able to claim free or subsidised healthcare from your home nation via an S1 health form. If not, you’ll need to arrange private healthcare from a recognised provider with a level of cover that you can afford, and which will cater to your needs. 

If you’re planning on living in the country, yes.  

If you’re visiting Germany temporarily, or waiting for your residency status to be finalised, your European Health Insurance Card (EHIC) entitles you to necessary and emergency medical treatment at a public healthcare facility on the same basis as German citizens.  

However, it’s important to remember that your EHIC doesn’t cover planned medical procedures, nor is it a long-term solution. If you’re staying in the country for more than six weeks, you’ll be considered a resident and must be registered to the German health insurance scheme or have a private plan. 

It’s one thing to have health insurance, but actually using healthcare services can be another thing entirely. Here are some key details to be aware of: 

Insurance card (Gesundheitskarte) 

Once you’ve registered with a Krankenkasse, they’ll issue you with a health insurance card (Gesundheitskarte). You’ll need to show this when you visit a hospital, doctor or specialist as it allows them to charge medical fees to your provider. 

Doctors and GPs (General Practitioner) 

For most non-emergency healthcare issues in Germany, a GP (Allgemeinarzt) or doctor (Hausarzt) will usually be your first point of contact. You don’t necessarily need to register with a specific practice, but some medical experts will only treat private patients. So, if you’re on the government’s public health insurance plan, it’s worth finding a local doctor that’s registered with the National Association of Statutory Health Insurance Physicians (Kassenärztliche Bundesvereinigung) in advance. A directory of these doctors is available here.  

Appointments can be made by phone or in person, and you may have to wait a few days for an appointment if you’re not a private patient. You should bring your health insurance card with you to any appointment so the doctor can bill your insurance company directly. If you’ve got private health insurance, you may need to pay for your appointment and any treatment up front and then claim a refund through your insurance provider. 

Emergencies 

The phone number for an ambulance in Germany is 112. This is also the number for the fire brigade (the number to call the police is 110). The A&E department at the hospital is called the Notaufnahme. 

If you need to see a doctor out-of-hours, but it’s not so critical that you need an ambulance, you can call 116 117 for a non-emergency doctor on call. 

Dental care 

In Germany, only basic treatments are covered by public health insurance. This usually includes things like routine dental checks, teeth cleaning and basic fillings. The dental industry in Germany is semi-privatised, so you’d need to pay extra for major treatments or cosmetic dentistry. However, you can choose a supplementary dental insurance policy to cover you for a wider range of dental care if you wish.  

If you have private health insurance, your level of cover will depend on your plan, but you should be able to add extra dental cover to your package. Either way, you should always check with your provider before undergoing any kind of dental treatment to make sure the cost is covered. It’s also worth bearing in mind that a lot of dentists in Germany are either private or public, so make sure you check. 

Pharmacies and medicine 

Any prescription you receive from a doctor needs to be filled at a pharmacy (Apotheke). Easily identified by the large red ‘A’ displayed outside the premises, pharmacies can be found throughout German towns and cities. German pharmacies also sell over-the-counter medications.  

Depending on your healthcare cover, you may have to pay for some or all the cost of your prescription. With private cover, you’d usually need to pay the full amount and then claim for a reimbursement from your provider if it’s covered. If you have statutory health insurance, you’ll usually need to pay a nominal co-payment fee of 10% of the cost of your medication (this is capped at €10, but the minimum is €5).  It's worth noting that this example only applies sometimes, on most of the other occasions you'd have to pay the entire medication fee. 

If you need medication urgently out-of-hours, most places will have an emergency pharmacy, which you can find by calling 0800 002 28 33 (or 22 8 33 from a mobile). 

If you have statutory health insurance in Germany, there are some treatments, products, and services for which you may need to make a co-payment. These are small, nominal payments that are usually capped.  

You may need to make co-payments for prescription medications, as outlined above, hospital stays or rehabilitation. For example, the co-payment for hospitalisation is €10 per day, but for a maximum of 28 days in one calendar year. 

A full list of services that require co-payments, along with details and exemptions, can be found on the Krankenkassen website.  

As we’ve outlined, it is a legal requirement to have some form of health insurance if you live in Germany. So, if you’re covered by the public health system, you won’t be required to have any private health insurance.  

However, you’ll need to show proof of adequate health cover to enter the country or secure a German residence permit. For EU citizens, this can be the European Health Insurance Card. Or for UK citizens this can be the GHIC card. But if you’re from elsewhere you may need a healthcare policy for the first three to six months of your stay. This is so you can show that you’re covered at least until your residency status is confirmed and you’re enrolled onto the public system.