How Health Insurance Works in Germany

In Germany, health insurance is not optional. The main question is which system applies to you and how to register correctly.

Before we start, a little warning.

Many people only start thinking about health insurance after arriving in Germany. By then, some decisions can be difficult or costly to change.

Take a moment to explore your options before you move. The right choice now can save you time, money, and stress later.

Every situation is different. Book a consultation with one of our health insurance experts and find out which option makes the most sense for you before you move to Germany.

OK, let’s go!

Germany has a mandatory health insurance system. Everyone who lives in Germany must have valid health insurance. This means either statutory public health insurance (Gesetzliche Krankenversicherung, GKV) or private health insurance (Private Krankenversicherung, PKV).

Public health insurance is regulated by law. This means that the core medical benefits are broadly standardized across public insurers. The contribution is based mainly on income, not on age, medical history, or individual health risk. Private insurance works differently: premiums are based on the individual contract, selected coverage, age, and health status.

Public vs Private Insurance

Topic	Public health insurance (GKV)	Private health insurance (PKV)
How contributions are calculated	Based mainly on income, up to the contribution assessment ceiling.	Based on age, health status, selected tariff, and contract benefits.
Medical history	No individual risk assessment for standard membership.	Health questions and risk surcharges or exclusions may apply.
Family members	Spouses and children may be covered at no extra cost if conditions are met.	Family members usually need separate contracts and separate premiums.
Long-term planning	Often easier for families and people who value predictable income-based contributions.	Can be attractive for some high-earning singles, but long-term costs and return-to-GKV rules should be considered carefully.

Employees

Most employees in Germany are compulsorily insured in the public system if their regular gross salary is below the annual compulsory insurance threshold. In 2026, this threshold is EUR 77,400 per year, or EUR 6,450 per month. Employees below this amount normally cannot choose private insurance as their main system; they choose one statutory public health insurance provider.

Employees earning above the threshold are considered exempt from compulsory statutory insurance. They may either remain voluntarily insured in the public system or choose private health insurance. For many international employees, especially those with families or uncertain long-term plans, staying in public insurance can still be the simpler and safer option.

Book a Consulting Appointment

Students

Students generally need valid health insurance to enroll at a German university. In many cases, they can benefit from reduced student rates offered by Germany's public health insurance system, subject to age and enrollment requirements.

Students from EU countries may often continue using their home-country insurance and EHIC while studying in Germany. However, they still need to complete the university enrollment process by obtaining confirmation of their insurance status through a German statutory health insurance provider. Before relying on an EHIC, students should carefully check whether it remains the most suitable option for the entire duration of their studies.

Non-EU students should not assume that travel insurance is sufficient for university enrollment, visa applications, or long-term access to healthcare in Germany. While more affordable private student health insurance options are available, choosing private insurance requires careful consideration.

In many cases, students who opt out of statutory student health insurance in favor of private insurance receive an exemption that remains valid for the duration of their studies. This means that switching back to public student health insurance later may not be possible until their circumstances change. For this reason, it is important to understand the long-term implications before making a decision.

Students who work during their studies should also be aware of the so-called 20-hour rule. During lecture periods, students can generally work up to 20 hours per week while retaining their student status for social insurance purposes. Different rules may apply during semester breaks.

Internships are subject to separate regulations. Mandatory internships that form part of a degree program are often treated differently from voluntary internships. Voluntary internships may create social insurance obligations similar to regular employment, depending on factors such as remuneration, duration, and working hours. Students should always clarify their insurance status before starting an internship.

Book a Consulting Appointment

Artists, Designers & Creative Freelancers

Artists and creative freelancers can often choose between voluntary public health insurance and private health insurance, depending on their individual circumstances and previous insurance history.

For many newcomers, private health insurance may appear attractive because the initial premiums can be significantly lower than public health insurance contributions. However, this decision should be considered carefully, especially for those planning to build a long-term career in Germany.

One important factor is that switching from private health insurance back to public health insurance can be difficult for self-employed individuals. While creative freelancers can generally choose either system when they first register, those who move into private health insurance may find that returning to public health insurance later is no longer possible while they remain self-employed.

In many cases, a return to public insurance only becomes possible after taking up qualifying employment subject to social security contributions or through another change in insurance status.

For this reason, artists and creative freelancers should think beyond the initial monthly premium and consider their long-term plans, expected income, family situation, and future flexibility before making a decision.

Public health insurance contributions are generally based on income. When starting your freelance career, your health insurance provider may initially calculate your contributions using your estimated earnings and later adjust them once your tax assessment becomes available. Depending on your actual income, this may result in either additional payments or refunds.

If you work as an artist, journalist, musician, designer, writer, photographer, illustrator, or another creative professional, you may also be eligible for support through the Künstlersozialkasse, or KSK. The KSK helps eligible self-employed artists and publicists by covering the employer-equivalent share of their statutory social insurance contributions, significantly reducing the cost of public health insurance.

Learn More About the KSK

Freelancers & Self-Employed People

Whether you are an EU citizen or a non-EU citizen, choosing the right health insurance is one of the most important decisions when moving to Germany as a freelancer or self-employed professional. Unlike employees, freelancers are generally responsible for arranging their own health insurance, and the options available depend on your individual circumstances, previous insurance history, and residence status.

Choosing Between Public and Private Health Insurance

Freelancers and self-employed individuals can often choose between voluntary public health insurance and private health insurance, depending on their eligibility.

Public health insurance contributions are generally based on your income. When you first register, your health insurance provider may calculate your contributions using your estimated annual earnings. Once your tax assessment becomes available, your contributions are adjusted to reflect your actual income. Depending on the outcome, this may result in either additional payments or a refund.

Private health insurance may seem attractive because the initial monthly premiums are often lower than public health insurance contributions. However, this decision should be considered carefully, particularly if you plan to live in Germany long term.

One important consideration is that switching back from private health insurance to the public system can be difficult for self-employed individuals. While many freelancers can choose either system when they first register, returning to public health insurance later may no longer be possible while they remain self-employed.

In many cases, a return is only possible after taking up qualifying employment subject to compulsory social security contributions or through another change in insurance status.

For this reason, it is important to look beyond the initial monthly premium and consider your long-term plans, expected income, family situation, and future flexibility before making a decision.

EU Citizens

If you are an EU citizen moving to Germany as a freelancer, your health insurance options depend on whether your move is temporary or permanent.

For temporary stays, you can often continue using your European Health Insurance Card, or EHIC, to receive medically necessary healthcare. However, the EHIC is intended for temporary visits and is not a long-term substitute for German health insurance.

Once you establish your residence or begin working as a freelancer in Germany, German health insurance rules generally apply.

EU Passport but Never Insured in Europe?

Many people hold an EU passport but have lived most of their lives outside the European Union, for example in the United States, Israel, Canada, Australia, Brazil, Argentina, or South Africa.

If this applies to you, do not assume that your EU citizenship alone determines your health insurance options. In many cases, joining German public health insurance may still be possible. However, statutory health insurance providers may request information about your previous insurance history, country of residence, and planned self-employed activity before determining your eligibility.

If you have never been insured in a European healthcare system, it is particularly important to seek advice before registering your freelance business, as your previous insurance history may influence the available options.

Non-EU Citizens

For most non-EU citizens, health insurance is one of the first requirements when moving to Germany.

Proof of adequate health insurance is often required for a visa, residence permit, or other immigration procedures. In some cases, you may initially need private health insurance that meets German legal requirements.

It is important to ensure that your chosen policy is accepted by the relevant immigration authorities and is suitable for your long-term plans in Germany.

Many newcomers focus on finding the cheapest insurance option. However, the choice you make when you first arrive can affect your future flexibility, family coverage, and ability to change insurance systems later. Taking the time to understand your options before relocating can help you avoid costly mistakes.

Not Sure Which Option Is Right for You?

Every freelancer's situation is different. Your nationality, previous insurance history, professional activity, and future plans all influence which health insurance solution is most suitable.

If you are unsure which option is best for your circumstances, it is recommended to seek professional advice before registering your freelance activity. A decision made at the beginning of your journey in Germany can have long-term consequences for your healthcare costs, insurance options, and financial security.

Book a Consulting Appointment

Costs and Contributions

Public Health Insurance

The general statutory contribution rate is 14.6%. Public insurers also charge an additional contribution (Zusatzbeitrag). The average additional contribution for 2026 is 2.9%, but each insurer sets its own rate. For employees, the general contribution and the additional contribution are usually split equally between employer and employee.

Contributions are not calculated on unlimited income. In 2026, the monthly contribution assessment ceiling for health and long-term care insurance is EUR 5,812.50. Income above this amount does not increase the statutory health insurance contribution.

Here are some examples:

Person	Status	Monthly Income	Insurance Type	Who Pays?	Approx. Monthly Cost
Anna, Software Developer	Compulsorily insured employee	€4,000 gross salary	Public Health Insurance (GKV)	Employer and employee share the contributions	Employee pays approx. €350/month; employer pays a similar amount
David, Senior Manager	Voluntarily insured employee, with income above €77,400 per year	€8,000 gross salary	Public Health Insurance (GKV)	Employer and employee share contributions up to the contribution ceiling	Employee pays approx. €509/month; employer pays a similar amount
Maria, International Student	Student	No regular employment	Student Public Health Insurance	Student pays the full student rate	Approx. €140–€150/month
Lucas, Freelance Web Designer	Self-employed	€4,000 taxable monthly income	Voluntary Public Health Insurance	Freelancer pays the full contribution	Approx. €700/month
Sophie, Freelance Graphic Designer (KSK member)	Self-employed artist covered by KSK	€4,000 taxable monthly income	Public Health Insurance via KSK	KSK effectively covers the employer-equivalent share	Approx. €350/month

Private health insurance

Private health insurance contributions are not based on income. Instead, premiums are calculated individually based on factors such as age, health status, occupation, and the selected level of coverage.

For younger and healthy individuals, private health insurance can often be less expensive than public health insurance. However, each family member usually requires a separate contract, and premiums may increase over time.

Employees earning above the compulsory insurance threshold can choose between public and private health insurance. In most cases, the employer contributes towards the cost of the private insurance premium. However not more that they would contribute to the public health insurance.

Important: While private health insurance may offer lower premiums initially, the decision should be considered carefully. Returning to public health insurance later can be difficult and, in some situations, impossible while remaining self-employed or employed with income above the threshold. Before choosing private health insurance, consider not only today's costs but also your long-term plans, family situation, and future flexibility.

Here are some examples. Note that the plans are different and each private insurance provider has their own price.

Person	Status	Monthly Income	Private Insurance Scenario	Approx. Monthly Premium
Maria, International Student (24)	Student	No regular employment	Student private insurance tariff	€80–€150
Lucas, Freelance Designer (28)	Self-employed	€4,000	Entry-level private tariff with deductible	€250–€450
Emma, Marketing Consultant (35)	Self-employed	€6,000	Comprehensive private coverage	€400–€700
David, IT Manager (42)	Employee earning above the insurance threshold	€8,000	Mid-range private tariff	€450–€850
Anna, Executive (50)	Employee earning above the insurance threshold	€10,000	Premium private tariff	€700–€1,200+
Family of 4	Self-employed parent, spouse and two children	€8,000	Separate contracts for each family member	€1,000–€2,000+

What Public Health Insurance Covers

Doctor Visits & Specialists

People insured in the public system can generally choose any doctor who is approved to treat statutory health insurance patients. This includes general practitioners, many specialists, dentists, and approved medical care centers.

Many patients first visit a Hausarzt (general practitioner), who can coordinate treatment and refer them to specialists when needed.

Hospital Treatment

If hospital treatment is medically necessary, public health insurance covers the core treatment costs.

Patients usually pay a statutory co-payment of €10 per day for a maximum of 28 days per calendar year. Emergency hospital admissions do not require a prior referral.

Medication

Prescription medication is usually covered when it is medically necessary and prescribed by a doctor.

Patients generally pay a co-payment of 10% of the medication price, with a minimum of €5 and a maximum of €10 per prescription.

Some medications are exempt from co-payments, while over-the-counter or lifestyle medications are generally not covered.

If you regularly take prescription medication, bring copies of your medical records, diagnoses, prescriptions, and treatment history when moving to Germany. Medication names, dosages, and availability may differ, and German physicians may require documentation before continuing long-term treatment.

To avoid interruptions, register with a Hausarzt as soon as possible after arriving. Your GP can review your medical history, issue new prescriptions where appropriate, coordinate treatment, and refer you to specialists if necessary.

Preventive Checkups

Public health insurance covers a broad range of preventive services, including dental examinations, childhood screenings, pregnancy examinations, recommended vaccinations, cancer screenings, and general health checkups depending on age and eligibility.

The services covered by all public insurers are defined by German law and recommendations issued by the Gemeinsamer Bundesausschuss (G-BA).

Many insurers also provide additional preventive screenings, wellness programs, and health services beyond the statutory minimum. Because these extra benefits vary considerably, comparing providers before enrolling is worthwhile.

Mental Health & Psychotherapy

Psychotherapy is a standard benefit of Germany's public health insurance system and can be fully covered when treatment is provided by an approved therapist participating in statutory healthcare.

Only therapists with a statutory health insurance license (Kassenzulassung) can generally bill public health insurance directly.

This can be challenging for internationals, as many English-speaking therapists work exclusively as private practitioners and therefore require patients to pay privately unless special exceptions apply.

Because waiting times for publicly funded psychotherapy can often be several months, it is advisable to begin searching as early as possible.

Before beginning treatment, always confirm whether the therapist accepts statutory health insurance and whether a referral or initial consultation is required.

Physiotherapy & Rehabilitation

Physiotherapy prescribed by a physician is generally covered by public health insurance, although patients usually pay a statutory co-payment.

Rehabilitation, medically necessary aids, and additional therapies may also be covered depending on the medical indication and approval requirements.

Pregnancy & Maternity Care

Public health insurance covers medically necessary pregnancy care, maternity examinations, childbirth in hospitals or approved facilities, and postnatal care.

Midwife services may also be covered within the statutory framework, although availability varies depending on the region.

Good to know for public health insurance

The Electronic Health Card & First Doctor Visit

Every publicly insured person receives an electronic health card, known as the eGK. The card proves insurance coverage and allows doctors, hospitals, and pharmacies to bill the health insurer directly for covered services.

For your first doctor visit, bring:

Your electronic health card
A photo ID, if requested
Relevant medical records and reports
A current medication list
Any referral documents

Before booking, check whether the doctor accepts statutory public health insurance patients. This may be shown as “gesetzlich versichert” or “Kassenpatienten.”

Doctor Visit Process

Book an appointment where possible. Walk-in appointments are less common than in some other countries.
Show your electronic health card at reception.
For common medical issues, begin with a Hausarzt, or general practitioner.
Many specialists allow patients to book directly, although a referral may be helpful or required in some cases.
After receiving a prescription, collect the medication from an Apotheke, or pharmacy. Prescription medications are not usually collected from supermarkets or drugstores.

For urgent but non-life-threatening medical assistance outside regular office hours, call 116117. For an emergency, call 112.

Digital Healthcare in Germany

Germany's healthcare system has become increasingly digital, making it easier for patients to access medical services, prescriptions, insurance documents, and health records.

Most statutory health insurance providers offer secure mobile apps and online portals through which members can manage many healthcare and administrative services.

Electronic Patient Record (ePA)

The Elektronische Patientenakte, or ePA, is a secure digital health record that allows important medical information to be stored in one place.

The ePA may include:

Medical reports
Hospital discharge letters
Laboratory results
Vaccination records
Medication information
X-rays and other medical documents

The electronic patient record can improve coordination between doctors, hospitals, pharmacies, and other healthcare professionals by making relevant information available when needed.

Patients remain in control of their data and can decide which healthcare providers are permitted to access particular documents. Most statutory health insurance providers offer ePA access through their mobile app.

Electronic Sick Note (eAU)

For most publicly insured patients, certificates of incapacity for work, known as an Arbeitsunfähigkeitsbescheinigung or eAU, are transmitted digitally.

Your doctor sends the electronic sick note to your health insurance provider, and your employer retrieves the relevant information electronically.

Even though the certificate is transmitted digitally, you are still responsible for informing your employer immediately when you are unable to work due to illness.

Electronic Prescription (eRezept)

Electronic prescriptions, known as eRezept, are now part of routine medical care in Germany.

Many prescriptions can be redeemed using:

Your electronic health insurance card
Your health insurer's app or the eRezept app
A printed QR code provided by the doctor's practice

Participating pharmacies can retrieve the prescription electronically, making the process faster and reducing the need for traditional paper prescriptions.

Health Insurance Apps

Most public health insurance providers offer mobile apps that allow members to:

Access their electronic patient record
View and manage electronic prescriptions
Upload documents and invoices
Request reimbursements
Submit certificates and forms
Receive secure messages from the insurer
Manage bonus programs and preventive-care rewards

Using these apps can reduce paperwork and simplify many routine administrative tasks.

Digital Health Applications (DiGA)

Germany's statutory health insurance system may cover approved Digital Health Applications, known as DiGA or health apps on prescription.

These certified applications may be prescribed by a doctor or psychotherapist to support treatment for certain medical conditions, including some mental health conditions, chronic illnesses, and rehabilitation needs.

Eligibility depends on the approved medical indication and the individual patient's treatment needs.

Telemedicine

Telemedicine allows patients to consult a doctor remotely through video or telephone appointments.

Virtual consultations may be useful for:

Minor illnesses
Follow-up appointments
Prescription renewals
General medical advice
Initial assessments

Telemedicine cannot replace emergency medical care. For severe symptoms such as chest pain, difficulty breathing, signs of a stroke, or another medical emergency, call 112 or go to the nearest emergency department.

Benefits of Digital Healthcare

Germany's digital healthcare services are designed to make medical care more accessible, efficient, and convenient.

By combining secure electronic records, digital prescriptions, online insurance services, health applications, and telemedicine, patients can manage many parts of their healthcare more easily while retaining control over their personal medical information.

Travel, EHIC & Coverage Abroad

Public health insurance normally includes a European Health Insurance Card, or EHIC, function on the back of the electronic health card.

The EHIC can help insured people access medically necessary public healthcare during temporary stays in EU and EEA countries and Switzerland, subject to the rules and conditions of the country being visited.

The EHIC is not the same as comprehensive travel insurance. It may not cover private medical treatment, medical repatriation, or all healthcare costs incurred abroad.

Public health insurance generally provides limited or no direct coverage outside the EU and EEA. Separate travel health insurance is therefore recommended, especially for travel outside Europe.

Changing Jobs

Health insurance coverage in Germany should remain continuous when a person changes jobs.

A new employer will need the employee's health insurance information for payroll processing and social security reporting.

If there is a short gap between jobs, coverage may continue. However, letters and requests from the health insurance provider should not be ignored, as the insurer may need confirmation of income, employment, or unemployment status.

Unemployment

Ending a job does not mean that health insurance coverage simply disappears. However, responsibility for paying the contributions may change.

If a person receives qualifying unemployment benefits, the responsible government agency may pay the health insurance contributions.

A person who does not qualify for benefits may have to pay voluntary health insurance contributions personally.

Contact the health insurer as early as possible and do not wait until contribution notices or payment reminders are received.

Leaving Germany

Someone leaving Germany permanently should deregister their German residence through an Abmeldung and inform their health insurance provider.

The insurer may request proof of the new residence, departure from Germany, or new health insurance coverage in another country.

Completing these steps helps prevent unnecessary future contributions from continuing after departure.

People moving to another EU country may also require special coordination documents depending on their employment, residence, pension, or family situation.

Common Mistakes to Avoid

Assuming travel insurance is enough: Travel insurance is usually not a replacement for German health insurance if someone works, studies, or lives in Germany long term.
Registering too late: Employees should sort out insurance before or at the start of employment so payroll and social security registration can work smoothly.
Ignoring letters from the insurer: Insurers may request income information, family insurance forms, or missing documents. Ignoring these letters can lead to high provisional contributions.
Choosing private insurance too quickly: Private insurance can be attractive in some cases but may be difficult to reverse later, especially for older people, families, or people with changing income.
Not deregistering when leaving Germany: Without proper deregistration and notification, contributions may continue.
Not checking whether a therapist or doctor bills statutory insurance: Some providers are private-pay only, even if they are licensed.

What Private Health Insurance Covers

Unlike public health insurance, there is no standard package of benefits that applies to all private health insurance policies. The services covered depend entirely on the insurer and the tariff you choose. For this reason, it is important to review the details of your policy carefully before signing a contract.

Doctor Visits & Specialists

Private health insurance generally provides access to a wide range of doctors, specialists, hospitals, and medical facilities.

Depending on your tariff, you may be able to visit specialists directly without first obtaining a referral from a general practitioner (Hausarzt).

Many private patients also benefit from shorter waiting times for appointments and access to additional treatment options. However, the exact benefits vary depending on your insurer and the policy you choose.

Hospital Treatment

Most private health insurance policies cover hospital treatment, but the level of coverage depends on the selected package.

Some tariffs include benefits such as treatment by a senior consultant (Chefarzt), private or semi-private hospital rooms, and access to a wider choice of hospitals.

Before choosing a policy, verify whether these services are included or require additional coverage.

Medication

Prescription medication is generally covered when medically necessary and prescribed by a physician. However, reimbursement rules vary between insurers and tariffs.

Some policies reimburse medication in full, while others include deductibles, reimbursement limits, or exclusions.

If you regularly take prescription medication, bring copies of your medical records, diagnoses, prescriptions, and treatment history when moving to Germany. Some medications may require additional medical documentation, and certain pre-existing conditions may affect coverage depending on the insurer and policy.

To avoid interruptions in treatment, new arrivals should register with a general practitioner (Hausarzt) as soon as possible after arriving in Germany.

Preventive Checkups

Many private health insurance policies cover preventive examinations, vaccinations, cancer screenings, and routine health checkups.

Some insurers provide benefits that go beyond those available under Germany's public health insurance system.

Because preventive care benefits vary significantly between insurers and tariffs, it is worthwhile comparing policies carefully before making a decision.

Mental Health & Psychotherapy

Psychotherapy may be covered by private health insurance, but the extent of coverage depends on your policy.

Some tariffs cover only a limited number of therapy sessions each year, while others provide more comprehensive mental health benefits.

One advantage of private insurance is that treatment by private therapists is often covered, provided the therapist meets the insurer's requirements. This can make it easier to find English-speaking therapists and often results in shorter waiting times than the public system.

Before beginning treatment, always verify whether psychotherapy is included in your tariff and whether prior authorization is required.

Physiotherapy & Rehabilitation

Physiotherapy, rehabilitation, medical aids, and other therapies are often covered when prescribed by a physician.

However, reimbursement levels, annual benefit limits, deductibles, and approval requirements differ between insurers and policy types.

Pregnancy & Maternity Care

Most private health insurance policies cover pregnancy care, maternity checkups, childbirth, and postnatal treatment.

The level of coverage varies considerably between tariffs, particularly for additional benefits such as private hospital rooms, specialist care, extended maternity services, and other premium healthcare options.

Important

Private health insurance is highly individualized. Two people insured with the same company may have completely different levels of coverage depending on their tariff. Before choosing a policy, review not only the monthly premium but also the benefits, exclusions, deductibles, waiting periods, and reimbursement limits.

The cheapest policy is not always the best option. Understanding what is covered — and what is not — can help you avoid unexpected costs in the future.

How to Register for Health Insurance

Our Health Insurance Partner

When it comes to health insurance in Germany, we work together with Feather, one of the leading digital insurance brokers for internationals.

We chose Feather because they make the often complex process of arranging health insurance simple, transparent, and accessible in English. Whether you're moving to Germany for work, studies, self-employment, or family reasons, Feather offers a wide range of public and private health insurance options from trusted German providers.

Our role is to help you understand the German healthcare system, determine which type of insurance best fits your personal situation, and guide you through the process. Once we've identified the right solution, our partnership with Feather allows you to compare suitable options and complete your application efficiently.

Why We Partner with Feather

Access to both public and private health insurance providers
English-speaking support throughout the application process
Digital application and document management
Transparent comparison of suitable insurance options

Every situation is different. Instead of recommending a single insurance company, we help you understand your options and, together with Feather, find the solution that best matches your needs and long-term plans.