Health insurance (Krankenversicherung) in Germany is mandatory for all residents — you cannot legally live in Germany without coverage. Understanding the system is one of the most important practical tasks for new arrivals.
The Two Systems
Germany has a dual health insurance system: statutory (gesetzliche Krankenversicherung, GKV) and private (private Krankenversicherung, PKV). GKV covers approximately 90% of the population; PKV covers approximately 10%. GKV (public health insurance): contributions are income-based — approximately 14.6% of gross salary (employer pays half, employee pays half, plus an additional fund-specific supplemental premium — typically 1–2%). For an employee earning €60,000/year, monthly contribution is approximately €400 total (€200 from employer, €200 from salary). There is a Beitragsbemessungsgrenze (contribution ceiling) — in 2025 approximately €5,175/month — above which no additional GKV contribution is charged. Key feature: GKV covers spouses and children who are not employed, at no additional cost (Familienversicherung). Coverage: comprehensive — GP, specialist, hospital, dental (basic), mental health, physiotherapy, prescriptions (with a small copay of €5–10 per prescription). No preauthorisation required for most treatments; no lifetime limits; no copays for GP visits. PKV (private health insurance): available to employees earning above the Versicherungspflichtgrenze (threshold — approximately €69,300/year in 2025, approximately €5,775/month) and to self-employed workers at any income. Premiums are based on health status and age at enrollment, not income — a healthy 30-year-old typically pays €300–500/month; the same person at 50 might pay €700–1,000+/month. Benefits: typically faster specialist access, single or double hospital rooms, direct access to senior physicians (Chefarzt), dental coverage included.
Choosing Between GKV and PKV
If you earn below the Versicherungspflichtgrenze: GKV is mandatory — you have no choice. If you earn above it: you can opt for PKV, but this is a significant long-term decision. The case for PKV: better access and service (shorter wait times, better hospital rooms, more dental coverage); lower premiums when young and healthy. The case for GKV: premiums proportional to income, not age or health (lower than PKV in later career years); family coverage at no extra cost; easier to switch back to GKV in certain circumstances. The PKV trap: premiums increase with age; if your income drops (career change, early retirement), PKV premiums do not decrease with income; switching from PKV back to GKV is only possible in limited circumstances (under 55 and income drops below threshold, or through specific employment contracts). The standard advice for expats: if you plan to stay in Germany long-term (10+ years), have a family, or anticipate income fluctuations, GKV is typically safer. If you are young, single, earning well, and plan to leave Germany within 5 years, PKV may offer better value and service. Self-employed workers: GKV for self-employed is possible (freiwillig versichert — voluntary membership) but the contributions are higher because you pay the full 14.6% yourself (no employer share). Many self-employed expats opt for PKV for cost reasons early in their career.
Practical Enrollment
GKV enrollment: choose a Krankenkasse (the main ones are TK — Techniker Krankenkasse, DAK, AOK, Barmer, Knappschaft). TK and DAK are popular with English-speaking expats — both have English-language customer service. Apply directly on the Krankenkasse website before starting your job or within days of arrival. Your employer registers you through payroll once you provide your Versicherungsnummer. European Health Insurance Card (EHIC): if you arrive from another EU country with an EHIC, this provides temporary coverage while you arrange German insurance — but it is not a substitute for German enrollment. Gap coverage: if you arrive without existing coverage, some private insurers offer short-term gap insurance (Reise-Krankenversicherung or short-term private policies) to cover you during the enrollment process.
