If you're planning to move to Germany, you've likely heard that Germany's healthcare system is one of the best in the world and is renowned for its efficiency, accessibility, and high standard of care. However, if you're new to Germany, understanding the nuances of its health insurance system can be confusing and complex - especially if you don't know the language!
In this guide, we'll walk you through the basics of understanding health insurance in Germany so that you can make well-informed decisions about your healthcare and ensure you're not caught out with poor-quality coverage, unplanned out-of-pocket costs, or other nasty surprises. Let's dive in!
Is it mandatory for foreigners to have health insurance in Germany?
In Germany, health insurance is compulsory for all residents, including foreigners. Failure to apply for health insurance upon arrival can result in visa issues, ineligibility to apply for certain forms of insurance down the line, having to make back payments to insurance providers, and an inability to receive your salary from your employer.
Understanding Germany's health insurance system
There are two main types of health insurance in Germany: Public health insurance (Krankenversicherung or GKV) and private health insurance (Private Krankenversicherung or PKV).
Factors that contribute to whether public or private health insurance is suitable for you are determined by:
- Whether you've been insured statutorily in Europe previously
- Your income and employment status
- Your age and health upon application
- How many dependents you currently have and family planning and;
- How long you plan to live in Germany
If you're unsure which system is right for you, it's best to speak to a neutral health insurance broker and advisor. A good broker will work with all the top providers and can provide you with a range of quotes to choose from whilst also offering in-depth advice to help you weigh your options. In Germany, broker services are completely free as mandated by German law. So even if you don't choose to buy any insurance, there's nothing to lose!
Here is a quick summary of the characteristics inherent in both the public and private health systems in Germany.
Statutory Health Insurance (GKV)
Eligibility: Employees earning below the income threshold set by the German government (currently €69,300 in 2024) are obliged to join the statutory health insurance system and become mandatory members upon their first day of work in Germany. Other groups of people can join as voluntary members if they have been insured statutorily in Europe before.
Coverage: Public health insurance provides standardized comprehensive coverage for essential healthcare services, including doctor visits, hospital stays, prescription medications, preventive care, and pregnancy and birth delivery.
Contributions: Contributions to public health insurance are typically shared between the employer and the employee, with each party responsible for paying approximately half of the total contribution. Those who are self-employed or unemployed pay their full contribution on their own.
In the public scheme, contributions are determined by how much you earn so the more you earn, the higher your monthly contribution. Fortunately, the highest possible monthly contribution is capped, but the cap increases yearly. Currently, the capped highest monthly contribution is approximately €1.040 so if you are a high-earner, this is the monthly contribution to expect when you apply for statutory coverage.
Key advantages:
- Cost-effective for families
- Easy entry for individuals with pre-existing health conditions
Key disadvantages:
- Can be very expensive for high-earning individuals who pay the maximum amount of contributions
- Coverage can't be customized to individual needs and benefit preferences
Private Health Insurance (PKV)
Eligibility: Employees with higher incomes (above the income threshold of €69,300 in 2024) or those who do not hold an employment contract who are self-employed, can opt for private health insurance. Eligibility is also dependent on whether an individual has pre-existing medical conditions.
Coverage: Although public health insurance will cover all essential healthcare needs, private health insurance offers more customizable plans and additional benefits not covered by the public scheme. This includes faster appointment times, access to specialists and private hospital rooms. Unlike in the public scheme, since coverage is customizable, in the private scheme you only pay for the benefits you'd like included in your coverage.
Contributions: Premiums for private health insurance are based on factors such as entry-age, health status upon application, and chosen coverage options and benefits. The premiums paid are locked in at the start of your contract and do not increase with age or illness but only increase due to inflation and the cost of medical progress (as does the cost of statutory insurance). As in the public scheme, contributions are also subsidized by 50% if you are employed.
Key advantages:
- Cost-effective for high earners and lifetime affordability when you join at a young age
- Fully customizable according to your benefit preferences
- Access to the best state-of-the-art medical care and enjoy perks and additional inclusions such as appointment priority
Key disadvantages:
- Contributions are paid per member so if you have a family with multiple dependents, monthly contributions can get costly
- Surcharges for pre-existing conditions
How to apply for and obtain health insurance in Germany
Step 1 - Explore your options: Research and compare both public and private health insurance providers based on your needs. Platforms such as Quickity can be a useful resource.
Helpful tip: working with a broker in Germany is free and they'll also be able to provide you with multiple quotes from different insurers so you can compare different providers, costs and the benefits they offer. Going directly to a provider means you have less of an opportunity to learn about what other providers offer and may be limited by one provider's coverage options.
Step 2 - Documentation: Gather necessary documents, including your passport, residence permit (if applicable), proof of prior insurance, employment contract and medical reports if there are pre-existing conditions.
Step 3 - Application: Apply directly with insurance providers, or through insurance brokers or advisors.
Step 4 - Registration: Once approved, register with your chosen health insurance provider's app. Your health insurance will be active immediately and you will receive a health insurance card in the mail.
Traps to avoid when obtaining health insurance in Germany
Relying on travel insurance or cheap international plans: Travel insurance for the first few days during the relocation process is fine whilst you seek longer-term insurance but it should be noted that this is not recognized by German law for permanent stays. Instead, to ensure you are buying legal healthcare coverage, your chosen insurance needs to include adequate coverage for essential healthcare services, including doctor visits, hospital stays, medications, and preventive care. It can be tempting to buy travel insurance or cheap “expat plans” offered by international providers but these often aren't recognized by German law and registering for these plans can often lead to visa problems in the future and an inability to enrol in the legitimate public or private system down the line.
Don't procrastinate: Signing up for health insurance is one of the first things you should do upon arrival in Germany. Failure to do so in time can lead to complications and irreversible situations. For instance, you may be unable to enrol for the public system if more than 3 months have passed since arrival in Germany or you may be confronted with painful back payments.
Avoid these traps by being proactive about your health insurance and your responsibilities as an expat relocating to Germany. Better yet, seek the advice of a health insurance broker or advisor who can guide you through the process and help you with the paperwork! A broker can also help you thoroughly review the terms and conditions of your insurance policy, including coverage limitations, exclusions, and potential additional costs.
Being on top of your health insurance obligations as an expat and newcomer in Germany requires careful consideration and understanding of the intricacies of the German health insurance system. By fulfilling mandatory health insurance requirements, applying for coverage, understanding costs, avoiding common pitfalls, and seeking advice when needed, as a new arrival in Germany, you can ensure you're well-equipped to navigate the healthcare system and enjoy your new life in Germany with peace of mind.
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