Health Insurance in Germany: A Comprehensive Guide

Germany is known for its strong social welfare system, and one of the key pillars of this system is its highly developed healthcare infrastructure. Central to this is the concept of health insurance, which is mandatory for all residents of Germany. Whether you're a German citizen, an expat, or a foreign student, understanding the health insurance landscape is crucial for living and working in the country.

This article offers an in-depth look into health insurance in Germany, including the types, costs, coverage, benefits, and how the system works.

1. Overview of the German Health Insurance System

Germany operates under a dual health insurance system consisting of:

Statutory Health Insurance (Gesetzliche Krankenversicherung – GKV)

Private Health Insurance (Private Krankenversicherung – PKV)

Health insurance is mandatory in Germany. Every resident must have coverage, and proof of insurance is required for employment, university registration, visa applications, and even rental agreements in some cases.

2. Statutory Health Insurance (GKV)

2.1 What is GKV?

Statutory health insurance, also known as public health insurance, is the most common form of health coverage in Germany. About 90% of the population is covered under GKV.

GKV operates on the solidarity principle, meaning that all insured individuals contribute based on their income, and in return, everyone gets access to the same level of care regardless of their contribution.

2.2 Eligibility

The following groups are typically covered under GKV:

Employees earning less than €69,300 per year (as of 2024)

Students enrolled at a German university

Pensioners

Unemployed individuals receiving benefits

Dependents of insured persons (spouse or children)

2.3 Contribution Rates

The contribution to GKV is income-based, currently set at 14.6% of gross salary (split between employer and employee), with an additional 1.6% average supplementary contribution charged by individual health funds (Krankenkassen).

So in total, most employees pay around 8% of their salary, and employers cover the same amount.

2.4 What Does GKV Cover?

Statutory health insurance provides comprehensive coverage, including:

Doctor visits

Hospital treatment

Prescription medication (with co-payments)

Mental health services

Maternity care

Vaccinations

Preventive check-ups

It also includes family coverage at no additional cost, meaning non-working spouses and children can be insured free of charge.

3. Private Health Insurance (PKV)

3.1 What is PKV?

Private health insurance is available to specific groups of people and offers tailored benefits, often with shorter waiting times and more extensive coverage. About 10% of the German population opts for PKV.

3.2 Who Can Get PKV?

Employees earning above the threshold (€69,300/year)

Self-employed individuals

Freelancers

Civil servants (Beamte)

Students under certain conditions

3.3 Costs of PKV

Unlike GKV, private health insurance is not income-based. Premiums depend on:

Age

Health condition

Chosen benefits

Deductibles

Young, healthy individuals may find PKV cheaper initially, but costs can rise with age and medical needs.

3.4 Benefits of PKV

Access to private doctors and hospitals

Single-bed hospital rooms

No waiting time for specialists

Customized plans

Reimbursement-based system (you pay first, then claim back)

However, family members are not automatically insured under one plan — each person must pay their own premium.

4. GKV vs. PKV: Pros and Cons

Feature Statutory (GKV) Private (PKV)

Cost Based on income Based on risk profile

Coverage Basic but sufficient Often superior

Dependents Free family coverage Each member pays

Access All public healthcare providers Private healthcare available

Flexibility Limited Highly customizable

Suitability Ideal for most residents Better for high earners, self-employed

5. How to Choose a Health Insurance Provider

There are over 100 public health insurance funds (Krankenkassen) in Germany, and dozens of private companies. When choosing a provider, consider the following:

Monthly premiums and additional contributions

Services included (e.g., dental, alternative treatments)

Customer support (especially in English if you're not fluent in German)

Digital services (app, online appointments)

Coverage while traveling

Some of the well-known public insurers include:

TK (Techniker Krankenkasse)

AOK

Barmer

DAK

KKH

Popular private insurers include:

Allianz

AXA

Debeka

Signal Iduna

Ottonova (digital insurance)

6. Special Considerations for Expats and Foreign Students

6.1 Expats

If you’re moving to Germany for work, your employer will typically enroll you in a GKV plan unless your income allows you to opt for PKV.

Freelancers should be careful — GKV premiums can be high due to the lack of an employer share, but PKV might have age or health restrictions.

6.2 Foreign Students

Students under 30 or in their first 14 semesters must take out statutory student insurance (around €120–€130/month). Private student insurance is also available but may not meet visa requirements.

EU students can often use their European Health Insurance Card (EHIC).

7. Switching Between Systems

Switching from GKV to PKV is relatively easy for eligible individuals. However, switching back from PKV to GKV is much more difficult and often impossible after a certain age or once you've passed certain milestones (e.g., self-employed for too long).

Therefore, the choice should be made carefully and with long-term planning in mind.

8. Healthcare Services in Germany

Once insured, you have access to one of the best healthcare systems in the world. Doctors, clinics, and hospitals in Germany offer high-quality treatment. You can visit:

Hausarzt (general practitioner) for initial care

Facharzt (specialist) if referred

Krankenhaus (hospital) in emergencies or for surgeries

Prescriptions are partially covered, with small co-pays (usually €5 to €10 per prescription).

9. Emergencies and Out-of-Hours Care

In emergencies, dial 112 for an ambulance.

For non-life-threatening issues outside normal hours, call 116 117 for the out-of-hours medical service.

Hospitals must treat you regardless of insurance, but proof will be required later for billing.