Understanding Health Insurance in Germany: A Comprehensive Guide

Germany is renowned for its high standard of healthcare, which is largely attributed to its well-structured and accessible health insurance system. Unlike many countries, health insurance in Germany is not just a privilege but a legal requirement. This comprehensive article explores how health insurance works in Germany, the types available, who is eligible, and what you need to know as a resident, employee, student, or expatriate.

1. The Basics of German Health Insurance

Health insurance (Krankenversicherung) is mandatory in Germany. Every resident must be covered by either statutory (public) health insurance or private health insurance. This system ensures that all individuals have access to essential healthcare services, regardless of their income or social status.

Germany’s health insurance model is a dual system, combining:

• Public (statutory) health insurance (Gesetzliche Krankenversicherung - GKV)

• Private health insurance (Private Krankenversicherung - PKV)

2. Statutory Health Insurance (GKV)

What is GKV?

Statutory health insurance is the most common form, covering about 90% of the population. It is managed by non-profit health funds (Krankenkassen) which are regulated by the government.

Who is Covered?

• Employees earning less than €69,300 per year (as of 2025)

• Pensioners

• Students

• Unemployed individuals (covered through job centers)

• Family members (spouse and children) without income are covered for free

How Contributions Work

Contributions are based on income. Employees pay approximately 14.6% of their gross salary (split between employer and employee), with a small additional premium set by each Krankenkasse (usually around 1.3%).

What Does GKV Cover?

• Doctor visits

• Hospital stays

• Prescription medications

• Preventive checkups

• Maternity care

• Mental health services

• Some dental care

Despite its extensive coverage, some services such as cosmetic treatments, advanced dental procedures, or certain medications may not be fully covered.

3. Private Health Insurance (PKV)

Who Can Choose PKV?

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

• Self-employed individuals

• Freelancers

• Civil servants (Beamte)

• Students (with certain restrictions)

How Premiums Work

Private insurance is not based on income, but on:

• Age

• Health condition

• Level of coverage

Younger and healthier individuals often benefit from lower premiums compared to the statutory system. However, premiums can rise significantly with age or chronic conditions.

What Does PKV Cover?

Private insurance often provides more comprehensive and faster services, such as:

• Private hospital rooms

• Alternative treatments

• Shorter waiting times

• Better dental care

• Access to top specialists

However, family members are not covered for free—each person needs their own policy.

4. Choosing Between GKV and PKV

For high earners and self-employed individuals, private insurance can be tempting due to better services and sometimes lower premiums in the early years. However, switching back to GKV is usually difficult, especially after age 55.

Pros of GKV:

• Stable premiums

• Family coverage included

• Less paperwork

• No medical checkups required

Pros of PKV:

• Higher quality services

• Shorter wait times

• Customized coverage

• Often cheaper when young and healthy

Choosing the right type depends on your age, income, health status, and long-term plans in Germany.

5. Health Insurance for Foreigners and Expats

If you're moving to Germany, securing health insurance is one of the first steps to legal residence. Here's how it works depending on your status:

a. Employees

You will be automatically enrolled in the statutory system unless you earn above the income threshold, in which case you can opt for private insurance.

b. Students

Foreign students must have valid health insurance to enroll at a university. Students under 30 are usually eligible for low-cost statutory plans. Others may need private coverage.

c. Freelancers and Self-employed

You can choose either public or private insurance. Private plans are more common due to the high costs of GKV for self-employed individuals without subsidies.

d. Tourists and Temporary Visitors

Travel insurance or international health plans are usually sufficient for short stays. If you plan to settle, switching to GKV or PKV is required.

6. How to Apply for Health Insurance

1. Compare plans – Use online comparison tools or consult a licensed insurance broker.

2. Choose a provider – Whether public or private, select one that suits your needs.

3. Submit your application – Including ID, address, proof of income, residence permit, etc.

4. Get confirmation – You will receive an insurance card (Gesundheitskarte) to present at hospitals or clinics.

7. Important Considerations

• Waiting periods: Some private insurers require waiting periods before certain benefits apply.

• Supplementary insurance (Zusatzversicherung): You can purchase add-ons for things not covered by GKV, like dental implants or international coverage.

• Pre-existing conditions: These may affect private insurance eligibility or premiums.

• Switching insurance: You can switch public providers anytime with notice, but switching between PKV and GKV is highly restricted.

8. The Role of the Gesundheitskarte

Once insured, you receive a health insurance card, which you must present during every medical visit. This chip card stores basic information and simplifies billing between providers and insurers.

9. Healthcare Access in Germany

Germany’s healthcare system is one of the most efficient globally, offering high-quality services. However, wait times for certain specialists can be long under GKV. Private patients often get faster appointments and access to top-tier hospitals.

10. Conclusion

Health insurance in Germany is more than just a legal obligation—it is a safeguard for your well-being in one of the most medically advanced countries in the world. Whether you’re a resident, a newcomer, or a freelancer exploring opportunities, understanding the system helps you make the right decisions for your health and finances.

Choosing between GKV and PKV requires careful consideration of your situation, both current and future. With the right plan, you can enjoy peace of mind, knowing you're covered in a country that values health as a fundamental right.