Understanding the German Health Insurance System
Every resident in Germany must have health insurance. This chapter explains the different types available and which one applies to your situation.
Insurance Is Mandatory
Germany requires every resident to have health insurance from day one. This is called the Krankenversicherungspflicht and it applies to everyone — employees, freelancers, students, and retirees.
€77,400
per year (gross) for employees to access PKV
€69,750
per year — GKV contributions are capped here
Which Type Am I Eligible For?
Your insurance options depend on your employment status, income, and visa type.
GKV (Public Insurance)
Default for most employees and residents- The public system (Gesetzliche Krankenversicherung) covers about 87% of people in Germany.
- Contributions are based on income — roughly 14.6% of gross salary plus supplements, split with your employer.
- Standardized benefits: everyone in GKV gets the same core coverage regardless of income or health.
- Free family co-insurance (Familienversicherung) for non-working spouses and children.
PKV (Private Insurance)
Employees above JAEG, freelancers, civil servants- Employees must earn above the JAEG threshold of €77,400/year (2026) for at least 12 months.
- Self-employed and freelancers can join PKV at any income level — no threshold applies.
- Civil servants (Beamte) receive Beihilfe subsidies covering 50-80% of costs, making PKV very affordable.
- Premiums are based on age, health, and coverage level — not income.
Incoming & Travel Insurance
Short-term cover for new arrivals- Designed for expats in their first weeks or months in Germany before securing long-term coverage.
- Covers emergency and essential medical care, typically for 6 to 24 months.
- Affordable: usually €30–€150 per month depending on coverage and provider.
- Does NOT satisfy the long-term Krankenversicherungspflicht requirement — you must transition to GKV or PKV.
Students
GKV student rate or PKV opt-out- Students under 30 get a discounted GKV rate of about €110/month (including nursing care).
- You can opt out of GKV for PKV within the first 3 months of enrollment — but this is binding for your entire degree.
- Students over 30 or beyond 14 semesters lose the discounted rate and must arrange voluntary GKV or PKV.
- International students may need incoming insurance first, then transition to student GKV.
New Arrivals to Germany
Depends on employment and visa type- Employed expats are automatically enrolled in GKV unless they earn above the JAEG and opt for PKV.
- Self-employed expats can choose GKV (voluntarily) or PKV from day one.
- EU/EEA citizens have the same rights as German nationals regarding insurance choice.
- Non-EU citizens should check visa conditions — some require specific insurance types or minimum coverage.
Key Things Expats Should Know
Switching Back From PKV After 55 Is Very Difficult
German law makes it nearly impossible to return to GKV after age 55. If you choose PKV, you should be prepared to stay with it long term. Consider your future financial situation, retirement plans, and family needs carefully.
GKV is the safe default. If you are unsure which system is right for you, GKV is a solid choice. It offers comprehensive coverage, free family co-insurance, and no medical underwriting.
PKV can save money — or cost more. Young, healthy, high-earning singles often pay less in PKV with better coverage. But families, older expats, or those with pre-existing conditions may find GKV more economical.
Incoming insurance is temporary. It bridges the gap when you first arrive but is not a long-term solution. Plan your transition to GKV or PKV early.
Your visa may dictate your options. Some visa types require specific insurance. For example, student visas typically require proof of GKV or equivalent coverage. Job seeker visas may accept travel insurance temporarily.
Frequently Asked Questions
Common questions about health insurance for expats in Germany.
Yes. Since 2009, every person living in Germany must have health insurance (Krankenversicherungspflicht). This applies to employees, freelancers, students, retirees, and even unemployed residents. You cannot legally live in Germany without coverage.
GKV (Gesetzliche Krankenversicherung) is the public system with income-based contributions and standardized benefits. PKV (Private Krankenversicherung) is the private system with risk-based premiums, individualized coverage, and often shorter wait times. About 87% of residents are in GKV and 11% in PKV.
No. Incoming and travel insurance are designed as short-term solutions, typically covering 6 to 24 months. They do not satisfy the long-term insurance requirement. You must transition to GKV or PKV once you have a residence permit or employment contract.
You may face problems registering your address (Anmeldung), opening a bank account, and obtaining a residence permit. If you start employment, your employer will enroll you in GKV automatically. Freelancers and non-employed residents should arrange coverage before arrival or immediately upon landing.
Switching from GKV to PKV is possible if you meet the eligibility criteria (e.g., income above the JAEG for employees). Switching back from PKV to GKV is more restricted — employees must drop below the income threshold, and it becomes nearly impossible after age 55.
Not Sure Which Type Is Right for You?
Take our quick quiz to find the best insurance type for your situation in under 2 minutes, or speak with a licensed broker who can assess your specific needs.