Germany Health Insurance (Krankenversicherung)
Germany has mandatory health insurance for all residents. If you live in Germany you must be insured one way or another, and without an insurance card (Versichertenkarte) you'll pay full price out of pocket. Foreign workers, students, and assignees are no exception — and you should generally be enrolled within three months of arrival to avoid trouble at residence permit renewal. The system has two main pillars: statutory insurance (GKV) and private insurance (PKV).
GKV (Gesetzliche Krankenversicherung, statutory)
- Covers about 88% of the population — the mainstream system.
- If your gross salary is below the compulsory insurance threshold (Versicherungspflichtgrenze, around EUR 73,800/year as of 2026; subject to change), you are automatically enrolled in GKV as a regular employee.
- Contributions are roughly 14.6% of gross income plus a supplementary rate (Zusatzbeitrag, averaging around 1.7%), split equally between employer and employee.
- You choose one of about 95 sickness funds (Krankenkassen) — TK, Barmer, AOK, DAK, etc.
- Free family co-insurance (Familienversicherung): spouses and children below an income threshold (around EUR 556/month as of 2026; subject to change) are covered free of additional premiums. A huge benefit for immigrant families.
PKV (Private Krankenversicherung, private)
- Available to high earners above the threshold, the self-employed, civil servants, and some students.
- Premiums are individually rated based on age, health, and coverage — typically cheaper than GKV when young and healthy, but can climb sharply later in life.
- No free family co-insurance — each spouse and child needs their own policy.
- Switching back from PKV to GKV is very difficult (basically impossible after age 55). Decide carefully.
What foreigners should know
- EU citizens: EHIC covers short-term emergencies, but if you stay over 6 months you must enrol in German insurance.
- Non-EU citizens: proof of insurance is required for visa/residence permit. Many people start with travel insurance and switch to a regular policy after Anmeldung.
- Students: under age 30 or 14 semesters get the student GKV rate (around EUR 130/month as of 2026; subject to change). Beyond that, you switch to PKV or regular GKV.
- Long-term care insurance (Pflegeversicherung) is bundled with health insurance and is a separate item (about 3.4%, with an extra surcharge for childless people aged 23+).
Things to watch
- Delaying enrolment leads to back-dated premiums (Beitragsschulden). Register as soon as you arrive.
- English-speaking doctors are concentrated in big cities, and waiting 1–3 months for an appointment (Termin) is common. For emergencies use the ER (Notaufnahme) or call 112.
- Some self-employed people skip insurance to save money — getting caught means heavy back-payments and possible residence permit issues.
Official guidance: Krankenkassen-Zentrale, GKV-Spitzenverband