German health insurance for expats

When you first move to Germany, understanding the structure of the healthcare system and what type of insurance you need as an expat can feel overwhelming. We’re here to help simplify it for you.

There are a multitude of reasons expats choose to move to Germany, including its strong economy, low unemployment rate and availability of English-speaking jobs with good salaries. Germany is also known for its clean and safe cities, green spaces and excellent healthcare system.

In 2022, Germany ranked 4th overall in the World Index of Healthcare Innovation with exceptionally high scores for level of choice, financial sustainability as well as innovative and affordable drug treatments.

In this article, we offer an overview for expats on how the German healthcare system is structured, types of insurance available, and how to determine which type of insurance is right for you.

How the German healthcare system works

Germany has a multi-payer healthcare system, funded by a combination of public and private health insurance.

Since 2009, health insurance has been mandatory for everyone living in Germany, including expats. Around 90% of the population is covered by statutory health insurance or gesetzliche Krankenversicherung (GKV) while the rest of the population are privately insured through private Krankenversicherung (PKV). Providers of both options are regulated by German law to ensure they meet required healthcare standards.

As an expat, you’ll need proof of health insurance before you can register as a German resident and obtain your visa or work permit, and the type of insurance you need varies by visa type.

Temporary visa holders will often qualify for short-term expat health insurance, whereas long-term residents must have a regulated GKV or PKV German policy. If you’re a foreign national with another primary residence abroad, you may also be able to maintain international health coverage which will supplement GKV or PKV.

Therefore, if you are planning to reside in Germany for a significant period, the first step is to understand whether you qualify for GKV or whether PKV is the better option for you based on your income, employment status, and nationality.

Choosing the right German health insurance

Public Health Insurance (GKV)

GKV is a nonprofit, income-based insurance system funded by contributions from both employees and their employers. Around 90% of German residents are enrolled in the GKV system.

Who is eligible for GKV?

Expats working in Germany on a local employment contract are generally eligible (and often required) to join GKV if they earn below the annual income threshold – in 2024, this is €69,300. If you are an employee earning less than the annual income threshold, you will be automatically enrolled into a GKV scheme.

Your GKV contributions will be proportionate to your income level. Typically, this will be 14.6% of your income (with a monthly cap of €683) and your employer will contribute around half this amount. Depending on your insurance provider, you may also need to pay an additional supplemental premium.

If you are self-employed, you are generally not required to join GKV. However, you can choose to opt-in if you were previously covered under a GKV plan in Germany or a similar scheme in another EU country. Self-employed expats with a GKV plan can expect to contribute between 15-16% of their income which may end up being more expensive than private health insurance – especially if you’re young and healthy.  

If you’re an EU/EEA or Swiss citizen, it may be relatively straightforward to transfer your existing public health insurance coverage to the GKV. To do this, you will usually need to complete an S1 form from your current health insurance provider confirming your existing coverage. This will then be converted into a health insurance card by your chosen GKV provider.

GKV will be available to non-EU nationals on long-term visas if they work for a German employer but typically won’t be available to them if they are self-employed without a previous GKV or European public health system history.

What is included in GKV?

Broadly speaking, all GKV policies will provide similar coverage, though there will likely be slight variations in services and level of coverage. GKV coverage tends to be comprehensive, providing access to doctors and hospitals within the GKV network and usually including preventative care, ongoing treatment for chronic illness, routine check-ups, hospital stays, some dental care and mental health services. It will also often be possible to include dependent spouses and children in your coverage for no additional cost.

If you require additional coverage not included in your GKV plan, you have the option of taking out individual private policies to cover services such as dental care, optical care and alternative treatments.

GKV eligibility summary for expats

Private Health Insurance (PKV)

Unlike GKV contributions, PKV premiums are not income-based. Premiums typically start lower than GKV, but the amount you pay will depend on factors such as your age, existing health conditions, required level of coverage and type of health services included.

Typically, PKV offers more flexibility in terms of coverage and is more comprehensive than GKV, though it can become more expensive as you age.

Benefits of PKV can include shorter waiting times for non-urgent care, access to a greater variety of treatment options and more choice in terms of doctors and specialists. When you apply for PKV, you will usually undergo a health assessment to determine your health status and therefore what premium you will pay.

Who is eligible for PKV?

PKV is available to self-employed expats, civil servants, and employed expats earning above the GKV income threshold of €66,300. If you earn below €66,300 you will usually be required to join GKV and cannot opt for PKV.

Self-employed expats are eligible for PKV regardless of income level and sometimes have the flexibility to choose between GKV (if previously insured in an EU public system) and PKV. However, many self-employed individuals choose PKV due to the potential for lower initial premiums and greater flexibility of coverage.

Later down the line, it is relatively easy to make the switch from GKV to PKV if you decide this is a better option for you. However, it is more difficult if you later choose to revert back from PKV to GKV, especially if you are above the age of 55. Therefore, it is important to consider your long-term plans before opting for private health insurance in Germany.

What is included in PKV?

PKV generally provides more extensive and customisable coverage than GKV, such as expedited access to specialist treatment, private rooms if you are hospitalised, dental and optical care, and alternative medical treatments.

The exact coverage you have will depend on the provider and policy you choose, so it is important to ensure you check the details of your policy carefully to understand exactly what is covered. PKV generally does not include coverage for dependent family members, meaning each family member must be insured individually.

PKV eligibility summary for expats

Expat Health Insurance in Germany

Expat health insurance is designed for expats who only intend to stay in Germany for a limited time. It is also commonly used as a temporary solution for newly arrived expats who for whatever reason are not yet eligible for GKV or PKV.

Coverage extends from a few months up to couple of years and tends to be less comprehensive than GKV or PKV. In many cases, expat health insurance is limited to emergency care, outpatient treatment and specified inpatient care only. It will not usually cover routine check-ups, preventative care or specialised medical treatments.

Premiums for expat health insurance tend to be lower than GKV or PKV as coverage is more limited. The amount you pay will be fixed rather than based on income and will usually increase based on the duration of your stay.

It is also important to note that not all healthcare providers in Germany will accept expat health insurance, and that some policies will require you to make an upfront payment for your healthcare costs and claim reimbursement afterwards.

If want to explore your health insurance options in Germany as an expat, speak to our partners Feather Insurance

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