Expat Health Insurance Germany

A Practical Guide: Health Insurance for Expats in Germany

Moving to Germany is exciting, but the health insurance system can feel like a maze when you arrive. Germany has one of the most thorough healthcare systems in the world, and understanding your options is part of settling in smoothly. This guide walks you through what expats need to know about getting health insurance in Germany. For a broader view of the insurance types you may need, see our complete insurance guide for Germany. Most expats also need personal liability insurance, which covers accidental damage you cause to others. You can also compare personal liability insurance plans to find an affordable option.

Why Health Insurance Is Mandatory in Germany

Health insurance is compulsory in Germany. You are either insured in the public system (Gesetzliche Krankenversicherung, GKV) or, if not, you must have private health cover (Private Krankenversicherung, PKV) under § 193 (3) VVG. The rules for compulsory public insurance are in §5 SGB V. You do not need proof of health insurance to register your address (Anmeldung); the registration office asks for your ID or passport and your landlord's confirmation. Your employer needs your insurance details, and if you need a residence permit, the immigration office (Ausländerbehörde) checks that you have adequate health insurance.

The 2026 Income Threshold (JAEG): €77,400

The Jahresarbeitsentgeltgrenze (JAEG) for 2026 is €77,400 per year, or €6,450 per month. The Federal Ministry of Health (BMG) explains the threshold. If you start a job in Germany and your regular annual pay is above €77,400, you are exempt from compulsory public insurance from the start and can choose private cover (§ 6 (1) no. 1 SGB V). If you are already compulsorily insured in GKV, that ends at the end of the calendar year in which your pay goes above the threshold, provided it is also above the threshold for the following year (§ 6 (4) SGB V). Employees below the threshold are generally compulsorily insured in GKV. If self-employment is your main occupation, you are not compulsorily insured in GKV and can choose PKV regardless of income (§ 5 (5) SGB V). Exception: self-employed artists and publicists are usually compulsorily insured through the Künstlersozialkasse (KSK) and can opt out only in specific cases. Civil servants (Beamte) who are entitled to Beihilfe are exempt from compulsory public insurance too (§ 6 (1) no. 2 SGB V).

Application Steps for Different Visa Classes

The right insurance depends partly on your visa or residence status. A few common situations:

• Blue Card holders (high-skilled workers): If your regular gross salary is above the 2026 JAEG of €77,400, you are not compulsorily insured in GKV and can choose private cover.
• Job seeker visa: You typically need an expat or international policy until you get a job; switch to GKV or PKV once your contract is signed.
• Family reunion / spouse visa: If your sponsor is in GKV, family insurance under §10 SGB V usually covers you free of charge.
• Student visa: Students are often required to be in GKV at a reduced rate. PKV is possible but usually only worth it for those with non-standard cases.
• EU citizens: If you have an EHIC and remain insured in your home country short-term, you can use it for emergencies. For longer stays, you'll typically join the German system.

Why Many Expats Choose Private Health Insurance

Some expats choose PKV for practical reasons. Some insurers offer support in English, and tariffs differ in benefits such as hospital rooms or dental cover, so compare the tariff terms before you sign. Want to look at private cover? Compare private health insurance plans.

The Application Process

You can start by requesting PKV offers through our partner's form; the form is in German. Answer every question on the health questionnaire fully. If you leave out a condition the insurer asked about, it can, depending on how serious the omission was, withdraw from the contract, cancel it or change its terms. For health insurance, these rights expire three years after the contract is concluded, but not for insured events that occurred within that time; the period is ten years if the omission was deliberate or fraudulent (§§ 19, 21, 194 VVG). Once the insurer accepts you, you receive your insurance certificate (Versicherungsbescheinigung). For a step-by-step walkthrough, see our PKV application guide.

When Your eGK Card Arrives

After approval, expect a few extra steps before your first doctor visit. Public funds issue an electronic health card (eGK); private insurers send their own insurance card or certificate. You bring this card to doctor appointments and pharmacies. If you need treatment before the card arrives, your Versicherungsbescheinigung or a temporary digital ID typically works as proof. PKV patients sometimes pay first and submit invoices for reimbursement; GKV patients show the card and usually pay nothing at the desk for covered treatments.

Pre-Existing Conditions

PKV underwriting handles pre-existing conditions case by case. Common, well-controlled conditions (allergies, hypertension on stable medication) often lead to standard acceptance, sometimes with a small risk premium. Chronic conditions may trigger waiting periods or partial exclusions for specific treatments. Severe pre-existing conditions can result in rejection by some insurers. If you are eligible for public insurance, the fund must accept you regardless of your health. If you cannot join the public system, a private insurer must still accept you in the Basistarif (§ 193 (5) VVG). Always disclose your full medical history. If you leave out a condition the insurer asked about, it can, depending on how serious the omission was, withdraw from the contract, cancel it or change its terms (§§ 19, 21 VVG).

Costs and Employer Contributions

For employed expats, the employer contributes to private health insurance under § 257 (2) SGB V. It pays half of what it would pay for public insurance, but no more than half of your actual premium. In 2026 the maximum employer subsidy for health insurance is €508.59 per month, provided the policy meets the requirements of § 257 (2a) SGB V.

Self-Employed and Freelancer Routes

If you're self-employed or a freelancer, you pay the full premium yourself. PKV is often attractive here because contributions are based on your tariff (not your income), so a young, healthy freelancer can find lower premiums than a comparable GKV setup. The BaFin oversees PKV insurers; you can read more about the regulatory framework on the BaFin website. Industry-wide statistics on PKV are published by the GDV (German Insurance Association).

Beyond Health: Protecting Your Family

Health insurance covers medical costs, but what happens to your family financially if something happens to you? Especially if you're the main earner, term life insurance in Germany can fill that gap. To find a plan that fits your situation, you can compare life insurance options. Many expats also add accident insurance for leisure-time accidents, which the statutory system does not cover.

Add-On Coverage: A Budget-Friendly Alternative

If you're happy in GKV but want a few extras, supplementary health insurance tops up your statutory cover with extras like better dental, private hospital rooms, or vision benefits.

Finding English-Speaking Doctors

You can find doctors who speak English through the 116117 doctor search (Arztsuche), which can filter by foreign language. Doctolib and Jameda also have a language filter with English as an option.