- Health insurance is not just a choice, but a legal requirement in Germany. This applies to everyone, including expats who live, work, or study in the country.
- The 2 pillars of health insurance in Germany are statutory health insurance (GKV) and private health insurance (PKV).
- Your income and employment status are key factors in deciding between statutory or private health insurance in Germany.
- Freelancers, self-employed individuals, and partially students can choose between the statutory and private health insurance systems.
- If employed, your employer pays 50% of your health insurance contributions.
- Supplementary insurance—for dental treatment and hospital stays, for example— offers the same coverage as private insurance.
Introduction: Why this article?
In Germany, health insurance is mandatory. This means everyone in the country must have health insurance, regardless of origin, profession, or residence status. For expats, this is often one of the first hurdles they face upon arrival: How does the system work? Which insurance is right for me?
The German healthcare system is based on 2 pillars: statutory health insurance (GKV) and private health insurance (PKV). Most people in Germany are covered by statutory health insurance, especially employees with low to medium incomes and many students. On the other hand, private health insurance is primarily an option for civil servants, freelancers and the self-employed, and employees with above-average incomes. Which option is right depends on several factors – we will show you what is essential.
This guide is designed to help you navigate the German healthcare system. It explains the basic structure of health insurance, guides you through the process of choosing between statutory (GKV) and private health insurance (PKV), and provides specific information for different situations – whether you are coming to Germany as an employee, self-employed person, student, or with your family.
Is Health Insurance Mandatory in Germany?
Yes, absolutely. In Germany, everyone is required by law to have health insurance, whether they are permanent or temporary residents. Compulsory health insurance in Germany was introduced in 2009. It aims to ensure equal access to medical care for all people while strengthening the public health system.
If you’re in Germany without health insurance, you’ll have to pay additional contributions for the uninsured period. Interest on the outstanding amounts and late payment penalties will also be added. Moreover, you’ll have to pay for medical treatment, which can be financially burdensome, especially in an emergency.
Therefore, expats must secure their health insurance early. Without proof of insurance, you’ll also face difficulties with other official procedures. For instance, you won’t be able to apply for or extend a residence permit or enroll at a university without health insurance.
During short stays in Germany, citizens of EU countries can receive medical treatment with the European health insurance card. The EHIC covers necessary medical services if you are still covered by health insurance in your home country. However, it does not apply if you move to Germany permanently and work or study here. In this case, you must take out health insurance in Germany.
The Two Pillars: Statutory (GKV) vs. Private (PKV) Health Insurance
In Germany, the healthcare system is based on a dual insurance system: statutory health insurance (GKV) and private health insurance (PKV).
Choosing between these two systems is often one of the most important decisions expats must make when moving to Germany. Both models work very differently, and the option that is right for you depends on your circumstances.
Statutory Health Insurance (GKV)
The GKV is the standard solution for most people, especially middle-income employees, students under 30, pensioners, and the unemployed. The statutory system delivers basic health insurance.
Who is eligible for statutory insurance?
- Employees with an income below the insurance obligation threshold
- National and international students
- The unemployed, pensioners, and other groups covered by social insurance
How does it work?
Statutory health insurance is based on the solidarity principle. The GKV system covers around 88% of all residents in Germany.
Contributions are income-based and currently (2025) amount to 14.6% of gross income. In addition, supplementary contributions average 1.6%, which the health insurance funds use to finance various additional services.
Particularly favorable contribution rates apply to student health insurance.
Employees with an income above the insurance obligation threshold, freelancers, self-employed individuals, and students over 30 can take out voluntary statutory insurance or switch to private insurance.
A major advantage of statutory health insurance is that spouses and children can be covered free of charge under family insurance if they have no or only a small income. This also applies to students under 25 whose parents are covered by statutory insurance in Germany.
If you want to take out statutory insurance in Germany, you can choose between 94 statutory health insurance providers that offer their members uniform standard benefits. Any services beyond this will not be reimbursed.
Statutory health insurance provides solid basic medical care. Standard benefits include:
- Outpatient and inpatient medical treatment
- Dental treatment
- Psychotherapy
- Medication, remedies, and aids
- Medical rehabilitation
- Home nursing care
Learn more here about statutory health insurance (GKV).
Private health insurance (PKV — Private Krankenversicherung)
Private health insurance is the second pillar of the German health care system. Benefits and premiums are agreed in individual contracts.
Who can take out private insurance?
- High-earning employees with an income above the insurance obligation threshold
- Civil servants
- Freelancers and self-employed people
- Students at the start of their studies and over 30
How does it work?
Like statutory health insurance, private insurance only covers medically necessary services. However, it offers significantly broader coverage options. Privately insured patients decide which services are important to them and have the option of purchasing tailor-made insurance coverage.
Many plans also cover alternative treatments and special services during hospital stays (treatment by the head physician, double or single room). Another advantage of private insurance is that getting specialist appointments is often much easier.
Premiums for private health insurance are set individually and are risk-based. They depend on the insured’s age and state of health at the policy’s start, on coverage, and agreed-upon deductibles.
Family members cannot be insured free of charge under private health insurance. Each insured person must pay separate premiums.
You can explore private health insurance options here.
Info: Take out private health insurance as early as possible (info box)
If private insurance is an option, you should take out a policy as early as possible. Young, healthy applicants can expect particularly favorable insurance premiums from most providers.
Key Differences between Statutory and Private Health Insurance
| Aspect | GKV | PKV |
|---|---|---|
| How contributions are calculated? | Based on income (approx. 14.6% + additional contribution, split with employer) | Based on age, health status, and selected coverage |
| Family insurance | Spouse and children are often included at no extra cost | Each person needs a separate (paid) policy |
| Eligibility | Mandatory for employees earning below the income threshold | Optional for high earners, freelancers, civil servants, and some students |
| Coverage scope | Defined by law, covers standard medical services | Contract-based, often includes enhanced or premium services |
| Cost development with age | Regulated and subsidized via solidarity system | Can increase with age (partly offset by aging reserves) |
| Access to doctors and hospitals | Free choice, but longer waiting times for specialists are possible | Often faster appointments, access to top-tier providers and private practices |
| Billing method | Doctors bill the insurance provider directly | Patients pay their medical bills upfront and get reimbursed |
| Returning to public insurance | Often difficult or not allowed,especially after age 55 |
See here a detailed comparison of Germany’s statutory and private health insurance.
Who Qualifies for Which System?
Whether employees must have statutory insurance or can choose a private policy depends on their gross income.
The insurance obligation threshold (compulsory insurance limit) for employees is set by law and adjusted annually. Currently (2025), it is €73,800 per year or €6,150 per month. Anyone employed and earning less than this amount must take out statutory health insurance.
Info: Insurance obligation threshold versus contribution assessment ceiling (info box)
The insurance obligation threshold defines whether employees can take out private insurance. This is different from the contribution assessment ceiling. It defines the maximum gross income on which statutory health insurance contributions are calculated. Any income above this threshold is not subject to additional contributions. In 2025, this ceiling is set at €66,150 per year or €5,512.50 per month.
On the other hand, civil servants, freelancers, and self-employed people can decide whether to take out statutory insurance or a private policy regardless of their income.
During the first 3 months of their studies, students can decide between statutory student insurance or PKV and are then bound to this choice until the end of their studies or until they reach the age of 30.
Check here your GKV eligibility.
Check here your PKV eligibility.
Health Insurance for Specific Situations
The requirements for optimal health insurance depend largely on personal circumstances and can change over time. Navigating the German health insurance system can be particularly complicated for expats who are new to Germany.
We have prepared a comprehensive Health Insurance Guide for Expats, which provides detailed information. Here, we provide a brief overview of aspects that are particularly important for your insurance decision.
Students can be insured under the statutory student health insurance scheme until they reach the age of 30. Subsequently, they can voluntarily take out statutory insurance, albeit at higher contributions than student insurance, or switch to a private insurance provider.
Learn more about student health insurance options (GKV & PKV) here.
Freelancers and self-employed individuals mostly opt for PKV, but can also voluntarily insure themselves under the statutory health insurance system.
Find out more about insurance for freelancers here.
For families, statutory health insurance is often the better option due to the possibility of contribution-free family insurance for non-working spouses and children. However, you can also find attractive offers for yourself and your family members from private insurers.
Our Family Health Insurance Information will help you decide between statutory and private insurance and explain important aspects of both systems.
Enhancing Your Coverage: Supplementary Insurance
Statutory health insurance (GKV) offers solid basic coverage, but many services are limited to what is medically necessary. Even with private health insurance (PKV), coverage gaps may exist depending on your chosen plan. Supplementary insurance offers the option of closing these gaps and improving your coverage.
Supplementary dental insurance: the most important addition
Dental treatment, especially dentures or orthodontics, is one of Germany’s most expensive medical services. Statutory health insurance dentists only provide care based on the standard coverage defined by public insurance, which often excludes high-quality materials or advanced treatments. A dental supplement plan can help close these gaps.
Therefore, it is no surprise that supplementary dental insurance is the most common form of supplementary policies. Depending on the plan, it covers many out-of-pocket costs for professional teeth cleaning, crowns, inlays, implants, or high-quality braces.
Improve your dental insurance coverage.
Other supplementary insurance options at a glance
- Supplementary hospital insurance (e.g., private room, treatment by a chief physician)
- Supplementary outpatient insurance (e.g., alternative healing methods, extended preventive care)
- Travel health insurance for stays abroad
- Glasses and eye insurance for visual aids and refractive surgery
- Accident insurance for medical treatment and financial compensation after accidents
Discover more supplementary insurance options.
Next Steps & Finding Providers
Now that you have a clear overview of the German health insurance system, it’s time to take the next steps: Compare providers and plans based on your situation. Use our in-depth guides to explore your options – or use our comparison tools to evaluate premiums, coverage levels, and additional benefits.
Compare statutory health insurance providers.
Compare private health insurance providers.
Compare dental insurance providers.
Conclusion
Choosing the right health insurance plan is one of the most important decisions for your life in Germany – whether you’re an employee, freelancer, student, or family member. Our detailed guides are designed to help you navigate the system and make well-informed choices. Use the available resources to tailor your health coverage to your individual needs.
Frequently asked questions — FAQ
Yes, there are a few exceptions. This applies, for example, to participants in language courses and preparatory programs who are not enrolled at a university, or visiting scholars who are not in regular employment with a university. They require a private policy, also available as special expat insurance from insurers such as ottonova or Feather.
For employees, the employer pays 50% of health insurance premiums, regardless of whether you have statutory or private insurance. However, an upper limit is based on the contribution assessment ceiling for statutory health insurance.
In principle, yes. Private health insurers can reject applicants due to high risks, such as serious pre-existing conditions. Alternatively, risk surcharges may be levied, or certain illnesses may be excluded from insurance coverage. However, health insurance companies assess existing risks very differently in some cases, so that those affected still have the chance to find suitable insurance. In contrast, statutory health insurance funds are not allowed to reject anyone who meets the basic requirements for public health insurance.