Health Insurance in Germany: A Guide for Expats
Your available route depends on employment, income, previous insurance, residence and other legal conditions. Not everyone can freely choose between GKV and PKV.
Law and 2026 values checked 13 October 2026
Four structures
Products that must not be treated as interchangeable
Statutory health insurance (GKV)
Legal membership rules, income-related contributions up to a ceiling, statutory benefits and fund-specific supplementary contribution rates. Eligibility is determined by law, not simply preference.
Private full health insurance (PKV)
A contract-based full-cost policy. Entry, premium and scope can depend on age, health assessment and tariff. Eligibility to apply is not an acceptance guarantee outside statutory special regimes.
Incoming or travel insurance
Usually time-limited and purpose-specific. A policy accepted for a short-stay visa is not automatically equivalent to GKV or substitutive PKV for long-term residence.
Supplementary insurance
Private add-on cover for defined gaps or preferences. It supplements rather than replaces the underlying full health-insurance route.
Care insurance
Health cover and long-term-care cover are linked but distinct. Private full-insurance customers generally need private mandatory care insurance.
EHIC
Evidence for medically necessary care during a temporary stay under coordination rules—not a blanket German resident policy, planned-treatment cover or repatriation insurance.
Life situations
Access questions differ by status
Employees
Employees are generally GKV-compulsory unless an exemption applies. For 2026, the general annual earnings threshold is €77,400. Regular expected pay—not merely a retrospective total—matters.
Self-employed people
Mainly self-employed people are generally outside employee-based compulsory insurance. GKV access can depend on prior membership, continued voluntary cover or another statutory route; self-employment is not a universal free-entry ticket.
Students
Students are generally subject to student insurance until age 30, subject to statutory exceptions. A timely exemption can have lasting consequences and is not freely revocable.
Family members
Spouses, registered partners and children may qualify for contribution-free family insurance if all legal residence, status and income tests are met. Unmarried partners are not included merely by living together.
New arrivals without a job
Previous cover, applicable German or cross-border law, residence title and other protection determine the route. Do not cancel foreign cover before written continuation is clear.
Previously insured abroad
EU/EEA/Swiss or agreement rules can affect classification. Nationality, residence title and insurance history must not be collapsed into one assumption.
Public vs private health insurance Germany
Compare mechanisms—not a universal winner
GKV
- Contributions generally linked to assessable income up to the contribution ceiling.
- Employer and employee generally split employment-based health contributions, including the fund-specific add-on.
- Eligible family members can be insured without a separate contribution.
- Benefits follow statutory rules; funds can differ in add-ons and service.
- Care insurance is charged separately.
PKV
- Premium depends on entry age, health and selected tariff—not current salary alone.
- Each family member generally needs separate cover and premium.
- Benefits, deductibles, reimbursement and exclusions follow the contract.
- Normal tariffs can involve health questions, risk surcharges or rejection.
- Private mandatory care insurance is separately required.
2026 thresholds
JAEG and BBG do different jobs
The 2026 general annual earnings threshold (JAEG) is €77,400. It helps determine employee insurance exemption. The health and care contribution ceiling (BBG) is lower at €69,750 annually / €5,812.50 monthly; it caps contribution assessment.
Earning above the JAEG does not force a PKV switch. Continued voluntary GKV may be possible. The special 2026 JAEG of €69,750 applies only to a protected legacy group defined by law.
Contribution rates used below
- General GKV rate: 14.6%.
- Assumed 2026 average add-on: 2.9%; actual fund rate differs.
- Care rate in the example: 3.6% for one child, outside Saxony.
- Childless surcharge and multi-child reductions are not used.
Checked employee example
€5,000 monthly gross salary in 2026
Assumptions: compulsory GKV employee, €5,000 monthly gross, general 14.6% rate, assumed 2.9% average add-on, one child, 3.6% care rate, outside Saxony, no special contribution treatment. Salary is below the €5,812.50 monthly BBG.
Total health contribution
€5,000 × 17.5%. Employee €437.50; employer €437.50.
Total care contribution
€5,000 × 3.6%. Employee €90.00; employer €90.00.
Employee total
Health €437.50 + care €90.00. Employer total is also €527.50 under these assumptions.
Family cover
Contribution-free does not mean condition-free
Section 10 SGB V requires, among other things, domestic residence or habitual stay, no overriding own membership, no main self-employment and income below the applicable limit. In 2026 the general monthly income limit is €565; the limit for marginal employment is €603.
Children can be excluded where the non-GKV parent is the higher earner and exceeds the statutory threshold—but all legal conditions must be tested. “One parent is private, so children must be private” is too broad.
PKV household planning
Private full insurance does not automatically include a spouse or children for free. Each person’s eligibility, health cover and care insurance must be checked, along with employer-subsidy limits and maternity/parental-income scenarios.
Incoming, travel and residence
Visa acceptance is not permanent-system equivalence
Schengen short stay
The Federal Foreign Office describes travel health insurance with at least €30,000 cover for Schengen short stays. This rule is not the general standard for a national visa or long-term German insurance.
Residence permission
Residence law treats sufficient health cover as part of secured livelihood. The competent mission or immigration authority assesses the concrete evidence for the residence purpose.
Contract scope
Check duration, termination on residence change, outpatient/inpatient scope, exclusions, deductibles, pre-existing conditions and whether long-term care is included. A label such as “incoming” proves none of these alone.
Switching and leaving
Decisions can shape access for years
GKV to PKV
Crossing an income threshold creates no recommendation. Consider family premiums, tariff benefits, deductibles, future premium capacity, care cover and return restrictions before existing protection ends.
PKV to GKV
A return is not freely available on demand; a statutory insurance route is required. After age 55, Section 6(3a) uses a multi-part test involving the previous five years—not an absolute age-only ban.
Internal PKV tariff change
BaFin explains that acquired rights and ageing provisions are considered for comparable internal tariff changes; extra benefits can trigger additional underwriting.
Long stays abroad
EHIC, GKV coordination and PKV territorial cover follow different rules. A German policy does not guarantee unchanged worldwide cover or reimbursement.
Permanent move
Destination, applicable coordination law and contract terms can change continuation. Ask both current insurer and competent authority before moving.
No coverage gap
Do not cancel current cover before the next insurer confirms acceptance, start date, evidence and any care-insurance requirement in writing.
Registration checklist
Clarify status and evidence before choosing a tariff
Define your status
Employment, expected regular income, self-employment, study, family role and residence purpose.
Map previous cover
Country, insurer, statutory/private classification, dates and cross-border entitlement documents.
Ask the competent institution
Employer, chosen statutory fund, private insurer, DVKA or immigration authority—depending on the question.
Compare full costs
Health plus care, family members, deductibles, excluded services and employer participation.
Check binding language and dates
Contract language, start date, waiting periods, proof, cancellation and continuity.
Protect sensitive documents
Send health, identity and insurance records only through the official channel requested by the responsible institution.
Primary sources
Law and official guidance checked 13 October 2026
Year-dependent figures are labelled 2026. No automatic legal or contribution update is claimed.
Evidence pack
Documents often needed to determine the route
Prepare verifiable facts
Keep the employment contract and regular-pay components, university enrolment, self-employment start date, German registration or residence documents, marriage and birth certificates where relevant, and a dated record of previous insurance. Cross-border cases may require an EHIC, S1 or another institution-specific confirmation; the right document depends on the applicable coordination rule.
A translation may help communication but does not change the legal nature of the original evidence. Ask the receiving institution whether it requires a certified translation, original, copy or digital submission.
Obtain written confirmation
Before cancelling existing cover, request written confirmation of the legal membership or contract start date, included family members, health and care components, contribution or premium basis, and any outstanding evidence. For private applications, distinguish an indicative price from final acceptance after underwriting.
Keep immigration evidence separate from the insurance contract: a document accepted for one visa stage does not itself prove indefinite insurance eligibility, and an insurer’s acceptance does not decide the residence authority’s evidence test.