How health insurance works in Germany
Health insurance is mandatory in Germany. Every resident must have some form of cover, whether public or private. This applies to employed workers, students, freelancers, and those who are self-employed.
Germany's system is split into two distinct paths:
Gesetzliche Krankenversicherung (GKV): the statutory, or public, health insurance system.
Private Krankenversicherung (PKV): the private health insurance system.
Understanding the difference between the two is the key to making the right choice for your situation.
Public health insurance (GKV)
The statutory system, known as Gesetzliche Krankenversicherung (GKV), covers the vast majority of people living in Germany. If you are an employed expat earning below a certain income threshold, you will generally be required to join a public fund.
Contributions are income-based, meaning what you pay each month is linked to what you earn. Your employer also contributes a share. Some key features of the public system include:
Contributions split between you and your employer.
Family members can often be added to the same policy at no extra cost.
Cover for a broad range of medically necessary treatments.
Pre-existing health conditions are not taken into account when you join.
The GKV is often the most practical choice for salaried employees and families, as it offers predictable, stable cover.
Private health insurance (PKV)
Private health insurance, known as Private Krankenversicherung (PKV), works differently. Premiums are based on your age, health status, and the level of cover you choose, not your income.
Access to PKV is restricted. It is generally available to:
Self-employed people and freelancers.
Employees whose income exceeds the annual threshold set by the German government.
Civil servants.
Students in certain circumstances.
Private cover can offer advantages such as faster access to specialists, more choice over where you are treated, and a wider range of included benefits. However, each family member needs their own separate policy, which can make it more expensive for families. It can also be difficult to switch back to the public system once you have joined a private fund.
What about international health insurance?
For many expats, particularly those who are not employed locally, international health insurance can be a very practical option. This is especially true if you are a freelancer, a student from outside the European Union (EU), or someone who moves between countries regularly.
An international plan gives you cover that travels with you, so you are not limited to the German system. Benefits can include:
Access to a global network of hospitals and clinics.
Direct billing, so you do not have to pay upfront and claim back later.
Cover for mental health support and specialist consultations.
Multilingual customer support, which can make a real difference when navigating a foreign healthcare system.
At APRIL International, we have been supporting expats for over thirty years. Our international health plans are designed to fit around your life, whether you are based in Germany full-time or splitting your time between countries.
Choosing the right cover for your situation
The right choice depends on your personal circumstances. Here are a few common expat profiles and what tends to suit them best:
Employed expat on a local contract: GKV is usually the default and often the most cost-effective option, especially for families.
High earner on a local contract: you may be eligible to opt into PKV, which can offer broader benefits if you are young and healthy.
Freelancer or self-employed expat: you can choose between PKV and international health insurance, depending on your income and travel habits.
Student from outside the EU: you may be able to join GKV under student rules, or an international student plan may better suit your needs.
Digital nomad or frequent traveller: an international plan is likely to offer the most flexibility, as it covers you across multiple countries.
If you are unsure which route to take, it is always worth reviewing your options carefully before you arrive in Germany.
FAQ: Health insurance options for expats in Germany
Is health insurance mandatory for expats in Germany?
Is health insurance mandatory for expats in Germany?
Yes, health insurance is compulsory for all residents in Germany. Whether you join the public or private system depends on your employment status and income.
Can I use my existing international health insurance in Germany?
Can I use my existing international health insurance in Germany?
In some cases, yes. However, certain visa categories and residence permits require you to hold locally recognised cover, so it is important to check the requirements for your specific situation.
What is the difference between GKV and PKV?
What is the difference between GKV and PKV?
GKV is the public system with income-based contributions and broad access, while PKV is a private contract with premiums based on age and health status and a wider range of optional benefits.
Can I add my family members to my German health insurance?
Can I add my family members to my German health insurance?
Under GKV, dependent family members can often be co-insured at no additional cost. Under PKV, each family member needs their own separate policy, which can significantly increase the overall cost.
What happens to my cover if I leave Germany?
What happens to my cover if I leave Germany?
GKV and PKV policies are generally tied to your German residency. If you leave, you will need to arrange alternative cover. An international health insurance plan can be a more flexible long-term solution if you expect to move again.
