Health insurance in Germany

Germany is often praised for having one of the best health insurance system in the world. It may very well be true but it also very complex! I have also struggled to understand it when first arriving here so i thought i’d share my experience in this overview covering the different types, and what to do if you need one of a residence permit. 🙂

health insurance in germany residence permit

Health insurance in Germany: efficient but complex

In some countries, health insurance is managed by the government as a public service, and in some others it is purely a private service. Germany has a hybrid & interesting system.

The German state has delegated around 300 insurance companies to manage it’s population’s health coverage. They all work under a contract with the state, can be public or private and are called “Krankenkasse”. Let’s try to understand how health insurance in Germany works.

The different provider types

There a 3 kinds of health insurance in Germany you can be under: Gesetzlich, Freiwillig or Privat.

This table aims at providing a quick overview. Read on for more details.

Public (Gesetzlich or GKV) Voluntary public insurance (Freiwillig) Private insurance – (Privat or PKV)
Who it is for– Employees earning less than 56k€/year– Employees earning more than 56k€/year
– Freelancers
– Employees earning more than 56k€/year
– Freelancers
– People that don’t qualify for public
Costs – 14,80 % – 16,30% of gross income– 14,80 % – 16,30% of gross incomeBased on health profile
Pros– 1/2 of costs paid by employer
– contribution follows your income
– covers household members at no extra cost
– contribution follows your income
– covers household members at no extra cost
– Shorter waiting times
– Better access to specialists
– Better treatment quality in some cases
– Included extras
Cons– Longer waiting times
– Sometimes only partial treatment coverage
– Sometimes lower priority at hospitals.

– Longer waiting times
– Sometimes only partial treatment coverage
– Sometimes lower priority at hospitals.
– Unpredictable rates long-term
– Pay extra for partners or kids
RemarksMostly suited for people with a very safe pension plan and income safety net or for people with no other option at the moment.

1- Public insurance – Gesetzlich (GKV)

Gesetzlich (versichert) also called pflicht(versichert) is most typical coverage as it compulsory for people earning less than 56K€ a year. Typical situation: you will be insured by a public insurance company that your employer will likely pick for you, if it is your first job in Germany. Your employer will directly take over the payment of the coverage by paying its share and yours through your wage. The rate is set by law between between 14,80 % and 16,30% of your gross income.

The good news is that what you pay is directly related to what you earn so if you face a sudden decrease in income, the fee will also decreasing. If you have people with no income in the household (kids or partner for example), being with the public system is really good because you cover them with your own policy at no extra cost.

Some drawbacks come with it though. Practitioners tend to prioritize private patients over public ones since they get paid better/faster. This induces longer waiting times when trying to get an appointment. If you go the hospital it’s also not guaranteed that your case will be followed by the most experienced doctor or that you get a private room, as it’s the case with private coverage usually. Also, expect some treatments to be only partly covered. For example when filling a tooth at the dentist; only the standard filling will be covered and not the higher quality more expensive one. In this case, you’d need to pay extra from your pocket.

2- Voluntary public insurance – Freiwillig

Freiwillig (versichert) is basically the same at Gesetzlich except that you earn more than 56K€ a year. You will then pay your whole share directly to your Krankenkasse. This has for the effect to increase your gross salary, since your employer is not paying for you share anymore. This can also mean that you are self-employed and choose to stay in the public system, to make use of its advantages, despite the higher costs compare to private coverage.

3- Private insurance – Privat (PKV)

Privat (versichert) means that you choose to insured at a private Krankenkasse provided you earn more than 56K€ a year or don’t qualify for the public system for any number of reasons. The fees applied by private Krankenkassen are usually lower than in public ones for a better coverage when you are a young healthy person, but it increases over time based on your health profile.

Indeed, in the public system, the contribution depends on what you earn. In the private system however, the fee depends on your health risks. So the more you age and/or have conditions, the higher the costs will become. Basically, you need to decide for yourself it’s worth the savings.

Private Krankenkassen have more complex offers than public ones in terms of what get covered and so on, so choose wisely. You also get different advantages like reduced waiting time at the clinic or at-home nurses. However, it does come with drawbacks. If you have people with no income in the household, you have to pay extra for each them too. Coming back to the public system after being in the private one is also extremely difficult if not impossible for freelancers.


The costs

Health insurance in Germany is efficient, but still costly for individuals.

In the public system

As stated earlier, being with the public system means that between 14,80 % and 16,30% of your income will be use to pay for your health insurance in Germany. As an employee, half of it is paid by you, and the other half by the employer. Some figures to get an idea:

  • Depending on your Krankenkasse and your income, you usually pay directly or indirectly a minimum of 180€ per month.
  • This rate falls down to 70-90€ for students enrolled at a Germany university (aged under 30), depending on a few things.
  • As a good earning freelancer in the public system, the bill can even reach up to 602,25 €, the maximum monthly contribution. This corresponds to a monthly earning of 4.125 €.

I’m coming from a country where social and health insurance is provided for free to all, so it came a bit as a shock the first months as you can imagine.

The biggest companies for public health insurance in Germany are : Techniker Krankenkasse, AOK : Allgemeine Ortskrankenkasse, BKK: Betriebskrankenkasse, IKK : Innungskrankenkasse, LKK : Landwirtschaftliche Krankenkasse, etc…

A minority of people also decide not to take coverage because they cannot afford health insurance in Germany. However this is illegal and i strongly advise against doing such thing.

Rates for private health insurance in Germany

Public Krankenkassen offer more or less the same amount of service across the board for roughly the same price. This is however not the case for private Krankenkassen. Think about how internet providers have different plans and different level of services; the market is more complex and more diverse. You need to pay attention, explore the market and pick something that suits your needs. A good place to do that are comparison platforms like TarifCheck or Preisvergleich. It lets you pick options to define what coverage you want. These are:

  • If you want additional coverage like teeth, vision, alternative medicine (Zusatzleistungen).
  • On the financial side, how much deductible you can afford (Selbstbeteiligung).
  • If you have to stop working for a while, when should a daily sickness allowance should kick in, and how much it should be (Krankentagegeld).
  • If you stay at a hospital, do you wish to have a private room, be handled by the head doctor, etc. (Krankenhausleistungen).
  • If additional household members should be covered.

Coverage abroad

Of course when you go home to visit your family and simply go abroad for holidays in Europe, your German health insurance will cover you and giving your reference number should be enough to be reimbursed in the end. Be careful though, you will be reimbursed at the rate that is considered normal for that particular treatment in Germany, so while it will probably cover most of the costs, the rest will come from your pocket in some cases.

The German healthcare system: a visual allegory. 😉

How to sign up for public health insurance in Germany

There are a number of ways to sign-up once you have made a choice. You could go to one of their offices or download a form on their websites. If you are in a hurry and need a certificate to start working or to apply for a long-term visa, you can sign-up for TK online, in only a few minutes via this form (100% in English).

The Techniker Krankenkasse has consistently been rated the best Krankenkasse for almost 10 years a row. A sure choice. And they are able to offer some guidance in English too, when needed.

If you are an artist, a writer, performer: think KSK

The German government knows it hard to make a living when being an artist. Paying an expensive health insurance on top of everything else is not easy. That’s why Künstlersozialkasse (KSK) exists. If you are able to prove your main occupation is to live from artistic and creative jobs, the KSK will pay half of your current fees every month (only if you are part of the public system). The tricky part is that there is not a clear distinctions between what’s a art job and what’s not so it might be hard to get into it. Some people hire specialists to fill in the paperwork to make sure they tick the right boxes.

A useful tip for freelancers when you are moving from another EU country

In some cases, especially for people who move to Germany to start as a freelancer, a public Krankenkasse might be reluctant to take you on. This because you might need to prove that you contributed to the public system in your home country. This procedure is normalized via the form E104, which you should request from your domestic system, before you leave the country. This form is a statement of your contributions for them to be transferred to the German system.

There is no need to download and fill it in yourself, this is done by your local health insurance provider and then sent to you. It is then your responsibility to communicate this document to your chosen Krankenkasse.

Taking on a German health insurance for residence permit or other visas

If you are not an EU citizen and you love Germany so much that you plan to stay to study or for a job, you will need to show that you have chosen an health insurance in Germany. It is required to obtain a residence permit or even enroll in a university. Germany is usually not very good at recognizing non-EU systems so make sure your health insurance is valid for the German system.

For a lot of foreigners applying for a German visa here for all sort of reasons, the solution here will be to sign-up for a German travel insurance provided by a German company, also sometimes called incoming insurance for Germany. This makes sure that the insurance policy complies with the minimum requirements expected by the authorities. It can be classified as a private health insurance in Germany but for limited stays for up to 5 years.

This is a temporary solution to sort out your residence status, most people switch to a local Krankenkasse afterwards.


If you want to study in Germany

If you are under 30 and enrolling in a university program in Germany, you have to take on a German public health insurance. This has a lot of benefits and costs only 81€ a month. It doesn’t happen automatically when you register at the university though. You have let the university know which Krankenkasse you picked. This is unfortunately only possible when you have registered an address in the country. If you are not able to join the public system for whatever reason, it is also possible to join a private insurance.

If you are self-employed

If you are running your own show, paying a Krankenkasse with everything else can be major hole in your monthly budget. This is definitely of the drawbacks of the German system; low-earning self-employed people pay a relatively high amount for their health insurance in Germany. If you have been in a public scheme within the E.U recently, you might to choose what is called a Freiwillige gesetzliche Krankenversicherung. This means that you stay in the public system, which is advised for people with kids and spouses.  For others, it is advised to stay with the private system.

I hope this little run-down helped you to understand the German health insurance system and make a better choice for your own coverage. Good luck.

Tip 1 : If you are lost on how to apply to a Krankenkasse and you plan to be a full time employee, you can often ask for help to your colleagues or to any administrative assistant that may exist in your company. They can be very helpful. In reality, you will most likely have to go on the chosen Krankenkasse website and open an “account” there. You will get a document that says that you subscribed to their coverage, you’ll send it to your company and poof ! There you go! Your employer will take care of the rest.

Sources: Ministry of Education & Research, More info on benefits and the state health system on its website here.

274 Comments

  • Reply Akshay 16/10/2019 at 11:01

    Hello Bastien,

    Greetings of the day & thank you for the comprehensive post!

    I have the following situation:
    Since Oct’18 I have been a MBA student in Germany & during the start of our MBA program, I opted for the TK public health insurance (EUR 94/month)
    Now, since our MBA is done & I will be opting for a job-seeking VISA hereafter, the TK representatives mentioned that I will have to take up a “voluntary” TK insurance which costs around EUR 186 per month which is very expensive for me.
    What are the cons of moving to a more cheaper private insurance at this point?

    • Reply Bastien - Settle in Berlin 21/10/2019 at 21:39

      Hey Akshay. That’s a decision to take for yourself but 186€ is actually fairly cheap and you won’t find something soooo much cheaper in the private. Presumably, you will only be looking for a job for a few months as well, as which point it will be paid through your salary. But by all means, shop around. 🙂

  • Reply Rich 11/09/2019 at 09:00

    Hi Bastien,

    I am planning on moving to Germany next year. While I will still be looking for a job across the startup sector in Berlin, do I need to register for insurance right away or can I file for insurance as soon as I find employment?

    Please note that I am a German citizen moving back to Germany for the very first time

    • Reply Bastien - Settle in Berlin 17/09/2019 at 10:55

      Hey Rich. Your nationality does not bear any influence on this. You need to have insurance at all times when you are in Germany yes.

  • Reply Carl 07/09/2019 at 18:46

    Hello Bastien,
    thanks a lot for your advice, very helpful.
    I have recently moved to Germany for a paid internship and I am confused about whether I should apply for a health insurance provider before my internship starts, or if my employer will do for me (choose the provider). So far the HR didn’t ask me any information.
    Thanks

    • Reply Bastien - Settle in Berlin 08/09/2019 at 16:00

      Hey Carl. It depends this internship is part of your curriculum at the University. If so, then you are covered by your student plan, if you also study at a German university at the moment.If you don’t have a provider at all, you can either sign up for something first or let your employer do it for you.

  • Reply Anamika 02/09/2019 at 12:31

    Hi ,
    I have a complex case.
    i was under TK from June 2015- Jan 2016. Then i left Germany and came back as a student. In 2o17 i was not insured by TK because i was a student and more than 30 years of age so i went with Private Mawista. Now in 2019 i graduated and got a full time job, but still TK denies to Insure me stating i did not opt them earlier (which they denied). And now my employer wants me to be in a statutory health insurance. What are my options? Where do i go finally.

    • Reply Bastien - Settle in Berlin 08/09/2019 at 15:47

      Hey Anamika. I honestly think that you are qualifying for TK, since you had statutory insurance in Germany before. Is this due to miscommunication or something? I’d recommend to get in touch with the guys at Popsure. They are handling cases like this the whole time.

  • Reply Paige 05/08/2019 at 18:36

    My husband works full time and pays insurance monthly covered half by his company and half by him. Am I covered on his insurance as his wife? I am unemployed at the moment and don’t earn anything but I would like to start freelancing in Germany – would I still be covered if I applied for and started using my Steuernummer as a freelancer in Germany or would I then need to pay my own insurance? Worried about potentially doing something illegal unknowingly but need to make sure before I start paying a lot of money I don’t have toward insurance.

    • Reply Bastien - Settle in Berlin 09/08/2019 at 16:21

      Hey Paige. If he belongs to the public system, then his policy would cover you as well, as a member of his family with no income. If you start freelancing, you would need to get your own coverage.

  • Reply a confused being 15/07/2019 at 22:14

    I am 31 and going to start MA in this winter. what could be the best plan for me? do i have access to public plans?

    • Reply Bastien - Settle in Berlin 16/07/2019 at 09:55

      Hey there. Since you are over 31, you would not be able to qualify for the cheap public plan (81€ per month). You can still sign-up for public, but the fee will be higher.

  • Reply Jonatham 17/06/2019 at 23:10

    I was hospitilized for half day but in a period when I didnt have an insurance, because I was changing my insurance and I aftee 5 days that O was in the hospital and choose one. What is the worst case in this situation. I am so worried.

    • Reply Bastien - Settle in Berlin 18/06/2019 at 11:24

      Hey John. Even though you were changing Krankenkasse, you were probably still covered by one or the other. Did i misunderstand something?

  • Reply Stephen Firth 08/06/2019 at 15:53

    Hi there. I’ve recently moved to Berlin from UK and it’s fair to say I’m confused by the health insurance thing as I’ve been looked after by the NHS all my life. I’m self employed currently still doing my job I had in uk but with a Berlin postcode. I don’t earn much ( well under 56k) so I’m looking for the €170 per month cover. I’m anmelded and have a tax code. Who would be the best to contact and how do I go about it? AOK or TK?
    Great read by the way. Thanks

    • Reply Bastien - Settle in Berlin 12/06/2019 at 15:45

      Hey Stephen. Both are good options but TK is known to have more English-speaking operators, if your German is a bit rusty.

  • Reply patrick 04/06/2019 at 16:03

    hey, thanks for the article – so i have a question, ive recently been offered a job i’d really like to do, however it would be working freelance (with autistic children) and not much money. i would definetly by my calculations earn less than the minimum limit/’Mindestbemessungsgrundlage’ of 1,038 – does this mean that I dont earn enough to pay health insurance on that income, or that i’d get some subsidized/pay less? (ive been until now insured by SBK)

    any help would be super helpful as im struggling to figure this out

    cheers 🙂

    • Reply Bastien - Settle in Berlin 05/06/2019 at 12:07

      Hey Patrick. Yes unfortunately, this means you would just pay the sum equivalent of the “Mindestbemessungsgrundlage”, even though you earn less.

  • Reply Brent Walker 28/05/2019 at 03:09

    Hi Bastien, i am trying to understand the German private health insurance system. A German friend came to Australia for his gap year, while he was in Australia and after he returned to Germany he was covered under his father’s private health insurance. He had a bad car accident in Australia and has suffered a disability that will be with him for life. After uni, when he establishes his own health insurance policy will he have to pay an increased premium with the same insurer if the cover is the same as what he is currently covered for? If he decided on a different insurer would he then have to pay a higher premium because of his disability?

    • Reply Bastien - Settle in Berlin 28/05/2019 at 11:02

      Hey Brent. As mentioned in the post; public system is based on income, private system is based on risks. The private system is wild and each company have their own pricing policy. The only way to answer to your question is to ask for a quote from each of them.

      • Reply Brent Walker 29/05/2019 at 05:11

        Thanks Bastien

  • Reply Andrew 22/05/2019 at 10:21

    Hello Bastien, this was a very informative and easy-to-find article on Google. Thank you for that.
    One ☝️ question please: I am self-employed, non-EU, with Mawista health insurance. I am now employing my wife and as an employee she will have public insurance.Does that mean our child and me will be covered by her health insurance now? I don’t see why not, but I also feel it isn’t that easy.

    • Reply Bastien - Settle in Berlin 28/05/2019 at 10:42

      Hey Andrew. Only your child would be covered by your wife’s policy.

  • Reply pico 21/05/2019 at 15:36

    I accidentally registered with both DAK and TK. I don’t speak German so I thought they were the same. Am I in trouble? What do I do?

    • Reply Bastien - Settle in Berlin 22/05/2019 at 10:00

      Hey Pico. If you are still within the 14 days of signing the contract, you are probably able to cancel any of them without providing any justification.

  • Reply Damian 13/05/2019 at 21:30

    Hi
    I am settling in Berlin with my wife who is a resident and has EU nationality. I am Argentinean so I have to do first the anmeldung and then get the residency. Which insurance would you recommend? I was advised to go along with Mawista, that works with Allianz. Thanks in Advance. Regards

    • Reply Bastien - Settle in Berlin 17/05/2019 at 14:18

      Hey Damian. Option 1 If you need to apply for a visa and don’t have a job lined up yet, Mawista can be a temporary insurance to cover you for the first few weeks, but you should switch to a public Krankenkasse as soon as possible. It’s all explained in details on this post why. Option 2 – Check if your wife is with a public krankenkasse. If she is, and since you have no income yet in Germany, you might already have sufficient coverage from her policy, since it also covers family members with no income.

  • Reply Sofia Berakha 11/05/2019 at 13:06

    Hi Bastien! So what would it be your advice for low-earning self-employed people? I´ve just made de Anmeldung and im super lost of how to proceed…Thanks

  • Reply Inês 07/05/2019 at 00:25

    Hello, I need some advice and would be very thankfull if you could answer some questions. I moved to Germany in January 2019 to make a unlaid Praktikum for 7 months as an Erasmus student, but i want to make the recognition of my profession and possibly apply for a Phd after the internship. So i registered in Germany and now that i am angemeldet I need to take the insurance. I went to one Krankenkasse to know if I could use my EHIC untill i find a job or get an imatriculation and can get a student Krankenversicherung. The whole conversation was um german and although i think i understood correctly I am still afraid I AM doing something wrong that could cause me problems in the future. They told me, because I have no salary that I can have a Freiwillige Krankenversicherung, but in that case, asside from beiing very expensive (190€ per month) I have to pay it retroactively , since January, although I did not used or did anything related to medical care in that time, or I can still rely on my EHIC for emergencies untill I get a job or get the PhD position, then I would be insured by my employer or as a student and would only have to pay from that point on. Did i understand correctly? Can you confirm this is truth? Thank you very much for your site and help.

    • Reply Bastien - Settle in Berlin 07/05/2019 at 10:23

      Hey there. In all cases, you will need to pay retroactively from the moment your became a German resident. 190€ is actually the lowest possible rate you can get. You would be taken in anyway for emergencies, EHIC or no EHIC.

      • Reply Inês 07/05/2019 at 11:27

        Thank you for your reply. So what the lady said in the Krankenkasse is wrong, is that it? Do you know any place I could get some advice in english?

        • Reply Inês 07/05/2019 at 11:33

          And I registered with the date of the begining of my internship, and that was also a mistake I think because I can always stay for 3 months without registering, do you know if I at least can clame that in order not to pay the first 3 months? Thank you

        • Reply Bastien - Settle in Berlin 10/05/2019 at 21:21

          Hey Ines. The lady was right.

  • Reply JACKELYN GONCALVES 10/04/2019 at 17:17

    Hello Bastien! I have a question.. I read on internet that the European health insurance card work in Germany during the first 3 months after arrive, so in that case is not necessary to have a insurance plan. Is this true? And if the answer is yes, is necessary to inform to any government office about this to don’t receive a fine?

    • Reply Bastien - Settle in Berlin 18/04/2019 at 10:33

      Hey Jackelyn. In theory yes, but if you become a German resident, you need to switch after you have registered here.

  • Reply Mikael 18/03/2019 at 09:29

    Hi Bastien, thank you for this very helpful page. A year ago I registered and got the Meldebescheinigung in order to become a nebenwohner in my girlfriends apartment in Berlin. As I am working in Denmark I spend about half my time there, and the other half in Berlin. I have an apartment in Denmark, where I also have my healthinsurance. I am now considering to look for a job in Berlin, but I am wondering if it will have any consequence that I have been registered here for a year without German insurance? Will it have any backlash, even though I have just been here from time to time as a nebenwohner?

    • Reply Bastien - Settle in Berlin 21/03/2019 at 09:25

      Hey Mikael. Not entirely sure what you mean with Nebenwohner. In your case though, i would probably assume that you were considered a Danish resident since you have a place there + you work there. If so, then you should probably be good.

      • Reply MIKAEL 25/03/2019 at 11:45

        Thank you for the reply! I meant to write that I am an untermieter at my girlfriends apartment, not nebenwohner.

  • Reply Camila Batista 14/03/2019 at 19:21

    Hello Bastien, thank you so much for this website, it has been my go to for a couple of curve balls life has been throwing at me recently! I’m currently trying to apply for a health insurance, since for the next 6 months I’ll be self employed before starting my masters, but everyone keeps asking me about the E104 Form? Do you perhaps have any information on that? I’ve been studying in Germany for a few years now, and always used my European Health Insurance Card to get a “Befreiung der Krankenversicherungspflicht”, so I almost wonder if maybe I couldn’t keep on doing that?

    • Reply Bastien - Settle in Berlin 17/03/2019 at 18:12

      Hey Camila. You can’t do that anymore since you will be a German resident. Having the E104 will help you get in the public system.

  • Reply Cedric 23/02/2019 at 18:12

    Bonjour Bastien,

    You mention that children can benefit from freiwillig insurance. Can the spouse too? I’ll be working but not my wife when we move to Germany.
    Thanks a lot for the great blog!

    • Reply Bastien - Settle in Berlin 24/02/2019 at 09:39

      Hey Cedric. When they don’t have any income, yes. (Source)

      • Reply Cedric 24/02/2019 at 14:49

        Bastien, merci ! You are correct, I found the answer meanwhile. Your topic has been very useful again! I will opt for TK as they have English service and their prices are fair. The only surprising thing for me is that many insurances do not cover Zahnreinigung/teeth cleaning/détartrage and I have been wondering how much it usually costs to pay for such a basic dental act in Germany, that we do at least once a year in France.

  • Reply Julen 21/02/2019 at 10:54

    Hi There! Thank you very much for this page, it is very useful! I wanted to ask you this: I am living in Berlin for one month now, I have EU passport from Spain and I am currently unemployed and can not pay 200/300 euros per month for health insurance. How should i proceed?

    • Reply Bastien - Settle in Berlin 24/02/2019 at 09:30

      Hey Julen. In this case, it’s quite likely that you’d need to apply for unemployment benefits, ALG1 or ALG2 depending on your eligibility. It would then take over the costs.

      • Reply Julen 25/02/2019 at 13:19

        Thanks a lot for taking the time to reply to me. I’ll check on this further. Gracias!

        • Reply Annie Nguyen 10/04/2019 at 13:59

          Hi Bastien, thanks alot for your helpful information. I’d like to have your advice for. T case (if it’s possible). Iam a master student but I turned 30 years old already. I’ve got a student job, working 20hours a week. Now I am insured by a private travel health insurance for international students. Meanwhile when I starts my student job, I am supposed to have social contribution obligation since the salary is above 450€ per month so I have to switch to either public or private insurance. But I am quite lost now, do you have any information about this matter? Is it extremely difficult to switch from private to public insurance when I am full time employed? Thank you in advance!

          • Bastien - Settle in Berlin 18/04/2019 at 10:34

            Hey Annie. I don’t have info about this sorry. However, you are not the first one to ask so i will be posting about it soon.

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