Medical Insurance in Germany
In Germany, high-quality medical care is available to everyone, regardless of income, age, social background, or health risk. After the 2007 healthcare reform, anyone who permanently resides in the country is required to have health insurance.
In this article, we will explain whether healthcare in Germany is actually free, what makes the German health insurance system so unique, and which type of policy a foreigner can obtain.
Earlier, we wrote about how to get a residence permit in Germany.
How the Healthcare System in Germany Works
Healthcare in Germany is mandatory and conditionally free. The insurance system is built on two main principles.
- The solidarity principle: The public system operates on an income-based model. The higher a person’s salary, the larger their healthcare contribution. As a result, everyone has equal access to medical services.
- The equivalence principle: Private insurance is based on an individual risk assessment, meaning that a person’s contributions depend on their age, profession, health condition, and level of coverage chosen.
The healthcare tax is deducted monthly from a citizen’s salary or pension. Employees and retirees pay only half — the remaining part is covered by the employer or the pension fund.
There is a contribution ceiling for mandatory health insurance. The portion of income exceeding this limit is not included in the calculation. The ceiling is adjusted according to salary dynamics; in 2025, it is set at €66,150 per year (or €5,512 per month).
Where Medical Care Comes From
Insurance funds, companies, and physicians’ associations are fully self-governed. In Germany, they are called “health insurance funds” (Krankenkasse). These organizations operate independently, fulfilling their legal obligations under state supervision and within a defined legal framework.
An interesting fact: the municipal hospitals in Germany are practically non-existent. Doctors usually have private practices (Praxis) or work together in private medical clinics. Tests and diagnostics are performed on-site, provided there is the necessary equipment or a partnership with laboratories.
Krankenkassen signs contracts with citizens and are entirely funded through contributions. The more registered members a fund has, the broader the range of services it can offer.
The key governing body is the Federal Joint Committee (G-BA). It sets medical service tariffs and decides which treatments are covered by mandatory health insurance and which are not.
How Can an Unemployed Person Get Insurance?
Public insurance funds only cover employed individuals. This raises an important question — what should a person do if they are unemployed and not covered under a parent’s or spouse’s policy?
While looking for a job, individuals previously employed in Germany can apply for unemployment benefits through the Federal Employment Agency. In this case, the government covers half of the mandatory health insurance contributions. This benefit is available only to citizens who have paid social contributions for at least 12 months during the past 30 months.
A person without a job may also apply directly to a public insurance company on a voluntary basis, provided they have sufficient funds. For example, individuals with passive income can join the GKV (statutory health insurance) and pay their contributions independently.
Those who were previously insured in another EU country can transfer to the German public health system by providing a certificate under form E-104 or S1.
Having health insurance is often a requirement for obtaining a visa to Germany. If a person plans to visit the country as a tourist or job seeker, they must obtain a temporary policy from a private insurance provider.
Public Health Insurance (GKV)
In Germany, anyone employed with an income above €535 per month is automatically enrolled in the statutory health insurance system — Gesetzliche Krankenversicherung (GKV). It is also called mandatory insurance, although there is always an option to switch entirely to private healthcare. Family members of the insured person (spouses and children under 25) receive GKV coverage free of charge, provided their own income is below the eligibility threshold.
Policyholders have the right to choose their insurance provider. The largest GKV companies in Germany are TK, BARMER, DAK Gesundheit, and AOK.
How Much Does Public Health Insurance Cost in Germany?
Obtaining the policy itself is free. Monthly contributions are deducted from the employee’s gross salary at rates set by the government:
- Base contribution (Beitragssätze): 14.6% of the employee’s gross income. You can request your employer to reduce it to 14%, but in that case, sick leave will not be paid.
- Additional contribution (Zusatzbeitrag): Health insurance companies may set their own additional rate, but not higher than 2.5%.
Both base and additional contributions are split equally between the employer and employee.
Example: Wolfgang earns €3,000 gross per month.
- The base contribution is €438, but Wolfgang pays only half — €219.
- The additional contribution is €75, and he pays €37.50.
In total, instead of €513, only €256.50 is deducted from Wolfgang’s salary for health insurance.
A major downside of the public system is that freelancers, self-employed individuals, and entrepreneurs — unlike employed workers — must pay both shares of the contributions in full.
People in creative professions are more fortunate: half of their insurance premiums are covered by the social insurance fund for artists, which includes painters, photographers, musicians, writers, and journalists.
What Does GKV Cover?
Public health insurance provides a wide range of medical services. When choosing a provider, review their catalog to see which doctors and treatments are covered. If a service is not listed, the insurer may refuse to pay for it.
The standard package typically includes:
- Routine check-ups and vaccinations (standard immunizations).
- Treatment of illnesses, assistance, and post-accident care.
- Inpatient care (€10 per day for patients over 18). Includes a bed in a shared room and basic nursing services.
- Only part of the cost of medications is covered. For most medicines (except those for children), patients pay a copayment of €5–10 per package.
- Cancer screening: for women aged 20+ and men aged 35+.
- Physiotherapy, speech therapy, and massages may be included with a copayment — 10% of the treatment cost plus €10 for adults.
- Medical aids: wheelchairs, hearing aids, prosthetics may be covered upon a doctor’s prescription. The patient’s copayment is 10%, minimum €5 and maximum €10.
- Medical consumables such as syringes or blood glucose test strips are covered with a 10% copayment, up to €10 per month.
- Dental treatment (excluding implants). By law, dentists must offer several options, one of which must be free of charge.
- Transport to medical facilities for chronically ill patients (reimbursement varies by insurer).
- Several psychotherapy sessions upon doctor’s recommendation and insurer approval.
Always consult your insurance representative or doctor to confirm whether additional payments apply.
How Payment for Medical Services Works
In most cases, GKV policyholders simply visit the clinic, receive treatment, and leave. The clinic bills the insurance company directly. If a service exceeds coverage, the doctor will inform the patient in advance, allowing them to either pay the difference or choose a free alternative.
By law, the total copayments cannot exceed 2% of the annual gross income for the same period. For individuals with chronic illnesses, the limit is 1%. If a patient notices that their payments exceed this limit, they can apply to the insurer for exemption from copayments.
All medical service rates in Germany are strictly regulated by law — clinics are not allowed to set unreasonably high prices.
Private Health Insurance (PKV)
Employees with an annual income above €73,800 (or €6,150 per month in 2025) are eligible to use private health insurance — Private Krankenversicherung (PKV), also known as “paid healthcare.” Transitioning from the public system is voluntary and serves as an alternative for individuals with higher earnings.
Most Germans choose public health insurance, while only about 13% of the population are privately insured. To qualify for PKV, you must meet at least one of the following criteria:
- earn more than €73,800 per year;
- be a freelancer, self-employed professional, or civil servant;
- be a foreign student (if your parents are not covered by public insurance);
- not qualify for GKV for any reason.
Cost
Premiums for private health insurance in Germany are fixed and depend on the applicant’s personal circumstances. There are no clearly defined percentage rates. The insured person can decide how much to pay by adding or removing services from their plan.
Choosing a company is the responsibility of the policyholder. Private insurers reserve the right to reject applicants based on profession, age, or pre-existing health conditions. It is common for insurers to require a medical examination before offering a plan. Individuals over 60 are often not accepted.
The average PKV premium is around €623 per month. Employees can reduce their costs through employer contributions — the employer covers half of the premium, but not more than €471.32 per month.
Foreign students pay significantly less. The PKSV (Private Krankenversicherung for students) costs on average €70–125 per month, depending on age — the younger the student, the lower the premium. An additional benefit is the removal of income limits that apply to GKV policyholders.
Advantages and Disadvantages of Private Healthcare in Germany
The fact that only 13% of the population uses private insurance does not mean public healthcare is of poor quality. The average gross annual salary in Germany is €52,300, and many people simply cannot afford private plans. Others prefer not to pay for separate family coverage or fear that they won’t be able to switch back to GKV later. Many choose to stay in the public system while purchasing small supplementary insurance — for example, dental or vision coverage.
Advantages of PKV:
- Available to foreigners who cannot obtain GKV.
- Shorter waiting times for medical appointments.
- Additional benefits such as extended dental or vision care.
- Alternative medicine is included in PKV coverage.
- For an extra fee, patients can access any specialist directly, bypassing the general practitioner (Hausarzt).
- Bonus programs and cashback rewards for not using medical services.
- Flexibility — you can choose the level of coverage and adjust your plan.
- Access to clinics that serve only privately insured patients.
Private insurance is most advantageous for young, healthy, single individuals under 40–50 years old without chronic diseases — premiums are lowest for this group. As you age, contributions rise due to higher health risks, eventually becoming comparable to GKV rates.
Disadvantages of PKV:
- Family members of a privately insured person are not automatically covered — each must have a separate policy, including children.
- Depending on the insurer, patients may need to pay medical bills upfront and later request reimbursement by submitting receipts.
- Some clinics may decline appointments for PKV holders (though, conversely, some refuse GKV patients).
- Switching back from PKV to GKV can be difficult.
- Despite fixed premiums, insurance costs may increase over time regardless of the client’s circumstances.
After registering with a private insurance provider, you will receive a Card für Privatversicherte (Private Insurance Card) by mail. Presenting it at a hospital or pharmacy is not mandatory but recommended, as it helps speed up medical appointments.
Comparison of Public and Private Health Insurance (GKV vs. PKV)
| Criterion | Public Insurance (GKV) | Private Insurance (PKV) |
|---|---|---|
| Who can apply | All employees earning over €535/month | Individuals earning over €73,800/year, freelancers, civil servants, and international students |
| Cost | Percentage of income: 14.6% + additional rate, shared equally with the employer | Fixed monthly premiums — average €623/month, depending on age and coverage plan |
| Family coverage | Spouse and children under 25 are insured for free (if they have no income) | Each family member must have a separate policy |
| Coverage | Basic medical services, partial coverage for medicines, limited dental care | Extended medical services, alternative medicine, cashback programs, access to private clinics |
| Convenience | Bills are paid directly by the insurance company; copayments are legally capped | Sometimes patients must pay upfront and later request reimbursement |
| Best suited for | Employees with families and people with chronic illnesses | Young, healthy, single individuals under 40–50 years old |
How Migrants Can Obtain Health Insurance in Germany
A foreigner who has just arrived in Germany has two main options for obtaining health insurance.
1. Employment
If you come to Germany for work, your employer is obligated to enroll you in the public health insurance system.
All foreign employees earning more than €538 per month are eligible for GKV (public health insurance).The employee only needs to choose an insurance provider (Krankenkasse) and inform the employer of their choice.
Freelancers and self-employed individuals can contact a public insurance provider directly, sign a contract, and pay contributions independently.
2. Private Insurance
If you are not employed or prefer private healthcare, contact a private insurance company to receive a consultation on available coverage options. To find the best plan, you can use the services of an insurance broker, who will assess your health, financial situation, and needs to recommend the most suitable provider.
If a foreigner chooses GKV, coverage will follow the standard Krankenkasse catalog. If they opt for PKV, the level of coverage can be adjusted individually. Overall, foreigners receive the same quality of healthcare as German citizens.
If you already have health insurance from another EU country, you automatically have the right to use GKV in Germany. You just need to obtain and present the E-104 or S1 form from your home country.
Required Documents
To apply for either public or private health insurance in Germany, you will need:
- Passport or ID card
- Visa or residence permit
- Proof of address in Germany (registration certificate or rental contract)
- Bank account details (for insurance payments)
Employees are registered in the public insurance system through their employer. Freelancers, entrepreneurs, and those seeking private coverage must apply directly to the chosen insurance company.
Money Transfers from Germany
Navigating the health insurance system in Germany can be challenging at first, but once you obtain a policy and visit a doctor a few times, everything will fall into place. A nice feature is that the employer or a special fund covers part of the contribution, allowing you to save money and direct it to more important needs. For example, for gifts for relatives who remain abroad.
The Korona app, like the German healthcare system, respects its users and offers some of the best conditions in the money transfer market. With Korona, you can delight friends and family from over 50 countries around the world. It is a fast and reliable way to send transfers with low fees. Korona is available on the App Store and Google Play.
Our blog provides a lot of information about working and living in Europe. If you’re interested in this topic, you might find another interesting article in the catalog.