Health insurance in Germany: Public vs. private, costs and how to enrol

Which one applies to you usually depends on your job status, income, and whether you are employed, self-employed, or moving to Germany from abroad. 

In this guide, you will find the main differences, what health insurance in Germany costs, who can join each system, and how to get covered. Los geht’s!

• Health insurance in Germany at a glance
• Is health insurance mandatory in Germany?
• The two types of health insurance in Germany
• How much does health insurance cost in Germany?
• GKV or PKV: Which applies to you?
• Health Insurance in Germany for foreigners and expats
• How to get health insurance in Germany
• FAQs

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Health insurance in Germany at a glance

Health insurance in Germany summarized
Legal requirement	Health insurance is mandatory for residents in Germany.
Insurance systems	There are two systems: statutory health insurance (GKV) and private health insurance (PKV).
Default for most employees	Most employees are insured through GKV by default.
When PKV is usually an option	Employees can usually choose PKV only if they earn above the compulsory insurance threshold.
How GKV is paid	In GKV, contributions are usually shared between employer and employee.
Switching later	Moving from PKV back to GKV later is often more difficult than moving the other way.

Is health insurance mandatory in Germany?

Yes, if you live in Germany, you need health insurance.

Everyone living in Germany must be covered, either through statutory health insurance (GKV) or private health insurance (PKV).

If you go without insurance, it can become expensive later. You may have to pay back contributions for the time you were uninsured.

If you are in GKV, some family members can often be included at no extra cost through family insurance. This usually applies to children and, in some cases, a spouse who does not have their own income.

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The two types of health insurance in Germany

Germany has two health insurance systems: GKV and PKV.

Both give you the cover you need by law, but they are set up differently. The biggest differences are who can join, how contributions are calculated, and how family cover works.

Statutory health insurance (GKV)

GKV is the public health insurance system and the one most people in Germany use.

It follows what is often called the ‘solidarity principle’. In simple terms, that means your contributions are based mainly on your income, not on your age or medical history.

What GKV usually covers

• doctor visits
• hospital treatment
• prescriptions
• rehabilitation
• pregnancy and childbirth care
• sick pay under the usual rules
• family co-insurance for eligible dependants

Key things to know about GKV

• Most employees in Germany are in GKV.
• You receive an electronic health card (eGK).
• The back of that card usually includes the European Health Insurance Card (EHIC).
• Large statutory insurers include TK, AOK, BARMER, and DAK.

Private health insurance (PKV)

PKV is the private system. Your premium is based on factors such as age, tariff, deductible, and health history, rather than directly on income.

Who can usually choose PKV

• employees above the compulsory insurance threshold
• self-employed people
• civil servants

Why some people choose PKV

• broader tariff options
• faster access in some cases
• possible extras such as a private hospital room or wider specialist access

Main trade-offs

• premiums are not linked to income
• family members are not automatically covered
• each family member usually needs their own policy
• switching back to GKV later can be restricted

How much does health insurance cost in Germany?

For most employees in GKV, what you pay depends on your gross monthly salary.

The statutory system uses a percentage of your income to calculate your contribution, up to a set ceiling. In practice, this means your employer usually covers about half, and the rest comes from your salary.

Example of employee cost in GKV:

If your gross salary is €3,000 per month, your estimated contribution is around €262.50 per month. That figure covers health insurance only, so long-term care insurance is still added separately.

Estimated monthly GKV employee share

Health insurance only, excluding long-term care insurance

Gross monthly salary	Estimated employee share
€2,000	€175.00
€3,000	€262.50
€4,500	€393.75
€5,812.50	€508.59

Who pays, depending on your situation

That depends on your status.

• Employees: your employer usually covers about half, and the rest comes from your salary.
• Self-employed people: if you are in GKV, you usually pay the full amount yourself.
• Unemployed people: contributions are often covered by the public authority responsible for your benefits.
• Students: usually pay a lower student rate instead of the regular employee contribution.

What does PKV cost?

There is no standard monthly price for PKV. The amount you pay depends on your age, health profile, tariff, and deductible.

As a rule, younger and healthier people tend to get lower quotes. The final premium can vary quite a bit depending on the insurer and the level of cover you want.

One more cost point: long-term care insurance

In Germany, health insurance also comes with long-term care insurance (Pflegeversicherung)

If you are insured through GKV, this is collected together with your health insurance. If you choose PKV, you still need long-term care cover as well.

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GKV or PKV: Which applies to you?

Most employees in Germany do not need to make an active choice right away.

If your income is below the compulsory insurance threshold, you will usually stay in GKV automatically. If you earn above that threshold, you can usually choose whether to stay in GKV voluntarily or switch to PKV.

Factor

What it usually means for GKV

What it usually means for PKV

Employment type

Default for most employees

Often an option for self-employed people and civil servants

Income level

Usually mandatory below the threshold

Usually possible above the threshold

Age

Your contribution is not based on your age or health history

Your age affects the premium

Family situation

Eligible dependants can often be included at no extra cost

Each family member usually needs their own policy

Long-term plans in Germany

Often simpler if your income or status changes over time

Switching back later can be difficult

The most important thing to keep in mind is this: moving into PKV can be fairly straightforward, but moving back to GKV later is often much harder.

Health Insurance in Germany for foreigners and expats

If you are moving to Germany from abroad, the key question is usually not your nationality. What matters more is how long you are staying and whether you are working in Germany.

EU citizens

If you are in Germany for a short stay, you can usually use the EHIC for medically necessary treatment while you are here.

If you move to Germany for the longer term or start working here, you will usually need to join the German health insurance system instead.

Non-EU workers

If you move to Germany for a job that comes with social security contributions, health insurance usually starts as part of that employment setup.

You will also normally need proof of health insurance for your visa or residence process.

Self-employed expats

If you are self-employed, you may be able to join GKV voluntarily or choose PKV, depending on your status and whether you meet the eligibility rules.

International health insurance

International health insurance can be useful when you first arrive, especially if you need temporary proof of cover.

But once German health insurance rules apply to you, it usually does not replace regular German health insurance long term.

Can foreigners join GKV?

Yes. Foreigners can join GKV if their residence and employment status make them eligible.

Employees who fall under compulsory insurance usually join automatically. Other residents may need to apply for voluntary membership instead.

Many large statutory insurers, including TK and AOK, also offer English-language information for people who are new to Germany.

How to get health insurance in Germany

The process is usually quite straightforward, especially if you are moving to Germany for work. What you need to do depends mainly on whether you are an employee or self-employed.

If you are an employee

If you will be in the statutory system (GKV), the first step is to choose a health insurance provider. Once you have chosen one, let your employer know. They will use that information to register you when you start your job. After that, the insurer will confirm your membership and send you your health card.

In most cases, your cover starts on your first day of employment.

If you are self-employed

If you are self-employed, you will usually need to check first whether GKV, PKV, or both are available to you. From there, you can compare providers, tariffs, and conditions, then apply directly to the insurer you choose.

You will also need to send in the documents they ask for before your cover can be set up.

Documents you will usually need

• passport
• residence registration (Anmeldung)
• employment contract, if applicable
• proof of income or status, especially if you are self-employed

FAQs

Can I live in Germany without health insurance?

No. Health insurance is mandatory, and delays can lead to back-payments or premium debts.

Is healthcare free in Germany?

No. Healthcare in Germany is not free. It is mainly paid for through health insurance contributions. If you are in GKV, you usually don’t pay the full cost of treatment yourself every time you go to the doctor, but the system is still funded through monthly payments.

Does my employer pay for health insurance in Germany?

Yes, if you are an employee. If you are in GKV, your employer will usually cover around half of the contribution, and the rest is taken from your salary.

What is the best health insurance in Germany?

There is no single best option for everyone. The right choice depends on your income, family setup, employment status, and whether you are comparing GKV providers or PKV tariffs.

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Before you sign up, here’s what matters most

If you are moving to Germany or starting a new job here, health insurance is one of the first things to sort out. For most employees, GKV is the standard route, while self-employed people and higher earners may also be able to choose PKV. The best next step is to check which system applies to you, compare your options carefully, and make sure your cover is in place as early as possible.

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