How to choose German health insurance

This guide explains how German health insurance works, and how to choose the best health insurance for your needs.

How German health insurance works

All German residents must have health insurance.

You pay for health insurance every month. When you are sick, your health insurance pays for all necessary healthcare. It covers medical operations, therapy and medication.

There are 2 health insurance systems:

• Public health insurance
  Managed by non-profit health insurance funds. The cost is a percentage of your income. The cost and coverage are almost the same with every public health insurer.
• Private health insurance
  Managed by private insurance companies. The cost depends on your age and health condition when you sign up. The coverage is more flexible, and the cost varies a lot.

Both systems are good. The best option depends on your situation. Most people can only choose public health insurance.

Your options

To know your options, use my health insurance calculator.

Back to options

Back to calculator

Your options depend on your situation and your income:

• If you are an employee, your options depend on your income. Your employer does not decide which insurance you can have. If you lose your job, you do not lose your health insurance.
  • If you earn under 69,300€ per year, you can only choose public health insurance.
  • If you earn over 69,300€ per year, you can choose public or private health insurance.
  • If you have a minijob, you can choose public or private health insurance.¹
  • If you are a civil servant, you can choose public or private health insurance.
• If you are a student, you can choose public or private health insurance.² If you are over 30 years old, and you just moved to Germany, you might be forced to get private health insurance.
• If you are unemployed, you can choose public or private health insurance. If you get ALG I or Bürgergeld, you must get public health insurance.
• If you are self-employed, you can choose public or private health insurance.² If you have a low income, private health insurers might reject you.
• If you are a doctor, you can choose public or private health insurance.²

Public health insurance

89% of German residents have public health insurance.³

Cost of public health insurance

Use my health insurance calculator. The cost depends on your occupation:

• If you are an employee, you pay 9.0% to 10.2% of your income. Your employer takes that amount from your salary every month.
  • If you make more than 62,100€ per year, you pay the maximum price: around 530€ per month.⁴ The maximum price goes up every year, so you pay a bit more every year.⁵
  • If you make less than 62,100€ per year, you pay 9.0% to 10.2% of your income.
  • If you have a minijob, you pay the minimum price: around 210€ per month.²⁵ Your employer does not pay half of it.⁶ Your spouse’s insurance can cover you for free. If you are under 25 years old, your parents’ insurance can cover you for free. If you are a student, you pay the student price (see “If you are a student”).
  • If you are a trainee (Azubi), you pay the same as other employees, but there is no minimum price. If you make less than 325€ per month, you pay nothing.⁹ Your parents’ and your spouse’s insurance can’t cover you.
• If you are a student, you usually pay a lower student tariff. It depends on your age:
  • If you are under 25 years old, you pay the student tariff: around 140€ per month.⁷ If you make less than 505€ per month, your parents’ or your spouse’s insurance can cover you for free.²⁶ If you are a EU citizen, your EHIC card can cover you.
  • If you are 25 to 29 years old, you pay the student tarif: around 140€ per month.⁷ If you make less than 505€ per month, your spouse’s insurance can cover you for free. Your parents’ insurance can’t cover you. If you are a EU citizen, your EHIC card can cover you.
  • If you are at least 30 years old, you are too old for the student tariff.³¹ You pay the same price as self-employed people (see “If you are self-employed”). Your spouse’s insurance can cover you for free. Your parents’ insurance can’t cover you.
• If you are self-employed, you pay 18.0% to 20.5% of your income. It’s taken from your bank account every month. The cost is based on your estimated income. It’s adjusted every year. If you paid too much, you get money back later. If you did not pay enough, you need to pay more later.
  • If you make more than 62,100€ per year, you pay the maximum price for the self-employed: around 1,050€ per month.⁴
  • If you make less than 1,178.33€ per month, you pay the minimum price (Mindestbeitrag): around 210€ per month.⁸
  • If you join the Künstlersozialkasse, they pay half of your health insurance. You pay 9.0% to 10.2% of your income per month. – More information
• If you are unemployed,⁹ you pay the minimum price: around 210€ per month.¹ Your parents’ or spouse’s insurance can cover you for free. If you are a EU citizen, your EHIC card can cover you. If you get ALG I or Bürgergeld, the government pays for your health insurance.¹⁰ During your first month of unemployment, your health insurance is free.

Benefits of public health insurance

• It matches your income
  Public health insurance costs a percentage of your income. If you make less money, you pay less. If you get ALG I or Bürgergeld, it pays for your health insurance.¹¹ Private health insurance does not adjust to your income; you pay the same even if you lose your job.
• It’s cheaper for students
  If you are a student, you pay around 140€ per month until you are 31 years old.¹ Public health insurance is usually the best option for students.
• It covers your dependents for free
  Public health insurance covers your children and your unemployed spouse. It’s called Familienversicherung. Your spouse is covered if (s)he earns less than 505€ per month.¹² Your children are covered until they are 23 years old, or 25 years old if they are students. With private insurance, you pay for each person you cover. If you plan to have children, public health insurance is often the best option.
• It’s easy to use
  When you go to the doctor, you show your insurance card, and you get healthcare. You don’t need to think about coverage, reimbursement or deductibles. There is no paperwork; it just works.
• You don’t pay more for pre-existing conditions
  If you are Pflichtversichert, public health insurers must accept you, even if you have serious health problems. You don’t pay more because of your bad health. Private health insurers refuse people with serious health problems, or they charge them more.

Disadvantages of public health insurance

• It’s expensive for young professionals
  If you have a high income, you pay more. If you are young, healthy and well-paid, private health insurance is often cheaper.
• Doctors prefer private insurance
  With public health insurance, you must wait longer for a doctor appointment. It’s hard to find a psychotherapist or urologist who accepts public health insurance.¹³ With private health insurance, you can see doctors faster.
• Special treatments are not included
  Public health insurance covers necessary care, not luxuries. If you want special treatments, you must pay the extra cost yourself. For example, it only covers amalgam tooth fillings. If you want fancy composite fillings, you must pay for the difference. Tooth cleanings are not fully covered. Eyeglasses are rarely covered. Private insurance lets you choose better coverage.
• Not everyone is accepted
  If you are a self-employed, and you just moved from a non-EU country, it’s really hard to get public health insurance. Public insurance companies are not forced to cover self-employed people.¹⁴ Most immigrant freelancers are forced to choose private or expat health insurance.

What it covers

Public health insurance covers all necessary healthcare. Important treatments and medical prescriptions are always covered. There is a small deductible (5€ to 10€ per month) for some prescriptions. There is no other deductible.

When you visit the doctor, you give your insurance card, and they charge the insurance company directly. If a treatment is not covered, you know before you start.

Public health insurance covers essential dental care, like removing your wisdom teeth. You also get 2 free dental check-ups every year. It does not cover tooth cleanings. Many people also get dental insurance to get better coverage.

Glasses and contact lenses are rarely covered. You need to pay for them yourself.

Which public health insurance should I choose?

It does not really matter. Public health insurance options are almost the same. The price and coverage are set by law. The biggest differences are the extra contribution (Zusatzbeitrag) and the customer service.¹⁵

If you don’t speak German, Techniker Krankenkasse and Barmer speak English. I used Techniker Krankenkasse for 6 years, and I liked them.

Ask an expert to help you choose. Their help is free.

Private health insurance

11% of German residents have private health insurance (private Krankenversicherung or PKV).¹⁶ Not everyone can choose private health insurance.

Cost of private health insurance

The cost depends on 3 things:

• Your age when you join
• Your health condition when you join
• The level of coverage you choose

After you join, your health does not affect the cost of your insurance. If you get very sick, you still pay the same price.

You can pay more and get better coverage. You can choose a higher deductible (Selbstbeteiligung) and pay less.¹⁷ Some insurers give you a discount if you don’t use your insurance.

Quick price estimation – Feather

Your employer pays half of your health insurance. If you are self-employed, you pay the full price yourself.¹⁸

Benefits of private health insurance

• Faster doctor appointment
  You can get a doctor appointment faster. Try it yourself: go on Doctolib, and look for the earliest doctor appointment. Try again with private health insurance.
• You choose your coverage
  Your insurance can cover dental care, travel insurance, special treatments etc. You can choose the minimum coverage to pay less.
• You can pay less with a deductible
  For example, if you have a 3,000€ per year deductible (Selbstbeteiligung), you pay the first 3,000€ in medical fees yourself, after that, your insurance pays for everything.¹⁷ If you have a high deductible, your monthly payments are lower. If you never go to the doctor, you can save a lot of money.
• You pay less if you don’t use it
  Many private health insurers have a no-claims bonus: if you don’t use your health insurance, your insurance gets cheaper. If you never get sick, you can save a lot of money.

Disadvantages of private health insurance

• You pay more when you use it
  With private health insurance, if you don’t go to the doctor, you save money. Deductibles and no-claims bonuses discourage you from seeing a doctor.
• It’s more paperwork
  With private health insurance, you pay the doctor, get an invoice, and ask your insurer to reimburse you. If you have a deductible (Selbstbeteiligung), you wait until you have enough expenses before you declare them.
• It’s cheap when you are young
  If you are young and healthy, you could pay just 175€ per month for private insurance (350€ if you are self-employed). Public health insurance can cost up to 530€ per month for employees (1,050€ if you are self-employed). If you are young, healthy and well-paid, private insurance can be much cheaper.
• It can get expensive when you are old
  When you retire, you have a lower income, but your insurance does not get cheaper. After 55 years old, it’s almost impossible to go back to public health insurance. You can be stuck with a very expensive health insurance. If you join the private system when you are young, your insurer saves a part of your payments for later, so your insurance won’t be too expensive when you are old.
• Private is expensive if you have pre-existing health problems
  Private health insurance often requires a health test before you join. If you have serious pre-existing health problems, they usually reject you. If they accept you, they can charge a lot more.¹⁴ For example, if you have a chronic disease, get psychotherapy, or need expensive medication, they will reject you. After you are accepted, the price does not change if you get sick.

With private health insurance, there is no nursing care insurance (Pflegeversicherung) surcharge. It’s included in the price of your insurance.

Who can have private health insurance?

If you are voluntarily insured (freiwillig versichert), you can choose private or public health insurance. If you are compulsorily insured (Pflichtversichert), you must choose public health insurance.

• If you are self-employed, you can choose private insurance. There is no minimum income. If you are a non-EU freelancer, and you just moved to Germany, private health insurance might be your only option, because public health insurers often reject freelancers who are not already on the public system. If you have a low income, private health insurers might reject you, and you might be forced to use expat health insurance.
• If you are an employee, and you earn more than 69,300€ per year (before taxes), you can choose public or private health insurance. Your employer will pay half of your insurance.
• If you are an employee, and you earn less than 69,300€ per year (before taxes), you can’t choose private health insurance. You must choose public health insurance.
• If you are a student, a doctor or a civil servant, you can choose private health insurance. If you are a student 30 years old or older, private health insurance can be cheaper than public health insurance. Private health insurers offer special rates for older students.

Even if you can have private health insurance, private health insurers can reject you. For example, if you have serious health problems, they will reject you. If you had psychotherapy, they usually reject you. If you have problems like AIDS, severe asthma, diabetes or obesity, they could also reject you, or charge a lot more.

What it covers

Private health insurance covers the same things as public health insurance, and often more. Necessary healthcare is always covered.

With private health insurance, you have more control over what is covered. For example, it can cover extra services like dental care, glasses and laser eye surgery. You can also pay less if you cover less, or if you have a higher deductible (Selbstbeteiligung).

You have more healthcare options, because you can visit doctors and therapists that don’t accept public health insurance. Doctors often give priority to patients with private health insurance.

With private health insurance, you usually pay for healthcare yourself, and get reimbursed by the insurance company. For big, expensive treatments, the insurance company pays the doctor directly. This is different from public health insurance, where you just show your insurance card.

Which private health insurance should I choose?

There are big differences between private health insurance companies. Each offers very different options. The best option depends on your situation.

The best way to choose is to ask a health insurance broker. Their help is free. They get paid by the insurance companies when they bring new customers.

Ottonova is popular option with expats, because they offer support in English, but they are not perfect.

Feather also offers private health insurance. They helped me get private health insurance, and I trust them. They are a health insurance broker, not a health insurer. This means that they sell insurance from different companies. They speak English. Their insurance works for residence permit applications.

Quick price estimation – Feather

How to switch to public health insurance

You can switch from private to public health insurance, but it can be hard. Sometimes, it’s impossible, and you are stuck with private health insurance.¹⁹

There are a few ways to switch:

• Get unemployment benefits (ALG I)
  If you lose your job and get ALG I, you are usually forced to get public health insurance.
• Lower your income
  If you are an employee, and your income goes below 69,300€, you must get public health insurance. This does not work for self-employed people.²⁰
• Join the Künstlersozialkasse
  If you are self-employed, and you join the Künstlersozialkasse, you can get public health insurance. Most of the time, you have no other choice.

If you are over 55 years old, you can’t switch to public insurance anymore.²¹ Otherwise, everyone would get cheap private health insurance when they are young, and cheap public health insurance when they are old. The public health insurers would go bankrupt.

Expat health insurance

Expat health insurance is a kind of private health insurance. It’s a temporary solution for people who move to Germany. It has much better coverage than travel insurance.

There are 3 reasons to get expat health insurance:

• You plan to live in Germany for less than 5 years. It’s the cheapest short-term health insurance.
• or you are applying for a German residence permit for the first time. Expat insurance is easier to get than public or private health insurance. It’s a good temporary insurance, before you get something better.
• or you have no other option, because public and private health insurers rejected you. If you are a freelancer and earn under ~30,000€ per year, it can happen. If you are over 50 years old, it can also happen.
• and you are not a EU citizen. EU citizens can rarely get expat health insurance.²⁹

Compared to public and private health insurance

• It’s not accepted when you renew a residence permit
  Expat insurance is rarely accepted when you renew your residence permit, or when you apply for a different residence permit.²⁷ You must have real public or private health insurance.
• It can expire after 5 years
  Some expat insurances are only valid for 5 years.²² Many freelancers stay on expat insurance for too long. When they need to switch to public or private insurance, no insurer wants to cover them. They can’t get health insurance, or the only options are very expensive. If you settle in Germany, switch to real health insurance as soon as possible.
• The price goes up faster
  The cost of expat insurance rises really quickly.²² If your expat insurance does not expire, it can become really expensive when you are old. If you stay in Germany for a long time, public or private health insurance is cheaper.
• The coverage is not as good
  Check-ups and dentist visits are rarely covered.³⁰ You usually pay a deductible for basic treatments. Long term treatments (like cancer) are 100% covered, without any deductible.

List of expat insurance options

You can get expat health insurance from Feather, Ottonova, or any health insurance broker.

Compared to travel insurance

• It covers more
  Travel insurance usually covers around 30,000€ of medical fees. Expat insurance has unlimited coverage. If you get very sick with travel insurance, you must end your trip and go home. With expat insurance, you can stay in Germany and recover.³²
• It lasts longer
  Expat insurance can be valid for a few years. Travel insurance is only valid for a few months.

Don’t stay on expat health insurance

Expat health insurance is a temporary option. Switch to public or private health insurance as soon as you can. If you wait too long, you can have problems:

Example 1: You are a freelancer, and you have expat insurance for 3 years. You regularly see a psychotherapist. You must renew your freelance visa, so you need public or private health insurance. Since you see a therapist, no insurer wants to cover you. You can’t find health insurance, so you can’t renew your freelance visa.¹¹

Example 2: You have expat health insurance. You get cancer. After 5 years, your expat insurance expires, and no insurer wants to cover you.

If your expat insurance stays valid, it gets more and more expensive. In the long term, public and private health insurance are cheaper.¹⁰

If you are a freelancer, switch to public or private health insurance as soon as possible. It’s more expensive, but you don’t really have a choice. You can get cheaper health insurance if you join the Künstlersozialkasse.

If you are a student, public health insurance is a little more expensive than expat insurance, but it’s much better. Switch to public health insurance maximum 3 months after you start university. If you wait too long, you will be stuck with expat insurance.

Travel insurance

Travel insurance is valid for visiting Germany. You need it to get a Schengen visa. It’s rarely valid for a residence permit application.

It only covers medical emergencies, and treatments that can’t wait until you go back home. It does not cover long-term treatments, health check-ups or pre-existing conditions.

You can buy travel insurance online in your home country. HanseMerkur’s travel insurance is valid for a Schengen visa application.

Other options

Insurance from other EU countries

If you come from another EU country, you can use your European Health Insurance Card (EHIC) in Germany. If you get healthcare in Germany, your health insurance in your home country pays for it.

• If you stay in Germany temporarily, your EHIC covers you. You do not need extra health insurance in Germany.
• If you are an Erasmus student from another EU country, your EHIC covers you.²³ You can use your EHIC card even if you study in Germany for your entire degree.²⁸ You do not need extra German health insurance unless you start working.
• When you start working in Germany, your EHIC does not cover you anymore. If you make more than 538€ per month, you must get German health insurance.²⁴

If health insurance is cheaper in your home country, using your EHIC is cheaper than getting German health insurance. You can save a lot of money every month with the EHIC.

What is the European Health Insurance Card? – europa.eu

Information for EU students – Feather Insurance

The Künst­ler­so­zi­al­kas­se (KSK)

If you are a freelance artist, journalist, publicist or influencer, join the Künstlersozialkasse (KSK). They pay half of your health insurance, and half of your public pension insurance. It’s always worth it.

How to apply for the KSK

Need help?

Insurance brokers

Health insurance brokers help you choose health insurance. Their help is free for you; they get paid by health insurers to bring them customers.

Always work with a broker, not an agent. Brokers are independent, and recommend health insurance from different companies. Agents only work for one company. They only sell that company’s health insurance.

If you are an immigrant, choose a broker who works with expats. Your needs are different, and your broker must know how to help you.

What to do next

Get liability insurance. It’s the second most important insurance after health insurance.

What is liability insurance?

Register as an organ donor. It’s really easy, and it can save another person’s life.

How to register as an organ donor

There are more types of insurance in Germany, but health and liability insurance are the most important.

Types of insurance in Germany

Sources and footnotes

1. nebenjob.de ⤴

2. krankenkasseninfo.de, krankenversicherung.net ⤴

3. gesundheitsinformation.de, gkv-spitzenverband.de ⤴

4. versicherungspflichtgrenzen.de ⤴

5. krankenkassen.wiki ⤴

6. minijob-zentrale.de ⤴

7. tk.de, aok.de, reddit.com/r/germany ⤴

8. krankenkassen.de, bundesregierung.de ⤴

9. check24.de ⤴

10. krankenkassenzentrale.de, tk.de ⤴

11. aok.de, aok.de, Arbeitsagentur ⤴

12. tk.de ⤴

13. reddit.com/r/berlin, reddit.com/r/berlin ⤴

14. reddit.com/r/germany ⤴

15. reddit.com/r/germany ⤴

16. gesundheitsinformation.de ⤴

17. blog.feather-insurance.com ⤴

18. reddit.com/r/germany ⤴

19. reddit.com/r/germany, wiwo.de ⤴

20. Finanztip, wiwo.de ⤴

21. Finanztip ⤴

22. toytowngermany.com ⤴

23. reddit.com/r/germany, krankenkassen.de ⤴

24. faq.feather-insurance.com ⤴

25. abc-der-krankenkassen.de ⤴

26. krankenkassenzentrale.de ⤴

27. facebook.com ⤴

28. krankenkassen.de ⤴

29. Dr. Rob Schumacher, Feather Insurance ⤴

30. Feather Insurance (May 2023) ⤴

31. tk.de, krankenkassen.de ⤴

32. Dr. Rob Schumacher at Feather Insurance (November 2023) ⤴