If you live in Germany, you must have health insurance. It's the law. You pay for health insurance every month, and health insurance pays for your healthcare.

In this guide, I help you choose the best health insurance for your situation. I also explain the difference between public health insurance and private health insurance.

What options do I have?

Germany has two health insurance systems: public and private. Both systems are good. Each system has advantages, and disadvantages. The best option depends on your situation.

Your health insurance options depend on your income and your occupation. Most people can only choose public health insurance. Some people can also choose private health insurance.

Compulsorily insured? Voluntarily insured?

If you are compulsorily insured (Pflichtversichert), you must have public health insurance. You can't choose private health insurance. Public health insurers are forced to accept you1, even if you have serious health problems.

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

Public health insurance

89% of German residents have public health insurance (gesetzliche Krankenversicherung or GKV)1, 2. It's sometimes called statutory health insurance.

How much does public health insurance cost?

Public health insurance costs 14.6% of your income, plus 3.05 to 3.3% for long-term care insurance (Pflegeversicherung). Health insurers can also charge a little more (the Zusatzbeitrag): 0.39% to 2.5%, depending on the insurer. In total, public health insurance costs 18.04% to 20.4% of your income.

If you have a job, your employer pays half of your health insurance, so you pay 9.02% to 10.3% of your income. If you are self-employed, you pay the full price yourself.

If you make more than 58050€/year, you pay the maximum amount.

  • If you are an employee, you pay half of your monthly contributions (9.02% to 10.3% of your income). Your employer pays the other half1. The amount is taken from your salary every month.
    • If you make more than 58050€ per year1, you pay the maximum amount (Höchstbeitrag): around 470€ per month1. The maximum amount goes up every year1, so next year, your health insurance will be more expensive.
    • If you have a minijob, you still need health insurance, but your employer does not help you. If your spouse or your parents have public health insurance, you can use their insurance for free (Familienversicherung). If you are a student, you pay the student price. If you can't use someone else's insurance, and you are not a student, you pay the minimum contribution (Mindestbeitrag): around 210€ per month1.
    • If you are an Azubi, you are treated like an employee. You pay 9.02% to 10.3% of your income. There is no minimum contribution. If you make less than 325€ per month, your employer pays for your health insurance1.
  • If you are a student, you pay a special student price until you are 31 years old.
    • If you are under 25 years old, you pay around 110€ per month1, 2, 3, 4. If you are a EU citizen, you can use your EHIC card while you study in Germany. If you make less than 450€ per month, you can also use your parents' public health insurance for free1.
    • If you are between 25 and 30 years old, you pay around 110€ per month1, 2, 3, 4. If you are a EU citizen, you can use your EHIC card while you study in Germany. You can't use your parents' health insurance1, because you are over 24 years old.
    • If you are a student over 30 years old, you pay the minimum contribution (Mindestbeitrag): around 210€ per month1, 2. You do not pay the student price, because you are too old. If you just moved to Germany, you might be forced to get private health insurance, because public health insurers can refuse to cover you. They might accept you if you had public insurance in another EU country.
  • If you are a freelancer, you pay 17.44% to 20.4% of your income. The amount is 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 are unemployed1, you pay the minimum price (Mindestbeitrag): around 210€ per month1. If your spouse or your parents have public health insurance, you can use their insurance for free. If you get ALG I or ALG II, the Jobcenteer pays for your health insurance1, 2.

Benefits of public health insurance

  • It matches your income
    Public health insurance is cheaper when you make less money. If you lose your job or you retire, public insurance is cheaper. If you receive ALG I or ALG II, your health insurance is free1, 2, 3. Private insurance does adjust to your income.
  • Public is cheaper for students under 31 years old
    If you are a student, you pay around 110€ per month1 until you are 31 years old. After 31, you pay the Mindestbeitrag: around 210€ per month1.
  • It covers your dependents for free
    Public health insurance covers your children and your unemployed spouse. This is called Familienversicherung. If your spouse earns less than 470€ per month, (s)he is covered for free1. If your children are under 25 years old and studying, they are covered for free. With private insurance, you must pay more to cover other people. If you plan to have children, public health insurance is often the best option.
  • It requires less paperwork
    Public health insurance is simple. The doctors and the insurance companies talk directly to each other, so there is no paperwork. When you go to the doctor, you show your insurance card, and you're done. You don't need to worry about coverage, reimbursement or deductibles.
  • You don't pay more for pre-existing conditions
    If you are Pflichtversichert, public health insurers can't refuse to cover you. If you have serious health problems, you don't pay more for your insurance. Private health insurers don't accept people with serious pre-existing health problems, or they charge more to cover them.

Disadvantages of public health insurance

  • It's expensive for young professionals
    Public insurance is based on your income, and private insurance is based on your health. If you are young, healthy and have a good income, private will be much cheaper than public. If you have a good salary during your entire career, private can be much cheaper than public, even in the long term.
  • You don't get the highest priority
    Doctors make more money with patients who have private health insurance, so they have priority1. If you have public health insurance, you can wait longer for appointments. It's also really hard to find a psychotherapist or urologist who accepts public health insurance1, 2. It's still very easy to see a doctor when you need it.
  • Special treatments are not included
    If you want special treatments, you must pay the extra cost yourself. Public health insurance covers necessary care, not luxuries. For example, it only covers amalgam tooth fillings. If you want fancy composite fillings, you must pay for the difference. Private insurance lets you choose the quality of your coverage.
  • Not everyone is accepted
    If you are a freelancer, and you just moved from a non-EU country, it's almost impossible get public health insurance. Public insurance companies are not forced to cover freelancers1. Most expat freelancers are forced to choose private health insurance.

What does public health insurance cover?

It covers all necessary healthcare. Important treatments and medical prescriptions are always covered. In general, you never have to pay for medical treatment. There is only 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. If a treatment is not covered, you will know before you start. You don't need to pay yourself, and you don't need to ask for a reimbursement. It's very simple.

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 companies (Krankenkassen) are almost the same. Their prices and coverage are set by the law1. The biggest difference between them is their extra contribution (Zusatsbeitrag), and their customer service1.

If you don't speak German, Techniker Krankenkasse and Barmer have support in English.

I was with Techniker Krankenkasse for 6 years before I switched to private health insurance. I was very happy with them. AOK, Barmer and DAK are three other important public health insurers.

If you don't know which health insurance to pick, ask a health insurance broker. Their help is free. They get paid by the insurance companies when they bring new customers.

Useful links:

Private health insurance

11% of German residents have private health insurance (private Krankenversicherung or PKV)1. You can only have private insurance if you are voluntarily insured (freiwillig versichert).

How much does private health insurance cost?

It depends on the coverage you choose, and your age and health when you join. If you are healthy, and you make a lot of money, private insurance can be much cheaper than public insurance, because it's not a percentage of your income. If you choose a higher deductible, or worse coverage, it gets even cheaper.

Your employer pays half of your health insurance. If you are self-employed, you pay the full price yourself1. This is why health insurance is so expensive for freelancers.

  • Private is cheap when you are young
    If you are young and healthy, you could pay just 175€ per month for private insurance (or 350€ for freelancers). If you make a lot of money, this is much cheaper than public insurance. Public health insurance can cost up to 470€ per month for employees, and 895€ per month for freelancers.
  • Private can cost more 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 very hard to go back to public health insurance. You can be stuck with very expensive health insurance. If you join the private system when you are young, it will be cheaper when you are old1, because your insurer saves part of your contributions for later.
  • Private is expensive if you have pre-existing health problems
    Usually, you must take a health test before you get private health insurance. If you have serious pre-existing health problems, they will often reject you or charge a lot1. This includes chronic diseases, psychotherapy or expensive medication, for example. Once you are accepted, your insurance does get more expensive because you use it, and it will cover every treatment you need.
  • You choose what you need
    You can choose dental coverage, travel insurance, special treatment etc. If you choose more options, your insurance will be more expensive. If you choose fewer options, it can be very cheap.
  • You can pay less with a higher deductible
    For example, if you have a 3000€/year deductible, you pay the first 3000€ in medical fees yourself, and your insurance pays everything after that. When you have a high deductible, you pay less in insurance every month. If you never go to the doctor, that's a good way to save money.
  • You pay less if you don't use it
    Many private health insurers charge less if you never use it. After 1 or 2 years without claims, your insurance can become cheaper. If you never get sick, you can save a lot of money.

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

Useful links:

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 a freelancer, 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 are an employee, and you earn more than 64350€ per year (in 2021, 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 64350€ per year (in 2021), 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 over 30 years old, 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 will 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 does private health insurance cover?

It 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 choose less coverage or a higher deductible.

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

Use Tarifcheck to compare private health insurance prices. Tarifcheck does not help you pick the best insurance. It only shows you the prices. It's always better to talk to a broker.

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.

Useful links:

Travel insurance

Travel insurance covers you for a few weeks when you visit Germany. It only covers medical emergencies, and treatments that can't wait until you return home. It does not cover long term treatments, health check-ups or pre-existing conditions. You can buy travel insurance online in your country of origin.

Travel insurance is enough to get a tourist visa, but it is not enough to get a German residence permit.

Expat health insurance

Expat health insurance is a temporary solution. Expat insurance is much better than travel insurance, but not as good as public or private health insurance.

There are two reasons to get expat health insurance:

  • You plan to live in Germany for less than 5 years
  • 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, until you can get something better.

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 a residence permit, or when you apply for a different residence permit1. You must have real public or private health insurance.
  • It can expire after 5 years
    Some expat insurances are only valid for 5 years1. 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 expensive1. If you settle in Germany, switch to real health insurance as soon as possible.
  • It's very expensive when you are old
    Health insurance gets more expensive every year. Compared to public or private health insurance, the cost of expat insurance rises really quickly1. If your expat insurance does not expire, it can become really expensive when you are old.
  • The coverage is not as good
    You usually pay a deductible for basic treatments. Simple check-ups and dentist visits are rarely covered. Long term treatments (like cancer) are 100% covered, without any deductible.

Useful links:

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 you1, 2. You can use your EHIC card even if you study in Germany for your entire degree1. 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 450€ per month, you must get a German health insurance1.

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.

Useful link:

The Künstlersozialkasse (KSK)

The Künstlersozialkasse (KSK) allows freelance artists to save money on health insurance. When you are on the KSK, the state acts as your employer, and pays 50% of your health insurance contributions. If you qualify, you can save a lot of money.

The KSK is not a health insurer. You must choose a health insurer yourself, then apply for the KSK.

It takes around 3 months to apply for the KSK1. They ask many questions, and require many documents. Staying into the is KSK also hard. You must prove that you still qualify every year.

Red Tape Translation can help you apply for the KSK. Tax advisors and health insurance brokers usually won't help you apply for the KSK.

Useful link: How to apply for the KSK - Settle in Berlin

Insurance brokers

You really should talk to a health insurance broker. Insurance brokers know a lot about health insurance, and they help you make better decisions. Only insurance brokers can give health insurance advice. Their help is completely free.

Always work with a broker, not an agent. An agent works for one insurance company, and only sells that company's insurance. A broker is independent, and can suggest insurance from different companies.

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

I work with Daniel at B-Protected since 2018. He helped hundreds of my readers, and I trust his advice. I also work with Feather. They helped me switch to private health insurance and save over 400€ per month. They also helped me write this guide and many others. They are based in Berlin, and they speak English.

How do insurance brokers get paid?

When you sign a health insurance contract, the broker gets a commission. For public health insurance, the commission is fixed. For private health insurance, the commission depends on your monthly premium. They also receive money every year for "holding" your contract, and answering your questions. You don't pay anything for their help.

Switching from private to public health insurance

Switching from private to public insurance can be really hard. Sometimes, it's impossible1, 2. If you are freiwillig versichert, public health insurers are not forced to accept you, so you can be stuck with private health insurance.

If you lower your income below 64350€, you become Pflichtversichert again, and you are forced to use public health insurance. This is one way to switch from private to public health insurance. This does not work for freelancers, because they are never Pflichtversichert1, 2. They must become employees to use this trick.

If you are over 55 years old, you can't switch to public insurance anymore, even if your income is below 64350€. It's almost impossible1. Otherwise, people would have private health insurance when it's cheaper, and switch to public health insurance when they are old. Public health insurance companies would go bankrupt!

Need help?

Health insurance brokers help you find the best health insurance for your situation. Only brokers can give health insurance recommendations.

I trust Feather and B-Protected. They helped me write this guide and helped many of my readers find health insurance. Rob from Feather helped me switch to private insurance and save over 400€ per month. I had a difficult case, and he worked for months to get me accepted. Both Feather and B-Protected and have a lot of experience with expats. To compare health insurance prices, you can also use Tarifcheck.

What's next?

Health insurance is essential, but liability insurance is also very important. It costs less than 5€ per month, and 82% of Germans have it. There are many other types of insurance in Germany, but health and liability insurance are the most important.