If you live in Germany, you must have health insurance. You pay for health insurance every month. When you need healthcare, your insurance pays for it.

In this guide, I explain the difference between public health insurance (gesetzliche Krankenversicherung) and private health insurance (private Krankenversicherung). I also help you pick the right health insurance.

This guide was verified by 7 separate health insurance brokers. Special thanks to Rob from Feather, who answered my questions for several hours.

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

Compulsorily insured? Voluntarily insured?

If you are compulsorily insured (Pflichtversichert), you must have public 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 insurers are not forced to accept you.

Public health insurance

Around 90% of German residents have public health insurance (gesetzliche Krankenversicherung or GKV)1, 2. It's also called statutory health insurance.

How much does public health insurance cost?

The cost of public health insurance depends on your income. You pay 14.6% to 15.6% of your income every month1. If you make more money, your health insurance becomes more expensive. If you make more than 58050€ per year, you pay the maximum amount, around 400€ per month.

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.

  • If you are an employee, you pay half of your monthly contributions (7.3% to 8.3% of your income). Your employer pays the other half1. The amount is taken directly from your paycheque every month.
    • If you make more than 58050€ per year, you pay around 400€ per month1. This is the maximum contribution (Höchstbeitrag). If your salary is higher than 58050€, you will not pay more. The maximum contribution goes up every year1, so next year, your health insurance will be more expensive.
    • If you are unemployed1, you pay around 180€ per month1. This is the minimum contribution (Mindestbeitrag). If your spouse or your parents have public health insurance, you can use their insurance for free. After you register as unemployed, the government pays your health insurance for you1, 2.
    • If you have a minijob, you still need health insurance. If your spouse or your parents have public health insurance, you can use their insurance for free. If not, you pay the minimum contribution (Mindestbeitrag): around 180€ per month1. Use this calculator to estimate the cost.
    • If you are an Azubi, you are treated like an employee. You pay 7.3% to 8.3% of your income. There is no minimum contribution. If you make less than 325€ per month, your employer must pay 100% of your health insurance1.
  • If you are a student under 25 years old, you will pay even less: 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 a student between 25 and 30 years old, you will 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 will pay around 180€ per month1, 2. This is the minimum contribution (Mindestbeitrag). You do not get a student discount anymore. If you just moved to Germany, you might be forced to get private health insurance. Public health insurers can refuse to cover you, because you are freiwillig versichert.
  • If you are a freelancer, you pay 14.6 to 15.6% of your income1. The amount is taken directly from your bank account every month.

If you are a freelancer, the cost is based on your estimated income. It is adjusted every year. If you paid too much, you will get a refund later. If you did not pay enough, you will have to pay more later.

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Benefits of public health insurance

  • Public is cheaper your income is low
    Public health insurance is based on your income. If you make less money, you pay less. If you lose your job or retire, your health insurance will be cheaper. When you are retired and make less money, public health insurance becomes cheaper than private health insurance.
  • Public is cheaper for students under 30 years old
    Students pay around 110€ per month1 until they are 30 years old. When they turn 30, they pay the Mindestbeitrag: around 180€ per month1.
  • It covers your dependents for free
    Public health insurance covers your children and your unemployed spouse for free. This is called Familienversicherung. If your spouse only has a minijob, (s)he is also covered by your insurance1. With private insurance, you must pay more to cover other people. If you plan to have children, public health insurance is often a better choice1.
  • It matches your income
    Public health insurance is cheaper when you make less money. If you lose your job or retire, public insurance will remain affordable. Private insurance will get more and more expensive, even if you lose your income.
  • 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. Even if you have serious health problems, you will not have to pay more for your insurance. Private health insurers won't accept people with serious health problems, or charge a lot more to cover them.

Disadvantages of public health insurance

  • Public is 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, public will be much more expensive than private. If you earn a good salary for your entire career, private can be much cheaper than public, even in the long term.
  • You don't get the best treatment
    Doctors make a lot more money with privately insured patients, so they get priority1. If you have private insurance, you will wait two days. With public insurance, you will wait two weeks. It's also very hard to find a psychotherapist or urologist who accepts public health insurance1, 2. You still get very good treatment, but not the best treatment.
  • 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, when my dentist removed my wisdom teeth, my insurance only paid for local anaesthesia. General anaesthesia was more expensive, so I had to pay the difference myself. Private insurance lets you choose the quality of your coverage.
  • It's not available for everyone
    If you are a freelancer, and you just moved from a non-EU country to Germany, 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.

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 customer service1.

Rob from Feather says "as an expat, Techniker Krankenkasse is a no-brainer, by a long way." TK is very popular with expats, because it offers support in English. I am with them since 2015, and I am very happy. AOK, DAK and Barmer are also 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

Around 10% 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?

The cost of private health insurance depends on your age and your health. 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.

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 as little as 175€ per month (350€ for freelancers) for private insurance. If you make a lot of money, this is much cheaper than public insurance.
  • 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 almost impossible 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 health problems
    You must take a health test before you get private health insurance. If you have pre-existing health issues that need constant treatment, your insurance will be much more expensive. If you have pre-existing conditions, they will often refuse to cover you1. This includes chronic diseases, psychotherapy or expensive medication, for example. Once you are accepted, your insurance will not go up because you get sick.
  • 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.

Who can have private health insurance?

You can only have private health insurance if you are voluntarily insured (freiwillig versichert). If you are compulsorily insured (Pflichtversichert), you can't have private 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. Public health insurers often refuse freelancers, unless they are already on the public system.
  • If you are an employee, and you earn more than 64350€ per year (in 2020, before taxes), you can choose 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 2020), you can't choose private health insurance. You must choose public health insurance. You can't choose private 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 students.

Even if you can have private health insurance, private health insurers might not accept you. For example, if you have health problems that require regular treatments, they will refuse you. If you had psychotherapy, they will usually refuse you. If you have problems like AIDS, sever asthma, diabetes or obesity, they could also refuse you, or charge you more. In other words, if you have serious preconditions, private health insurers will refuse to cover you.

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 better to talk to a broker.

Ottonova is popular option with expats, because they offer support in English, but they have their problems. HanseMerkur is also popular with expat freelancers. Hallesche accepts people before they get their residence permit. Most private health insurers require a residence permit.

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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.

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 covers you for up to 5 years. It's 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.

Expat insurance has a few disadvantages compared to public and private health insurance:

  • Expat insurance is not accepted when you renew a residence permit1, or change to another residence permit. You must have real public or private health insurance to renew a residence permit.
  • Expat insurance is a temporary insurance. It's only valid for up to 5 years. If you settle in Germany, switch to real health insurance as soon as possible. Many freelancers stay on expat insurance for too long. When they need to renew their visa, no insurer wants to cover them. They can't get health insurance, so they can't renew their visa1.
  • You usually pay a deductible for basic treatments. Simple check-ups and dentist visits are rarely covered. However, long term treatments (like cancer) are 100% covered, without any deductible.

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Insurance from other EU countries

If you stay temporarily in Germany, you can use your EHIC card. This proves that your health insurance back home covers healthcare in Germany.

If you are an Erasmus student from another EU country, the EHIC card is enough1, 2. You can use your EHIC card even if you study in Germany for your entire degree1.

Once you start working in Germany, your EHIC card does not cover you anymore. You must get a German health insurance.

The EHIC card is only available to European Union citizens. Read more about it here.

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, it can save you a lot of money.

Applying for the KSK is a long, difficult process. They ask a lot of questions and require many documents. It can take up to 6 months. Staying into the KSK also takes a lot of effort. You must prove that you still qualify every year.

Insurance brokers

You really should talk to a health insurance broker. Insurance brokers know a lot more about health insurance, and help you make better decisions. Only insurance brokers are allowed to recommend health insurance. Their services are completely free.

Always look for independent insurance brokers. Don't choose brokers who work for a single insurance company. They will recommend this company even when it's not the right one for you.

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

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.

Switching from private to public health insurance

Switching from private to public health insurance can be extremely hard, and sometimes impossible1, 2. If you are Pflichtversichert, public health insurers are not forced to accept you. You can be stuck with private health insurance.

If you are over 55 years old, you can't switch to public insurance anymore1. 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!

If you reduce your income below 64350€, you become Pflichtversichert again, and you are forced to use public health insurance. This does not work for freelancers, because they are never Pflichtversichert1, 2. They must become employees to use that trick. This does not work for people over 55 years old either.

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 500€ 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.