If you live in Germany, you must have health insurance. It's the law. 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 and private health insurance. I also help you choose the best health insurance for your situation.

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.

  • Public health insurance (gesetzliche Krankenversicherung or GKV)
    The cost is a percentage of your income. There are many public health insurers (Krankenkassen). They are non-profit funds, but they are not owned by the government. They offer almost identical prices and coverage. 89% of Germans have public health insurance.
  • Private health insurance (private Krankenversicherung or PKV)
    The cost is based on your age and health condition when you sign up. You can choose how much coverage you want. The cost and the coverage vary a lot. 11% of Germans have private health insurance.

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 89% 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?

Public health insurance costs 17.9% to 20.6% of your income1, but your employer pays half of it. The minimum contribution (Mindestbeitrag) is 180€/month for employees, and 200€ per month for freelancers. The maximum contribution (Höchstbeitrag) is 450€ per month for employees, and 895€ per month for freelancers1.

The base contribution is 14.6% of your income. You also pay 3.05% to 3.3% for the nursing care insurance (Pflegeversicherung). Public health insurers can also charge an extra contribution (Zusatzbeitrag). In 2021, the average Zusatzbeitrag is 1.3%1.

Your employer pays half of your health insurance, so it only costs you 8.9% to 10.3% of your income. 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 (8.9% to 10.3% of your income). Your employer pays the other half1. The amount is taken directly from your salary every month.
    • If you make more than 58050€ per year, you pay around 450€ 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 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 8.9% to 10.3% 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. Sometimes, they will accept because you had public insurance in another EU country.
  • If you are a freelancer, you pay 17.9% to 20.6% of your income1. The amount is taken directly from your bank account every month. The cost is based on your estimated income. It is adjusted every year. If you paid too much, you will get money back later. If you did not pay enough, you will need to pay more later.
  • 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.

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Benefits of public health insurance

  • Public is cheaper when 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 retire, your income could be lower than when you work. Public health insurance will adjust to your new income. Private health insurance does not adjust to your income.
  • Public is cheaper for students under 30 years old
    If you are a student, you pay around 110€ per month1 until they you are 30 years old. When you turn 30, you 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 you retire, public insurance will stay affordable. Private insurance does not get cheaper 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 pre-existing health problems, or they charge 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.

What does public health insurance cover?

It covers all necessary healthcare. Important treatments and medical prescriptions are always covered. In general, you will 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.

The only exception is glasses and dental care. Only essential dental care (like removing your wisdom teeth) is covered. You also get 2 free dental check-ups every year. This is why many people also get dental insurance. Glasses and contact lenses are rarely covered.

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.

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.

I was with TK for 6 years, before switching to private health insurance. I was very happy with them. TK is very popular with expats, because they have support in English. Barmer also has an English phone line. AOK and DAK are two other big 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.

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Private health insurance

Around 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 your age, your health and the insurance coverage. 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 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. Public health insurance can cost up to 450€ 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 health problems
    Usually, you must take a health test before you get private health insurance. If you have pre-existing health problems that need constant treatment, your insurance will be more expensive. If you have pre-existing health problems, they will often refuse to accept you1. This includes chronic diseases, psychotherapy or expensive medication, for example. Once you are accepted, your insurance will not get more expensive 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.
  • You pay less if you don't use it
    Many private health insurers give you some money back if you make no insurance claims. If you never get sick, you save even more money.

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

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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 must have 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. 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.

What does private health insurance cover?

It covers the same things as public health insurance, and often more. You will never be refused necessary healthcare. With private health insurance, you have more control over what is covered. It can cover extra services like dental care, glasses and laser eye surgery. You can also pay less if you want less coverage, or a high deductible.

You have more healthcare options, because you can visit doctors and therapists that don't accept public 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 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.

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. They speak English. Their insurance works for visa applications.

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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. 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 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. It's a good temporary insurance, until you can get something better.

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 a different 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 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 temporarily in Germany, 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.
  • When you start working in Germany, your EHIC does not cover you anymore. You must get a German health insurance.

If health insurance is cheaper in your home country, it's cheaper if you use your EHIC than if you get German health insurance. You can save a lot of money every month with the EHIC.

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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 services are 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.

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 freiwillig versichert, 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 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.