How to choose German health insurance

By Nicolas Bouliane Verified by 3 experts

If you live in Germany, you must have health insurance. It pays for your healthcare when you are sick. You must get insured before you start a new job, study at a German university, or apply for a residence permit.

This guide explains how to choose the best health insurance for your needs.

Your options

There is public, private and expat health insurance. The best option depends on your situation.

There is a guide for each occupation:

Public health insurance

87% of Germans have public health insurance.2 It might be your only option.

Public health insurance is run by non-profit insurance funds. It’s not run by the state. There are dozens of insurers. Their cost and coverage are almost the same.65

Cost of public health insurance

Public health insurance costs a percentage of your income. The cost is not affected by your age, your health condition, or how often you get sick.

Healthcare and medication are usually free. There is sometimes a €5 to €10 deductible for some treatments and prescriptions.53

The cost of public health insurance is tax-deductible.

What public insurance covers

Public health insurance covers all necessary healthcare. All important treatments and medical prescriptions are covered. It covers all pre-existing health problems. There is no limit on the cost of treatments. You can get healthcare as often as you need. Your health insurance does not get more expensive if you use it often.

Public health insurance covers “economic, sufficient, necessary and appropriate” healthcare. This means that they pay for the cheapest treatment that works.

Your insurance covers…

  • Your children and your unemployed spouse (Familienversicherung)
  • Long-term sick leave
  • Emergency healthcare in other EU countries
  • Psychotherapy
  • Basic vaccinations7
  • Cancer screenings
  • Necessary dental care (wisdom tooth removals, 2 dental check-ups per year)11

It does not cover…

  • Glasses and contact lenses (there are exceptions)
  • Travel vaccinations (some insurers cover them)
  • Cosmetic treatments like removing a mole, tooth whitening, orthodontics, nicer tooth fillings1
  • Alternative medicine like acupuncture and osteopathy

To get better coverage, get dental insurance or supplementary health insurance.

When you go to the doctor, you show your insurance card, and they charge your Krankenkasse directly. There is no reimbursement process.4 If a treatment is not covered, you know before you start. There are no surprise costs.

Benefits of public health insurance

  • The cost is proportional to your income
    If you earn less money, your insurance is cheaper. If you have an unstable income, if you lose your job, or if you retire, your insurance stays affordable. If you just started your business, choose public health insurance.26
  • It’s cheap for students
    Students under 30 years old pay around €140 per month. If you are under 30 years old, public is usually the best option.47
  • It covers your family for free
    Your children and your unemployed spouse get free health insurance. Private health insurance charges for each person you cover. If you have more than 2 children, public is usually the cheapest option.12
  • It’s simple
    When you go to the doctor, you show your insurance card, and you get healthcare. You don’t need to worry about coverage, deductibles or reimbursement. There are no surprises; it just works.
  • The cost is not tied to your health
    If you are over 45 years old or you have health problems, public health insurance is usually the cheapest option.27 Private health insurers might reject you, or charge a lot more.
  • It’s the safest option
    Public health insurance is never a bad decision. Insurers have similar prices and coverage, so you can’t choose wrong. If you change your mind, you can choose another public health insurer, or switch to private health insurance later.62 If you choose private health insurance, it’s much harder to change your mind.19

Disadvantages of public health insurance

  • High earners pay more
    If you have make a lot of money, you pay more. If you are young, healthy and well-paid, private health insurance can be better and cheaper.46
  • Doctor appointments are harder to get13
    It can take weeks or months to see a specialist. Psychotherapists, psychiatrists, gynaecologists, paediatricians and urologists that accept public health insurance are hard to find. If you want to see a doctor quickly, private health insurance is much better.
  • Special treatments are not covered
    Public health insurance covers the cheapest effective treatment.40 To get better treatments and better coverage, choose private health insurance.61
  • It’s not available to everyone
    If you come from outside the EU, and you are self-employed or a student over 30, you can’t get public health insurance. You must get private or expat health insurance instead. There are some exceptions.

Best public health insurance

Public health insurers have almost the same cost and coverage.65 The price difference is less than €20 per month after taxes. The biggest differences are customer service, and coverage of specific treatments.14 For example, one insurer can have better coverage for pregnancy, eyeglasses, dental care or travel vaccinations.

Barmer and Techniker Krankenkasse are good English-speaking options. Barmer has the best English-language support and service for immigrants.45 Techniker Krankenkasse is also very good, and it’s a little cheaper.

Ask my insurance expert to help you choose the best public health insurance. It’s a free service. He can also help you choose between public and private health insurance.

Private health insurance

You can choose private health insurance if…

  • You are an employee, and you earn more than €73,800 per year3
  • or you are self-employed
  • or you are a student
  • or you have a minijob
  • or you earn less than €535 per month
  • or you are a civil servant (Beamter)30

Everyone else must choose public health insurance. Only 13% of Germans have private health insurance.2

Cost of private health insurance

Use my health insurance recommendation tool to get a price estimate.

A healthy 30-year-old employee pays around €250 per month.50 I am self-employed, I have a pre-existing health condition, and I pay €600 per month. Students pay around €130 per month.34

The cost depends on 4 factors:

  • Your age when you join
    Younger people pay less. Your insurer saves a part of your payments for old age. If you join when you are young, you pay less when you are old. If you plan to leave Germany after a few years, you can get insurance without old-age provisions. It’s around 50% cheaper.
  • Your health condition when you join
    If you have no health insurance history, you must get a health check at the doctor.41 If you have pre-existing health problems, insurers reject you or charge more.9 After you join, your health does not affect the price, even if you get really sick.
  • The coverage you choose
    You can get the best coverage or the lowest price. You must pay more to cover your spouse and children.
  • Your deductible
    If you choose a high deductible (€1,200 per year), your health insurance is cheaper. When you get sick, you must pay out of pocket for most of your healthcare. You also get a yearly discount if you don’t use your health insurance.16 I get around €650 back every year.

Your employer pays half of your health insurance. If you are self-employed or a student, you pay the full price yourself.17 You pay for your health insurance every month by bank transfer.8

The cost of private health insurance is tax-deductible.

Benefits of private health insurance

  • It’s better and cheaper for high earners18
    If you are young, healthy and well-paid, private is usually better and better than public. I save around €600 per month.
  • Faster doctor appointments
    It’s much easier to see a specialist. You get an appointment in days instead of weeks. You can try it yourself. Go on Doctolib, and find a doctor appointment with public, then private health insurance.
  • Better treatment
    Private clinics usually have better service. Doctors are more patient. They take the time to listen to you.24 They also prescribe the best treatment instead of trying cheaper options first.
  • You choose your coverage
    Your insurance can cover dental care, travel health insurance, special medication and special treatments. You can pay more to get the best coverage. If you want to pay less, you can get lower coverage and choose a high deductible.16
  • You pay less when you don’t use it
    Many private health insurers have a no-claims bonus. If you don’t use your health insurance, you get money back every year. If you never get sick, you can save a lot of money. In 2024, I got a €640 refund.

Disadvantages of private health insurance

  • If your income changes, the cost stays the same
    If you lose your job, if you go on parental leave, if your business fails or if you retire, your health insurance does not get cheaper. You can be stuck with expensive health insurance. Public health insurance is safer, because the cost is proportional to your income.
  • It makes you avoid seeing a doctor
    If you have a deductible, you pay for most healthcare yourself. You might ignore a small problem because it costs €70 to see a doctor. You also get a yearly bonus if you don’t use your insurance. It makes you avoid healthcare to save money.
  • You pay, then get reimbursed
    When you go to the doctor, you pay for the treatment, and your insurance pays you back later. You need enough money to pay the doctor. It’s also more effort and more paperwork. You must also check if your insurance covers your treatment, or you will not get reimbursed.38
  • You can be stuck with private
    If you choose private, it’s hard to change your mind.19 It’s really hard to switch to public health insurance, or to another private insurance. You can be stuck with expensive private health insurance. Always ask an expert before you choosing private; it’s a very serious decision.
  • They reject people
    If you have health problems, insurers will reject you or charge more. They often reject people because of psychotherapy, HIV, severe asthma, diabetes or obesity. They can refuse to cover healthcare related to a pre-existing health problem.56 If you are over 45 years old or you have pre-existing health conditions, public health insurance is usually cheaper.27

What private insurance covers

The coverage depends on the plan you choose. Necessary healthcare is always covered. The coverage is usually equal or better to public health insurance.

The overall coverage is unlimited. There is no yearly cost limit. If you get cancer and the treatment costs millions of euros, your insurance pays for everything. Some treatments might have deductibles or yearly limits. For example, some plans have coverage limits for psychotherapy.48 A broker can help you choose a plan that fits your needs.

You can customize your coverage. For example, your insurance can cover extra services like dental care, eyeglasses and laser eye surgery. It can cover better dental implants, a better wheelchair, or a better hospital room. You can also get lower coverage to pay less every month.

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 and get treated.

Best private health insurance

There is no best private health insurance. There are thousands of very different options. The best option depends on your situation.

Do not choose private health insurance yourself. It’s a really bad idea. Ask a health insurance broker to compare all options and help you choose. Their help is free.

Feather sells private health insurance, but they only offer one or two options. If you ask a broker, they compare all options to find the best one.

Ottonova sells their own private health insurance. It’s rarely the best option.58 Don’t choose Ottonova directly; ask a broker to help you. If Ottonova is a good option for you, they will tell you.57

Free health insurance

Your parents’ insurance covers you for free if…

  • Your parents have public health insurance
  • and you are under 23 years old (under 25 years old if you are a student)
  • and your total income is under €535 per month (€556 per month for a minijob)
  • and you are not self-employed full time
  • and you are not an apprentice (Azubi)44

Your spouse’s insurance covers you for free if…32

  • Your spouse has public health insurance
  • and your total income is under €535 per month (€556 per month for a minijob)
  • and you are not self-employed full time35
  • and you are not a apprentice (Azubi)44

Your health insurance from another EU country covers you if…

  • You are visiting Germany
  • or you are a student and you have no income39

Your employer pays for your health insurance if…43

  • You are an apprentice (Azubi)
  • and you earn €325 per month or less

The state pays for your public health insurance if…42

When you lose your job, your public health insurance is sometimes free for 1 month (nachgehender Leistungsanspruch). This happens automatically; you don’t need to apply for it.

Other options

Expat health insurance

Expat health insurance is a temporary private health insurance. It’s bad, but it’s cheap. You can use it to apply for a National Visa, an opportunity card, a student visa or a freelance visa.

Only choose expat health insurance if…

  • You need temporary coverage
    It’s perfect if you stay in Germany for a few months, or you need temporary health insurance before your public health insurance coverage starts.
  • or you are a student over 30 years old
    It’s much cheaper than public health insurance. You can switch to public or private after you graduate and start working. If you are under 30 years old, public health insurance is usually the best option.
  • or you are a freelancer with a low income
    You can use it to apply for a freelance visa.6 It could be the only health insurance you can afford, or the only one that accepts you. Ask our expert if it’s the correct choice.
  • or you are retired
    If you move from a non-EU country, it might be your only option. Public and private insurers might reject you. Ask our expert if it’s the correct choice.

Expat health insurance is bad because…

  • The coverage is limited
    It does not cover pre-existing health problems. It rarely covers therapy, dentist visits, health check-ups and preventative treatments.25 There are high deductibles for some treatments. There are limits on the cost of some treatments.
  • It’s temporary
    You can rarely use it for more than 5 years.21 When it expires, you must get public or private health insurance. If you have developed health problems during that time, it can be really hard to find another insurance. You can end up with a really expensive insurance.
  • It gets very expensive
    The price increases every year. There is no limit on the price increases. In the long term, public and private health insurance are cheaper.10
  • You can get kicked out
    Insurers can end your contract, and refuse to keep covering you. It can be hard to find another health insurance.52
  • It’s not always valid
    You can use expat health insurance to apply for a Schengen visa or a National Visa.5 You can’t use it to change or renew an existing residence permit.28

Do not stay on expat health insurance. If you develop a health condition while you have expat insurance, it can be really hard to find long-term health insurance, because all insurers will refuse to cover you.

Get expat health insurance from a health insurance broker. Feather and Ottonova sell expat insurance, but brokers are more neutral, and compare all options from all insurers.

List of expat insurance options

Travel health insurance

Travel health insurance covers medical emergencies in other countries. It does not cover therapy, long-term treatments, health check-ups or pre-existing health problems.

  • If you visit Germany, travel insurance covers you during your trip. You need travel health insurance to get a Schengen visa. It does not cover you after you move to Germany. It’s rarely valid for a residence permit application.
  • If you move to Germany, travel health insurance is not valid. You must get public, private or expat health insurance.
  • If you live in Germany, travel health insurance covers medical emergencies when you when you travel to other countries. It costs around €40 per year.59 If you have private health insurance, it usually includes travel insurance.

You can get travel health insurance from Feather, Envivas or Allianz. Your private health insurance might include travel insurance. Some banks accounts like N26 Metal include travel insurance.

Insurance from other EU countries

If you come from another EU country, your health insurance might cover you in Germany. You can use your European Health Insurance Card to get healthcare.

  • If you visit Germany
    Your EU health insurance covers medical emergencies.22 It only covers treatments that can’t wait until you go home. For example, if you break your ankle on a hike, it covers the hospital visit. If you stay longer than 3 months, you must get German health insurance.36
  • If you study in Germany
    Your EU health insurance covers you until you graduate, and during your job search after graduation.37 It covers all treatments that can’t wait until after your studies.

If health insurance is cheaper in your home country, EHIC is a good way to save money, because you don’t need German health insurance. Apply for EHIC with your health insurance in your home country.15

You can only get treatments that are covered by German public health insurance.31 It does not cover repatriation if you are sick. For that, you need travel health insurance.23

If you start working in Germany, your EHIC stops working, and you must get German health insurance.39

More information about EHIC

What is the best option?

  • Public health insurance is the safest option, because you can choose private health insurance later.62 Public health insurers have very similar prices and coverage, so you can’t choose wrong.
  • Private health insurance is a risky decision, but it can be better and cheaper than public. If you are not happy, it’s really hard to switch to public health insurance. Never choose private health insurance yourself.
  • Expat health insurance is a temporary option. It’s cheap, but the coverage is bad. Use it when you have no other choice.

Do not choose your insurance yourself. You can make expensive mistakes. Ask an expert to help you choose. Their help is free.

Choose public health insurance if…

  • You have a low or unstable income
    If you are not sure you will always have a high income, public health insurance is safer. It costs a percentage of your income, so if you make less, your pay less. If you just started your business or your make less than €30,000 per year, choose public health insurance.26
  • You want something simple
    Just show your card and get healthcare. It takes longer to get an appointment, but you don’t have to deal with paperwork, deductibles or the reimbursement process.
  • You want more than 2 children
    Public health insurance covers your children for free. If you have 1 or 2 children, private health insurance could still be cheaper.12
  • You are a student under 30 years old
    The student tariff is a really good deal.47 There is cheaper private or expat health insurance, but the coverage is usually worse.
  • You have pre-existing health problems
    Private health insurers might charge more or refuse to cover you. Even getting psychotherapy can disqualify you. Public health insurance is usually forced to accept you.

Choose private health insurance if…

  • You have stable income
    Private health insurance makes sense if you know you will always have a high income.
  • You want faster doctor appointments
    It’s much easier to find a doctor, a psychotherapist, a paediatrician or a gynaecologist. It takes a few days instead of a few weeks.
  • You want the best coverage
    Private health insurance lets you pay more and get the best coverage for you and your family.
  • You want better treatment
    You can choose a specific doctor, or a specific kind of treatment. For example, you can get innovative therapy or medication that is not yet covered by public health insurance.54 It can cover better dental implants, a better wheelchair, or a better hospital room.
  • You plan to leave Germany in a few years
    You can get short-term private health insurance. It’s up to 50% cheaper, because there is no old-age provision.55
  • You can’t choose public health insurance
    If you are a freelancer or a student from a non-EU country, public health insurers might reject you. Private health insurance might be your only option.

Choose expat health insurance if…

  • You are a foreign student over 30 years old
    If you come from a non-EU country, it’s often the only option. Public health insurance will reject you.
  • You need temporary insurance coverage
    Expat health insurance covers you until your public health insurance starts working. You might need it to apply for a German visa.
  • You have no other choice
    If you are self-employed and you have pre-existing health problems, it might be your only option. Expat health insurance is usually the cheapest option. It’s a bad long-term solution, but it might be the only insurance you can afford.
  • You apply for an opportunity card
    Expat health insurance is perfect for this. When you find a job, switch to public or private health insurance.

Choose travel health insurance if…

  • You are a tourist
    Travel insurance covers medical emergencies while you travel. It’s cheap.
  • You apply for a Schengen visa
    You need valid health insurance to apply for the Schengen visa. HanseMerkur Visa Plus works well for this.

Insurance brokers

Do not choose health insurance yourself. Our broker can help you find better and cheaper health insurance. This is a free service.

Talk to a broker (Makler), not an agent (Vertreter). Brokers are independent. They recommend health insurance from different companies. Agents only sell insurance from specific companies.

Choose a broker who works with immigrants. Your needs are different, and your broker must know how to help you.

Feather is an agent, not a broker. They have an excellent service, but they only sell insurance from a few companies.49 They might not sell the best insurance for your needs.

Ottonova sells their own insurance. It’s rarely the best option.63 Even if you get Ottonova, it’s better to get it through a broker. See my review of Ottonova.

How to get insured

1. Understand your options

Use my recommendation tool to know your options. There are 3 types of health insurance and hundreds of options. The best option depends on your situation.

2. Ask an expert to choose

Do not choose health insurance yourself. The cheapest option now can be an expensive mistake later. Your visa application can get rejected because you chose the wrong insurance.

Always ask a broker to help you. They ask you the right questions, look at all the options, and help you find the best health insurance. You can get better coverage for a lower price. Their help is free.

3. Apply for health insurance

The process is different with each insurer. Your health insurance broker can take care of this.

You only need an ID document and a photo for your insurance card. You do not need a German address or an Anmeldung.51

If you choose private health insurance, you usually need a health check from a doctor.41 It costs around €250.29

If you are self-employed and new in Germany, it can be hard to get health insurance. Public and private health insurers can reject you.

4. Get your documents

Once you are insured, you get…

If you are a student, your health insurer will tell your school that you are insured (the M10 Meldung). It’s done digitally; you don’t need to do anything. It takes around 3 days.66

5. Pay every month

If you have public health insurance, you pay out of your paycheck every month. If you have private health insurance or you are self-employed, you pay by bank transfer or direct debit authorisation.33

When you are self-employed, the cost of public health insurance is based on your estimated income. It’s adjusted every year. If you paid too much, you get money back. If you did not pay enough, you must make an extra payment.20

What to do next

  • Tell your employer
    When you change your health insurance, tell your employer.64 Tell the human resources department.
  • Get liability insurance 
    Liability insurance is the second most important insurance. Most Germans have it. I got mine from Feather.
  • Get travel health insurance
    It covers you when you travel outside of Germany. It costs €25 to €40 per year.59 You can get travel insurance from Feather, Envivas or Allianz. Your private health insurance might include travel insurance. Some banks accounts like N26 Metal include travel insurance.
  • Become an organ donor 
    It’s really easy. It can save another person’s life.
Sources and footnotes

  1. verbraucherzentrale.de (March 2025) ⤴

  2. gesundheitsinformation.de, gkv-spitzenverband.de, verwaltung.bund.de (April 2025) ⤴

  3. versicherungspflichtgrenzen.de ⤴

  4. krankenkassen.de (July 2025) ⤴

  5. Emily Archer (April 2025), Feather (April 2025) ⤴

  6. Emily Archer (April 2025) ⤴

  7. krankenkassen.de (June 2025) ⤴

  8. Seamus Wolf (April 2025) ⤴

  9. FinanXpats (April 2025), Feather Insurance (April 2025) ⤴

  10. krankenkassenzentrale.de, tk.de ⤴

  11. verbraucherzentrale.de (March 2025) ⤴

  12. Seamus Wolf (April 2025), Mona Anbari (April 2025), Emily Archer (April 2025), finanztip.de (January 2025), FinanXpats (April 2025) ⤴

  13. arzt-wirtschaft.de (2024), sueddeutsche.de (2024), study (2013) ⤴

  14. Seamus Wolf (April 2025) ⤴

  15. verwaltung.bund.de ⤴

  16. blog.feather-insurance.com ⤴

  17. reddit.com/r/germany ⤴

  18. Feather Insurance (April 2025) ⤴

  19. Seamus Wolf (June 2025) ⤴

  20. Personal experience (2020) ⤴

  21. care-concept.de (April 2025), mawista.com (April 2025), Feather Insurance (April 2025) ⤴

  22. health-insurance.de (April 2025), ec.europa.eu (April 2025) ⤴

  23. dvka.de, Seamus Wolf (April 2025) ⤴

  24. Twitter (June 2025), Reddit (July 2025) ⤴

  25. Mona Anbari (April 2025) ⤴

  26. finanztip.de (January 2025), Feather Insurance (April 2025), Emily Archer says that the amount is not fixed, but that insurers need to see that you can cover your insurance bills (April 2025) ⤴

  27. finanztip.de (January 2025), Mona Anbari (April 2025) ⤴

  28. Emily Archer (April 2025), multiple relocation consultants (2025) ⤴

  29. Seamus Wolf (April 2025), Emily Archer (April 2025) ⤴

  30. pkv.de (April 2025) ⤴

  31. verwaltung.bund.de (April 2025) ⤴

  32. verbraucherzentrale.de (January 2025) minijob-zentrale.de (February 2025) ⤴

  33. Personal experience (2025), Seamus Wolf (April 2025) ⤴

  34. check24.de (July 2025), Ottonova (July 2025) ⤴

  35. verbraucherzentrale.de (February 2025) ⤴

  36. Feather Insurance (2023) ⤴

  37. Feather Insurance (2023), Feather Insurance (May 2025), krankenkassen.de (May 2025) ⤴

  38. Reddit (July 2025) ⤴

  39. feather-insurance.com (2023), verwaltung.bund.de (April 2025), uni-frankfurt.de (May 2025) ⤴

  40. Mona Anbari (April 2025) ⤴

  41. Seamus Wolf (April 2025), Emily Archer (April 2025) ⤴

  42. Techniker Krankenkasse (May 2025), familienportal.de (May 2025) ⤴

  43. AOK (March 2025), Check24 (March 2025), Techniker Krankenkasse (March 2025) ⤴

  44. gesetzliche-krankenkassen.de (March 2025) ⤴

  45. Carina Busch, Seamus Wolf (April 2025) ⤴

  46. Seamus Wolf (April 2025), finanztip (February 2025), verbraucherzentrale.de (2024) ⤴

  47. finanztip.de (January 2025), Feather Insurance (May 2025) ⤴

  48. Seamus Wolf (April 2025) ⤴

  49. Emily Archer (April 2025), Seamus Wolf (April 2025), multiple insurance brokers (2024, 2025) ⤴

  50. €250 to €350 (FinanXpats) (April 2025), €250 to €390 (Feather) (April 2025), €260 to €350 (Ottonova) (April 2025) ⤴

  51. Seamus Wolf (May 2025) ⤴

  52. Seamus Wolf (April 2025) ⤴

  53. online-pkv.de (January 2025), gesetzlichekrankenkassen.de (June 2025) ⤴

  54. Mona Anbari (April 2025) ⤴

  55. Seamus Wolf (April 2025) ⤴

  56. Seamus Wolf (April 2025) ⤴

  57. Seamus Wolf (April 2025) ⤴

  58. Seamus Wolf (April 2025) ⤴

  59. Feather Insurance, Seamus Wolf (April 2025) ⤴

  60. Emily Archer (April 2025) ⤴

  61. Mona Anbari (April 2025) ⤴

  62. Seamus Wolf (April 2025) ⤴

  63. Seamus Wolf (April 2025) ⤴

  64. check24.de (May 2025), krankenkassen.de (May 2025) ⤴

  65. “95 the same” (June 2025), check24.de (May 2025) ⤴

  66. Feather Insurance (May 2025), Uni Frankfurt (May 2025) ⤴