Health Insurance in Germany for Immigrants and Expats
Health insurance in Germany is mandatory — not optional. Every person legally residing in Germany must be covered by health insurance, from the first day of their stay. For immigrants and expats, understanding the German health insurance system is one of the most important first steps in settling here.
The Two-Track System: Public vs Private
Germany operates a dual health insurance system. The majority of residents — including most immigrants and employees — are in the public (statutory) system, known as gesetzliche Krankenversicherung (GKV). A smaller group of high earners and self-employed individuals can opt for private health insurance (private Krankenversicherung, PKV).
Public Health Insurance (GKV)
Public health insurance covers all medically necessary treatment: GP visits, specialist consultations, hospital treatment, surgeries, prescription medication (with a small co-payment), mental health treatment, maternity care, and preventive care. Dental care is partially covered — routine check-ups yes, extensive dental work may require additional top-up insurance.
The contribution rate for public health insurance in 2025 is 14.6% of your gross salary, split equally between you and your employer — so each pays 7.3%. In addition, each insurer charges a supplementary contribution (Zusatzbeitrag) averaging around 1.6% in 2025. This additional premium also varies by insurer, which is why it pays to compare.
For an employee earning €3,500 gross per month, total health insurance contributions are approximately €560/month (employer pays half = €280 each). The contribution is capped at a maximum salary ceiling (Beitragsbemessungsgrenze) of €5,175/month in 2025 — earnings above this are not subject to additional contribution.
Coverage of dependants: One of the great advantages of GKV is free family co-insurance. If your spouse does not work (or earns below the mini-job threshold of €538/month), they are covered under your insurance for free. Children are also covered for free regardless of the number.
Private Health Insurance (PKV)
Private health insurance is available to employees whose gross salary exceeds the compulsory insurance threshold (€69,300 annual gross in 2025) and to self-employed individuals. Private insurance typically offers faster appointments, access to senior doctors (Chefarzt), single hospital rooms, and broader dental coverage.
However, private insurance is based on individual risk assessment — premiums increase with age and pre-existing conditions, and your dependants are NOT automatically covered for free. For families, private insurance can become very expensive. Switching back from private to public insurance is difficult after age 55.
Which Public Insurer Should You Choose?
There are around 100 statutory health insurers in Germany. As an employee, you can choose any insurer that operates nationwide. The largest and most popular insurers for expats include: TK (Techniker Krankenkasse) — widely regarded as the best for English-speaking expats, with excellent online services; AOK — regional insurers with good local networks; Barmer — nationwide, good for families; DAK-Gesundheit — competitive supplementary contribution rate; and KKH — strong digital services.
The key differences between public insurers are the supplementary contribution rate (Zusatzbeitrag) and additional benefits — some offer free dental cleanings, eye tests, or complementary medicine. Core medical coverage is identical across all public insurers by law.
Enrolling in Health Insurance as a New Arrival
If you are starting a job in Germany, your employer will ask which insurer you want when you onboard. If you don’t choose, they will assign one. Simply contact your chosen insurer, complete their online enrolment form, and they will send you your health insurance card (Gesundheitskarte) within 2–4 weeks. You are covered from your first day of work — you don’t need to wait for the card to arrive.
If you are not yet employed, you may need to purchase private travel health insurance initially. Students must enrol in public student insurance (approximately €110–€130/month) within three months of enrollment.
What Is Covered?
Public health insurance in Germany covers a wide range of services. GP visits: no co-payment (a quarterly practice fee was abolished in 2013). Specialist visits: covered, though some require a GP referral. Hospital treatment: €10/day co-payment for the first 28 days. Prescription medication: €5–€10 co-payment per prescription. Dental: routine check-ups and basic fillings covered; complex work requires patient contribution. Mental health: covered including psychotherapy (waiting times can be long). Maternity care: fully covered including all prenatal check-ups, childbirth, and postnatal care. Preventive care: cancer screenings, vaccinations, health check-ups at various ages.
Practical Tips for New Arrivals
Choose TK or Barmer first if you don’t speak German — they both have English-speaking customer service and good digital apps. Register for health insurance before or on your first day of work. Carry your Gesundheitskarte to every medical appointment. If you need specialist care, getting a referral from your GP (Hausarzt) often reduces waiting times. For dental work, get a treatment plan (Heil- und Kostenplan) from your dentist approved by your insurer before expensive procedures — this determines what the insurer covers.