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Health Insurance In Germany: A Guide For American Expats

Moving abroad is a tricky proposition from all angles, but healthcare is one of the main worries people state when they are considering making an intercontinental move. If you’re moving from the USA to Germany, you might be wondering about the quality of healthcare available, how to sign up to the healthcare system there, and whether and how to take out private health insurance, either as a supplement to your national health care or instead of it. Below, we will take a look at the options that are open to you and how to apply.

The good news is that Germany has one of the best healthcare systems in the world, so after the initial push you’ll rarely have to worry about it again. But be prepared, good things don’t come cheaply. Organising health insurance should be one of the very first things on your ‘to-do’ list if you’re planning to move to Germany; you won’t be able to apply for a visa or residency permit without it.

There are two healthcare systems in Germany: the government health insurance system (Gesetzliche Krankenkassen) and private health insurance system (Private Krankenversicherung). Around 85% of people in Germany will choose to, or will be obligated to, use the government system. That is, only some people will be allowed to leave the public system to opt into private healthcare.

One of the first questions you will need to find out is whether or not you are in fact eligible to choose a private health insurance. For instance, if you are employed by a German company and your gross annual salary is less than €57,600 you will be required to use the government system. On the other hand, if you earn over this amount, or you are self-employed, then you will be able to choose your preferred healthcare. Find out early whether you have the option of choosing, as you could save yourself the time of tediously comparing the two systems.

Be careful in considering which system to choose though, as if you opt for private health insurance then it can be difficult to switch back to the government system.

One might be tempted, given the complexity of navigating German healthcare, to go for an international health insurance package. This may actually end up being more stressful though, as the German government has strict regulations in place regarding health insurance. Often international companies do not meet these regulations, and will not be sufficient when applying for a visa or residence permit. It is also important to note that German authorities will not grant your visa unless they are sure that your health insurance will cover the entirety of your stay, and so travel insurance or international expatriate insurance may not suffice. If you are staying in Germany for a prolonged period, it is highly recommended to choose an insurer within the country.

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Nursing insurance is also a legal obligation in Germany, and so in addition to the healthcare package that you choose, you will be charged a small percentage of your gross income to cover this.

It is also important to note that in 2010 a significant portion of one’s health insurance premiums were made tax deductible, so be sure to claim back your costs.

Private vs. public: the pros and cons

There are two reasons why people may want to use private health insurance. The first is that it may be more affordable if you have a high income. That is because contributions to state insurance are based on your gross income, whereas private health insurance contributions are calculated by your personal risk profile and the level of benefits chosen. For the majority of people however, the public system will still be the more affordable option.

The other reason to choose private healthcare is because it often offers more extensive cover of dental, optical and hospital treatment, as well as a broader range of alternative therapies. Yet as many government system companies have increased their coverage of alternative treatments recently, it is worthwhile checking whether your desired therapy is covered publicly, before turning to private insurance.

The government insurance system also has one key advantage, which is that it is free to insure your spouse and children. As long as they earn less than €400 per month you will be able to insure them on your policy. If you want your family to be included on insurance plan, then simply register them with your insurer and they will be automatically covered.

What is covered

There are a number of large non-profit insurance companies within the government healthcare system, the most popular being AOK, TK, SBK, BEK, and DEK. Germany is a land of rules and regulations, and in regards to health insurance this is increasingly useful. Because of this, most health insurance companies tied to the public system will offer roughly the same benefits in terms of treatment and coverage. That said, it may be worth considering different companies within the system as the cost of contributions may vary.

All public system companies will cover:

• Medical treatment
• Basic dental treatment
• Prescribed drugs
• Hospital treatment
• Immunisations
• X-rays
• Referred specialists
• Part of your wages if you fall ill and are unable to work

This insurance will cover some medical care in other EU countries, but this does not extend outside of Europe.

Private health insurers tends to cover:

• More alternative treatments
• Private hospital treatment
• Access to private doctors or surgeons
• Extended dental care
• Optical care

Since 2009, private health insurance companies have also been obliged to accept all eligible applicants irrespective of pre-existing health conditions. If you have a serious pre-existing condition, then you will be able to purchase a “Basistarif” at a private health insurance company. Unfortunately, the cost of this insurance is capped at a significantly higher rate at €683 per month for adults.

Employees of German companies

If you are employed by a German company the contributions to health insurance will be roughly split between you and your employer, no matter whether you choose private or state health insurance. If you choose or are obliged to use the government healthcare system, then your contributions will be based on your income. Generally, insurers within the government healthcare scheme charge a rate of around 14.6% of your gross salary. However, if you earn over €4,350 per month your rate will be capped, meaning you won’t pay extra. The quickest and easiest way to find out about the cost of your contributions would be to email your potential health insurer or speak to your employer.

Truthfully, if you are working for a German company, you probably won’t need to worry too much about health insurance as your company may have automatically signed you up to the public system. Once this has happened, you will need to get a certificate from your insurer in order to apply for a visa or residence permit. If you do want to opt for private insurance then you should speak with your employer quickly to avoid being automatically enrolled in the public system. Your health insurer is your decision, and legally your employer is not able to restrict the freedom of your choice.

Self-employed individuals

As a self-employed foreigner in Germany finding healthcare may be somewhat of a bureaucratic ordeal. Alas, many German health insurance companies are unenthusiastic about insuring self-employed foreigners. On the bright side, if you are self-employed then you are one of the people eligible to choose private health insurance, so theoretically there should be more insurance options open to you. Yet unlike the majority of cases, self-employed people will have to see whether they are even allowed to join the public system, as some may not be.

The best option for you is to speak to a professional insurance broker, who is informed about which companies are open to insuring foreign self-employed people. They will also be able to tell you if you can use the public system, as your eligibility depends on a number of different circumstances. Unfortunately, there does not seem to be any hard and fast rule about which companies will accept foreign self-employed applicants.


Getting health insurance as a student is (thankfully) incredibly straightforward. All public system health insurance companies are legally required to offer a special student plan with the same benefits and costs. At this stage, student health insurance costs around €80 per month, though over the last few years this amount has been incrementally increasing. Unless your circumstances are particularly exceptional, there should be no need for you look any further than these plans. In this case, it makes no difference which public company you choose to take out cover with, but AOK do tend to offer information in a series of languages, so they may be preferable to foreigners.

Often health insurers will offer some information in English. If you cannot find the information you need, the easiest way is to write to the company and ask them whether it will be possible to communicate in English. Some companies, such as AOK, do provide this service, while others do not. Obviously, it is beneficial to go with a company that does offer English services, as the technical German used in the information brochures and letters will require an exceptional command of the German language.

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