Health insurance in Germany, explained for internationals
Everything an English speaker needs to understand the German system and choose the right cover, from the mandatory rules to public versus private.
Is health insurance mandatory in Germany?
Yes. Everyone who lives in Germany is legally required to hold health insurance. This duty is set out under Section 193 of the Insurance Contract Act (§193 VVG) and Section 5 of the Social Code Book V (§5 SGB V). There is no opt-out. Whether you are employed, self-employed, studying or joining family, you must be able to show valid cover.
This is not only a formality. Proof of health insurance is required at several practical checkpoints. You will need it to register your address, to complete your visa or residence permit process, and before an employer can add you to payroll. Without it, these steps stall.
For internationals and newcomers, the question is rarely whether you need cover. It is which system you belong to, and whether you have a choice between the two. This guide walks through exactly that, so you can see your path before you commit to anything.
The two systems at a glance
Public or private. The difference comes down to how your cost is calculated.
How public health insurance works
Funded collectively. Your contribution is a percentage of your gross income, split with your employer, and does not depend on age or health. Family members can often be covered under family insurance.
How private health insurance works
An individual contract. Your premium is based on your chosen benefits, your age and your health when you join, not on your income. Typically faster specialist access and broader benefits.
The core difference
Public contributions rise and fall with income. Private premiums are priced by risk and the cover you select. Higher earners, the self-employed and students are the ones who get to choose.
Public vs private health insurance, side by side
A neutral orientation, not a verdict. The right system depends on your situation.
Public
Statutory, income-based
Private
Risk-based, configurable
How it works
Choose a plan to compare
Which one should you choose?
There is no single best answer. The right choice depends on your income, job, stage of life and plans in Germany. These are the four situations we see most often among internationals.
- Employees above the income threshold
Once your gross salary passes 77,400 euros a year (2026), you can choose private instead of public. Start with our [private health insurance guide](/private-health-insurance-germany).
- Self-employed and freelancers
You can choose private at any income. Public works differently for the self-employed, so compare both. See [who qualifies](/advice/who-qualifies).
- Students
Students have their own rules and can often choose private at competitive early-life rates. Read our [student page](/private-health-insurance-students-germany).
- EU Blue Card holders
The Blue Card salary minimum sits below the private-choice threshold, so a specific route often applies. See our [Blue Card page](/eu-blue-card-health-insurance-germany).
How to get covered, step by step
Confirm your status
- Work out which system you belong to and whether you have a choice.
- This depends on whether you are employed, self-employed or studying, and on your income.
Compare your options
- If you can choose, compare what each system and insurer offers for your situation.
- Look at benefits, access and long-term cost, not just the first-year price.
Apply
- Private cover includes some health questions; public cover is a straightforward enrolment.
- We guide the paperwork so nothing is missed.
Get your proof
- You receive confirmation of coverage.
- Use it for your residence registration, visa process and employer payroll.
What does health insurance cost in Germany?
Cost works differently in each system, so there is no single number that applies to everyone.
In the public system, your contribution is a percentage of your gross income up to a ceiling, and your employer pays a share. For 2026, the employer subsidy is capped at up to 508.59 euros per month toward health insurance and up to 104.63 euros per month toward long-term care insurance.
In the private system, your premium depends on your age, health and chosen benefits rather than your income. We do not quote a fixed figure here, because an honest number can only come from your profile. For illustrative ranges see our cost breakdown, and get a personalised figure through a free comparison.
Frequently asked
Not sure which system fits you?
Get a free, no-obligation comparison from independent English-speaking advisers. We look at your income, job and status and show you the right path in plain English. A phone number is required so we can arrange a free consultation to assess your situation.
Related guides
Where most people go next from here.
Private health insurance in Germany
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Learn moreCompare private health insurers
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Learn moreHealth insurance for foreigners
Your first 90 days and the arrival sequence.
Learn moreWhat private really costs
The drivers behind your premium and long-term cost.
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