Health insurance in Germany: how it works for internationals

Yes, health insurance is mandatory for everyone who lives in Germany, whatever passport they hold. The law sets this duty for both systems: § 5 SGB V for public cover and § 193 (3) VVG for private cover, in force since 2009. Employed, self-employed, studying or joining family, the rule is the same.

In practice, you need proof long before you see a doctor: for your visa, your residence permit, your first payroll or your university enrolment. Here is what counts as health insurance for your German visa.

A gap is expensive. If you belong in public insurance, membership is usually backdated to your first day without cover and you owe contributions for that period. In private insurance, if you apply more than a month late, you pay a one-off surcharge of one monthly premium per further started month without cover, a sixth of one from month six. So arrange cover that starts on the day you arrive. If you earn above €77,400 a year (2026) or work for yourself, that can be a private policy from day one: check if you can go private.

Employees earning up to €77,400 a year (2026) get public health insurance. Higher earners, self-employed people, freelancers and civil servants can choose private. Mainly your job status and income decide this, not your nationality: an EU Blue Card holder earning up to €77,400 is in public like any other employee. Run our free eligibility check or read who qualifies for private health insurance.

2027 brings a change. A law passed in July 2026 raises the threshold from 1 January 2027 by an extra €3,600 on top of the normal wage-based increase. The euro figure is expected with the 2027 regulation this autumn. If you are already privately insured on 31 December 2026 because your pay was above the threshold, the extra €3,600 does not apply to you, only the normal increase. Earning above €77,400 or close to the new line? Book a free consultation to check your timing.

Public health insurance in Germany costs about 21% of gross pay in 2026, including long-term care, and your employer pays about half. That is 14.6% plus your fund's additional rate (2.9% on average), plus 3.6% for long-term care, or 4.2% if you are childless and 23 or older. Contributions are only charged on pay up to €5,812.50 a month, so a childless employee at the average rate pays at most about €648 a month. Self-employed members pay both halves, up to about €1,261. Students pay about €146 a month at TK.

Private health insurance ignores your income. The premium depends on your age at entry, your health and the tariff. A healthy professional in their early 30s typically pays €380 to €550 a month for solid comprehensive cover. As an employee, your employer pays half, up to €613.22 a month in 2026, so your own share is well below the €648 public maximum.

Look beyond year one. Private premiums can rise when medical costs rise, softened by ageing reserves built from your first month, while public contributions follow your income and the yearly ceiling. Our full cost breakdown shows how premiums develop. Freelancers should read about private cover for freelancers, and the cheapest private options show where saving makes sense.

Both systems pay for GP and specialist visits, hospital treatment, prescriptions, pregnancy and birth (in private, depending on your tariff), and preventive check-ups. Public insurance follows a catalogue defined by law. The core benefits are the same at every fund. You show your electronic health card (elektronische Gesundheitskarte) at the practice, and adults pay small co-payments, for example on prescriptions and hospital days.

Private insurance works from your contract. The insurer cannot cut the benefits in your contract on its own or cancel it, and changes to the public catalogue do not apply to you. Your tariff decides the extras: a single or twin room, treatment by the head physician, how much you get back for crowns, implants and glasses. Long-term care is a separate compulsory insurance in both systems. See public vs private in detail or how private health insurance in Germany works for you.

In public health insurance, your spouse or registered partner and your children are insured free through family insurance (Familienversicherung) if their own income is at most €565 a month in 2026, or €603 with a minijob. Children qualify until 18 without conditions, until 23 if they are not working, until 25 in school, training or university, and with no age limit if they have a disability. One catch: if one parent is privately insured and earns more than €6,450 a month (2026) and more than the publicly insured parent, the children cannot be family-insured for free.

In private health insurance, each family member has their own policy, and children's tariffs cost less than adult tariffs. As an employee, your employer's subsidy can also cover dependants who would be family-insured in public, up to the cap.

Our view: public is mainly the better deal for single-income families with two or more children. With one child, or two incomes in the household, private is often still ahead, so compare your real numbers. Read about family cover in the public system or get a free comparison.

Yes. If you need a visa, the embassy wants proof of health insurance valid from the day you enter Germany. For short visits on a Schengen visa, travel health insurance is enough if it covers at least €30,000, is valid in all Schengen states and includes repatriation.

For a national visa it depends on why you come. Employees are usually covered from their first working day, through a public fund or a private policy. If your job pays above €77,400 a year (2026), your private policy can start on the day you land. Job seekers, language students and self-funded researchers are not in public insurance on arrival, so they need private or incoming health insurance built for living here, not ordinary travel insurance. Requirements differ between embassies, and an EHIC is not enough for a long stay. Our guide to visa-ready health insurance lists what to check.

EU citizens can use their EHIC for necessary treatment during temporary stays only. Once you work in Germany, employed or self-employed, you join the German system. Posted workers are the exception: with an A1 certificate they stay in their home system.

Yes, but going private is easier than coming back. If a new job pays above the threshold (€77,400 in 2026), you can go private from day one. If you are already in public insurance, you leave at the end of the calendar year in which your regular pay goes above the threshold, and only if it is also above the next year's threshold, which for 2027 includes an extra €3,600. Self-employed people can switch at any income, subject to their public fund's notice period. Always get a binding acceptance from the private insurer before you give notice, so there is never a day without cover.

You can only return to public insurance if you are required to join it again, for example because your salary drops below the threshold while you are employed. After 55 the way back is generally closed (§ 6 (3a) SGB V). Plan for the long term.

We handle the switch for you, free of charge: we compare tariffs, check your health details anonymously before you apply, and time the move with your employer. Follow our step-by-step switching guide or book a free consultation.