Health insurance in Germany for Americans
No networks, no surprise billing, no income-based marketplace tiers. The German system works differently from what you know, and US plans give you no cover here. Here is what actually matters.
Five things Americans should know
Your US plan stops at the border
Marketplace plans, employer PPOs and Medicare provide no meaningful cover in Germany. Residents need a German contract from day one.
There are no networks
Both public and private insurance work with essentially every doctor and hospital in Germany. No in-network lists, no balance billing.
Premiums are not income-based in private
Private premiums depend on age, health and tariff. Public contributions are a percentage of income up to a monthly ceiling.
The choice depends on your status
Employees need EUR 77,400+ gross per year (2026) to choose private. Freelancers on the self-employment visa can choose at any income level.
Pre-existing conditions are handled differently
Public insurance accepts everyone with no health questions. Private insurers run a health check and can add surcharges or decline.
How German cover differs from what you know
The biggest adjustment for American clients is trust in the baseline. Both systems cover hospital care, specialists, prescriptions and pregnancy as contractual rights: if your tariff lists it, it is covered, and the insurer cannot cancel your contract because you got sick. Deductibles exist in private tariffs only as an option you choose to lower the premium (Selbstbeteiligung). Employees split the premium with their employer in both systems, roughly half and half. For the full comparison, see public vs. private health insurance.
- Every doctor and hospital, no network restrictions in either system.
- Covered benefits are contractual; no claim adjusters second-guessing treatment.
- Deductibles are optional in private tariffs, not a market default.
- Your employer pays about half of the premium in both systems.
Public vs. private at a glance
Typical profile: US software engineer on a local contract, gross salary EUR 90,000, healthy, mid 30s.
Public health insurance
Income-based
Private health insurance
Age and tariff based
The essentials
Choose a plan to compare
Figures are 2026 values and typical ranges. Your exact premium depends on age, health and tariff. Get a free quote for a personal calculation.
Common situations for US citizens
Most American clients fall into one of four situations. Employees on a German contract follow the salary threshold rules. Freelancers and founders on the self-employment residence permit can pick private at any income; we recommend it from around EUR 40,000 per year. Students under 30 use the public student rate of roughly EUR 135 per month. And accompanying spouses without their own income can join a partner's public policy for free, which is often the deciding factor for families. If you may move back to the US, ask about Anwartschaft, which pauses a private contract cheaply instead of cancelling it.
- Employee above EUR 77,400: free choice, compare both with real numbers.
- Freelancer or founder: private open at any income, sensible from about EUR 40,000.
- Student under 30: public student tariff is the standard route.
- Accompanying spouse without income: free public family cover beats a second private premium.
Common questions from American clients
No. Medicare provides essentially no cover outside the US, and marketplace or employer plans treat Germany as out of area. German residents need a German contract.
It is closer to a lifetime contract than an annual plan. There is no annual re-enrollment, the insurer cannot cancel you for getting sick, and premiums are based on age and health at entry, not income.
Public insurance accepts everyone without health questions. Private insurers ask health questions and can add a surcharge or decline. If you have significant history, public is often the better route; a free consultation sorts this out quickly.
Both systems fully cover pregnancy and birth. Public insurance adds a non-working spouse and children for free. In private insurance each family member has their own contract and premium.
Public membership simply ends when you deregister. Private contracts can be paused with an Anwartschaft option, which keeps your entry age and health rating if you return to Germany later.
Yes. TK offers strong English service on the public side, and Ottonova, DKV and Allianz sign private contracts in English. My Healthcare Broker advises in English end to end, for free.
Talk it through in
Related guides
Two more pages that come up most often when people are at this stage.