Healthcare for Expatriates in Germany: Understanding, Choosing, Navigating

Published on January 17, 2026 and written by Cyril Jarnias

Moving to Germany means gaining access to one of the world’s most high-performing healthcare systems… provided you understand its rules. Mandatory insurance, a jungle of options between public funds, private contracts, “incoming” insurance, emergency care, the language barrier, vaccinations, mental health: for an expat, the questions multiply quickly.

A universal, high-performing… but highly regulated system

Germany has a universal, multi-payer healthcare system considered one of the best in the world. It is based on well-equipped hospitals, a dense network of primary care physicians, and strong regulation of prices and services.

The system rests on two main pillars:

– Gesetzliche Krankenversicherung (GKV), public/statutory, non-profit, highly regulated health insurance, covering about 87 to 90% of the population;

– Private Krankenversicherung (PKV), private, for-profit, modular health insurance, covering 10 to 13% of residents.

In addition, there are complementary layers: private “expat” or “incoming” insurance for newcomers, dental or hospital supplementary insurance, international coverage, etc.

For an expat, the first challenge is to understand which category you fall into, and what that means in terms of cost, rights, and flexibility.

GKV or PKV: How does health insurance really work in Germany?

GKV and PKV follow completely different logics. The first is based on solidarity: contributions depend on income, not health status. The second is individualized: the premium depends on your age, medical history, and the chosen level of coverage.

GKV: Public insurance, the cornerstone of the system

The GKV is managed by non-profit public health insurance funds (Krankenkassen) under the supervision of the Federal Ministry of Health and the GKV‑Spitzenverband, the umbrella organization. There are over a hundred funds (TK, AOK, Barmer, DAK, hkk, KKH, etc.), but the “basket of care” is largely standardized by the Federal Joint Committee (G‑BA).

In practice, the GKV:

– covers all “medically necessary” care;

– accepts everyone, without medical screening or surcharges for pre-existing conditions;

– automatically includes mandatory long-term care insurance (Pflegeversicherung);

– allows for Familienversicherung: a spouse and children without significant income can be covered for free.

From the point of view of an employed or student expat, this is generally the simplest and safest entry route.

PKV: Private insurance, flexible but selective

The PKV is offered by private companies (about 41 different insurers), with a classic insurance logic: premium calculated on individual risk, modular contracts, multiple options (private hospital room, treatment by head of department, enhanced dental coverage, alternative medicine, worldwide coverage, etc.).

Some key mechanisms:

– premiums not linked to income, but to age at entry, health, and level of coverage;

– possible medical screening: some conditions can lead to exclusion, surcharges, or even refusal;

– each family member must have their own paid contract;

– many contracts operate on a reverse third-party payer basis: you pay the bill and are reimbursed.

The PKV can be cheaper than the GKV for a young, healthy expat with a high salary… and become much more expensive in the long term, especially with a family and as you age. Switching back to GKV after age 55 is in practice very difficult.

Who is eligible for what? The eligibility rules

Access to GKV or PKV is not completely free. It depends mainly on your employment status and income.

Employees

– Below an annual gross income threshold (€69,300 in 2024, €73,800 in 2025, thresholds expected to continue rising), affiliation to GKV is mandatory: you are “pflichtversichert”.

– Above this threshold, you become “freiwillig versichert”: you can stay in GKV or switch to PKV.

Self-employed, freelancers, professionals

Self-employed workers can in principle choose:

– GKV, by contributing voluntarily (and paying both the employer and employee shares);

– or PKV, very common for freelancers.

Some income thresholds are sometimes mentioned by private insurers: for example, a minimum monthly income of around €2,500 to €3,750 for certain freelance profiles, or €35,000 annually to be eligible for some products. These figures serve as commercial criteria more than strict legal rules.

Students

– Up to age 30, students can benefit from a student GKV scheme at a reduced rate.

– After age 30, they must either switch to PKV or voluntarily join GKV at a significantly higher rate.

Foreign students must provide proof of insurance for university enrollment and for the visa. Purely temporary “incoming” insurance is often refused for long stays.

Civil servants, visiting researchers, other cases

– Civil servants often benefit from specific subsidies (Beihilfe) and opt for PKV.

– Visiting researchers, visiting professors, students in preparatory courses or long-term language courses may need to use PKV or dedicated expat insurance.

– Retirees receiving a German pension are, however, switched back to a specific GKV scheme (KVdR).

How much does GKV cost for an expat?

Contributions to GKV are calculated as a percentage of gross income, up to a contribution assessment ceiling (Beitragsbemessungsgrenze). A mandatory long-term care insurance is added on top.

The principle: a percentage of income, shared with the employer

The basic GKV rate is 14.6% of gross income. To this is added a supplementary contribution (Zusatzbeitrag), specific to each fund, averaging 1.7% in 2024. In total, the range is approximately between 16.4% and 19% of income.

For employees:

– the contribution is shared 50/50 with the employer;

– beyond a certain monthly income (approx. €5,175 in 2024, more in 2025 and 2026), no contributions are paid on the excess portion.

For the self-employed:

– they pay the entire 14.6% + Zusatzbeitrag on a minimum fictitious income base (approx. €1,178 per month minimum in 2024), which is why GKV can become expensive for a low-income freelancer.

Mandatory long-term care insurance

Pflegeversicherung is inseparable from GKV:

– about 3.6% for insured persons with children;

– about 4.2% for insured persons without children.

Some orders of magnitude

Here is an indicative table (excluding specific surcharges) for an employee, taking an average Zusatzbeitrag.

Situation	Monthly calculation base (2024)	Total GKV + Pflege rate (approx.)	Employee share (50%)
Gross salary €3,000/month	€3,000	~18%	≈ €270/month
Gross salary €5,000/month	€5,000	~18% (below ceiling)	≈ €450/month
Gross salary €7,000/month	€5,175 (2024 ceiling)	~18% (capped)	≈ €465/month

These amounts include long-term care insurance and remain approximate, but give a clear idea: GKV is proportional to income, up to a relatively stable maximum, whether your salary is €5,200 or €8,000 per month.

Special schemes: Students, apprentices, unemployed

– Students < 30 years: fixed contribution around €90 to €130 per month, including long-term care insurance.

– Students > 29 years: switch to minimum contributions of around €180 to €250 per month.

– Apprentices (Azubis) earning less than €325 per month: the employer covers 100% of the insurance.

– Unemployed persons who previously contributed: remain covered by GKV via the employment agency or social assistance.

How much does PKV cost for an expat?

With PKV, premiums do not depend on income, but on individual factors: age at entry, health status, chosen coverage, annual deductible. The differences are therefore considerable.

Orders of magnitude

Studies and market data indicate:

– premiums ranging from €150 to over €1,500 per month, depending on profile and coverage;

– for a healthy employee around 35 years old:

– “basic” plan: €350–550/month;

– “comfort” plan: €450–700/month;

– “premium” plan: €550–900/month;

– observed average premium around €535/month (excluding civil servants).

The employer contributes up to 50% of the premium, limited to what they would pay for a GKV employee, i.e., around €420–510/month depending on the year. Any excess portion remains your responsibility.

Deductibles, bonuses, taxation

The flexibility of PKV relies on several levers:

For a very high income, young and without short-term family plans, PKV may seem advantageous. But switching back to GKV later is complex, even impossible after age 55. It’s a structuring choice, better made with an independent broker rather than solely based on an online comparison tool.

What does health insurance actually cover in Germany?

For an expat, the difference in comfort level between GKV and PKV often matters as much as the price difference.

GKV: Broad coverage, logic of “necessity”

GKV covers all care considered medically necessary and economically reasonable:

Pre-existing conditions are fully covered: you cannot be refused or penalized for arriving with a chronic condition.

In return, some areas remain modestly covered or highly regulated:

– optics (glasses, contact lenses): very limited coverage;

– alternative medicine and supplements (homeopathy, osteopathy, acupuncture): heavily restricted or not covered, except for specific programs;

– complex dental work: significant out-of-pocket costs, hence the rise of supplementary insurance.

Small co-payments (Zuzahlungen) are systematic:

Type of expense	Patient participation rule
Prescription drugs	10% of price, min. €5, max. €10
Hospitalization	€10/day, capped at 28 days per year
Various devices (canes, compression stockings, etc.)	Variable partial participation depending on item

An annual out-of-pocket spending cap (2% of gross income, 1% for chronically ill patients) limits the overall bill.

PKV: Comfort, speed, international options

PKV includes at minimum what GKV covers, but often adds significant comfort levels:

However:

– family members are never covered automatically;

– pre-existing conditions can lead to exclusions or surcharges;

– most contracts operate on a reimbursement basis after the patient pays the bills.

For stays or regular trips outside Germany, some PKV contracts offer broader protection than the simple European Health Insurance Card for GKV insured persons.

“Incoming” / expat insurance: A temporary solution, not a lasting substitute

Alongside GKV and PKV, there are private products called “incoming” or “expat health insurance”. They are designed for:

– newcomers who do not yet have a GKV/PKV contract;

– people coming to Germany for a few months;

– holders of a national D visa during the initial setup phase.

These insurances are:

They often allow obtaining an initial visa, but are sometimes not accepted for residence permit renewal. Some providers are regularly mentioned (Feather, Ottonova, HanseMerkur, Care Concept, Dr. Walter, Mawista, etc.), with very mixed feedback on the quality of reimbursement.

For an expat planning to settle long-term, the recommendation is clear: use incoming insurance only as a stepping stone, then switch to GKV or a proper PKV as soon as possible.

Accessing care daily: Doctors, hospitals, pharmacies

Understanding the structure of the German healthcare system helps reduce daily friction.

The central role of the Hausarzt

The general practitioner (Hausarzt) is the usual entry point:

– appointments, sometimes open consultation hours (Sprechstunde);

– typical hours: 8 a.m. – 5 p.m., with closure on Wednesday afternoons and weekends;

– they coordinate your care, prescribe tests, refer to specialists.

Unlike some other countries, you are not required to be “registered” with a specific GP, and you are free to change doctors. In practice, finding a practice still accepting new patients is sometimes a challenge in some urban areas.

Specialists are accessible:

– with or without a referral letter (Überweisung), depending on the specialty;

– with often longer wait times than in general medicine (several weeks or even months).

You just need to present your electronic health insurance card (eGK) or PKV proof at each visit.

Emergencies: Useful numbers and organization

In case of a life-threatening emergency (chest pain, respiratory distress, suspected stroke, severe trauma, etc.), the single number is 112. It works throughout Europe and care is free, the call as well.

– an on-call practice;

– an on-call medical center;

– or, if necessary, a home visit.

Hospital emergency departments are called Notaufnahme. As elsewhere, they are reserved for truly urgent situations. The German system has public emergency services (“Rettungsdienst”), often operated by fire departments, the Red Cross, or other organizations.

Pharmacies: What you find there, how they work

Medications are obtained at an Apotheke, recognizable by their large red “A”. Germany has about 20,000 pharmacies, all run by a highly trained pharmacist authorized to:

– verify your prescriptions;

– advise you on over-the-counter medications;

– refuse to dispense a treatment if in doubt.

Two major differences from some countries:

Prescriptions (Rezepte) from German doctors are generally required for antibiotics, antihypertensives, antidiabetics, contraceptive pill beyond age 18, etc. Non-German prescriptions, especially from outside the EU, are generally not accepted.

Non-prescription drugs are not reimbursed, except for children. For reimbursable medications, the GKV rule is simple: 10% of the price with a minimum of €5 and a maximum of €10.

Outside regular hours, on-call pharmacies (Notdienst‑Apotheken) take turns, sometimes with a modest surcharge for dispensing.

Without insurance: What happens?

Even though the law requires health insurance, about 0.1% of the population remains uninsured. In this case:

– a GP typically charges €40–70 per consultation;

– a specialist can charge €80–150 or more;

– hospitals cannot refuse a life-threatening emergency, but bill at full price afterwards.

An uninsured expat also risks being refused by some practices for non-urgent consultations. And the authorities can demand back payments of contributions if they deem you should have been enrolled earlier.

Language barrier: A real healthcare challenge

More than a quarter of residents in Germany have a “migration background”, and about 17% of households speak a language other than German at home. Yet, the healthcare system remains largely German-speaking.

Studies show that language barriers:

– increase the risk of misunderstanding diagnoses and treatments;

– lead to redundant tests, preventable hospitalizations, longer stays;

– degrade patient satisfaction and trust;

– discourage some migrants from seeking care.

Linguistic support remains uneven:

– about 70% of primary care practices offer only German;

– 28.6% also offer English, 9.9% French;

– barely 1.4% cover at least one Middle Eastern language (Arabic, Farsi, Turkish, etc.).

Hospitals often rely on makeshift solutions:

– bilingual caregivers;

– relatives or friends acting as translators;

– mainstream translation apps.

For an expat, this means two things:

– plan ahead: look for doctors speaking your language via directories (Jameda, Doctolib, medical association websites, insurer recommendations, expat groups);

– prepare for appointments: bring a written summary of your treatments, allergies, and medical history in German or English, note down symptoms and important questions in advance.

Mental health: A generous but saturated system

Mental health is an area where Germany appears both very advanced on paper and under significant pressure.

Rights and coverage

Since 2009, GKV covers outpatient psychotherapy for diagnosed mental disorders (depression, anxiety disorders, PTSD, etc.), provided you consult a therapist authorized to bill the insurance fund (Kassenzulassung).

The typical procedure:

The covered methods are strictly regulated (cognitive-behavioral therapy, psychodynamic psychotherapy, psychoanalysis, systemic therapy, etc.). The number of sessions can range from a few dozen to over 300 sessions in the case of psychoanalysis.

The major problem: Wait times

In large cities, waiting times for therapy reimbursed by GKV can range:

– from a few weeks in the best case;

– to several months, sometimes six months or more.

To address this saturation, the law now requires therapists:

– to reserve a quota of “emergency” hours per week;

– to be reachable by phone a minimum amount of time weekly.

Many expats prefer:

– to turn to private English- or French-speaking therapists and pay out of pocket (typically €100–160 per session);

– to use unreimbursed international online therapy platforms.

For acute situations (suicidal thoughts, risk of self-harm, psychosis), hospital psychiatric emergency services and day clinics (Tageskliniken) take over, regardless of your insurance status.

Vaccinations: Schedule, obligations, and reimbursement

Germany is very structured on vaccination, with several key institutions:

– STIKO (Standing Committee on Vaccination), an independent commission issuing national recommendations;

– the Robert Koch Institute (RKI), the national public health institute;

– the G‑BA, which decides which vaccinations are reimbursed by GKV.

For an expat, three points deserve attention: basic vaccines, specific obligations, and financial coverage.

Routine vaccines and age recommendations

Vaccination schedules are organized by age group:

For adults:

– D–T boosters every 10 years, a pertussis booster to combine;

– MMR catch-up for people born after 1970 with incomplete vaccination status.

For those over 60:

– annual flu vaccination;

– vaccination against pneumococcus, shingles;

– annual COVID‑19 booster in the fall, especially for the more vulnerable.

Pregnant women should be vaccinated against flu and pertussis (3rd trimester), and complete their COVID‑19 schedule.

Obligations and checks

Vaccination is not generally mandatory, except for:

– measles in community facilities (daycare, schools, certain accommodations): parents who refuse face fines of up to €2,500.

Costs and coverage for an expat

Public funds are required to reimburse all vaccines recommended by STIKO. Many go further and also cover part of travel vaccines (hepatitis A, typhoid, yellow fever, tick-borne encephalitis, rabies, etc.). Policies vary by fund; some even publish lists with the number of travel vaccines reimbursed.

For PKV insured persons, it all depends on the contract: the most comprehensive products typically include 100% of STIKO vaccinations, or more.

Expats can:

– have their old vaccination records transcribed into a German Impfpass by a doctor;

– organize catch-up vaccinations if necessary.

Cross-border care in Europe: European card and reimbursements

For European expats, the European Health Insurance Card (EHIC/GHIC) plays an important role. It allows, during temporary stays in another EU/EEA country or Switzerland, access to medically necessary care in the public system of the host country, under the same conditions as local insured persons.

In practice, if you are insured with GKV and travel to Spain or France, the EHIC allows you:

However, the EHIC does not cover strictly private care, nor travel specifically for planned treatment. For planned care in another EU country, a separate system (S2 form / prior authorization) applies, with complex rules on reimbursements and excess fees.

For expats from third countries (outside EU/EEA/Switzerland), these mechanisms do not apply, and only German insurance (or international insurance) decides the level of coverage abroad.

Special cases: Students, asylum seekers, refugees

Certain expat profiles face specific rules.

Foreign students

Students enrolled in Germany:

– must prove health coverage to obtain a visa and enrollment;

– can take out GKV insurance at a favorable rate until age 30;

– after age 30, must switch to a higher voluntary rate or move to PKV.

EU students can sometimes use their EHIC for short stays, but for long-term settlement and local work, GKV affiliation becomes the norm.

Asylum seekers, refugees

Persons in the asylum procedure benefit, during the first months (up to 36 months according to recent rules), from limited access to a mainly emergency care basket via a system of treatment vouchers (Krankenschein). Beyond that, or upon obtaining a stable residence permit, they enter the standard GKV scheme.

Cross-border workers, temporary assignments

For assignments of a few months, rules often combine the system of the country of origin and Germany (S1 forms, posting, etc.). Again, it is essential to clarify the situation with your employer and insurer before crossing the border.

How to concretely choose your health insurance when arriving in Germany?

For a newly arrived expat, the safest roadmap often looks like this:

1. Clarify your status: employee, freelancer, student, visiting researcher, non-working spouse, etc. 2. Determine eligibility: GKV mandatory or option to choose PKV. 3. Assess the time horizon: short stay (less than 1 year) or long-term settlement. 4. Compare costs and security:

– GKV: more expensive for high incomes, but very stable, solidarity-based, family-friendly.

– PKV: potentially cheaper initially, but riskier in the long term and for families. 5. Beware of overly “easy” solutions: cheap incoming insurance but inadequate for a long stay.

For typical profiles:

– Expat employee below income threshold: GKV mandatory, it’s simple.

– Well-paid employee (above threshold): GKV/PKV trade-off to be made with neutral advice, considering family plans and age.

– Young freelancer without immediate family plans: PKV may seem attractive, but you must plan for the future (rising premiums, impossibility of returning to GKV later).

– Student: student GKV until 30 is often the best security/price ratio.

– Digital nomad or highly mobile stays: an international health insurance contract can complement, or even substitute for the local system depending on the administrative situation.

Some practical tips for navigating the German system

Beyond rules and tables, some habits make life easier for expats in the German healthcare system.

Always carry your insurance card

The eGK (for GKV) or the PKV insurance card is the key to all practices and hospitals. Without it, your care will be delayed or you’ll have to pay upfront and settle later.

Document your medical history

Arrive with:

– a list of your chronic treatments;

– the names of the molecules (not just brand names);

– a summary of your medical history, important tests, allergies,

facilitates the transition, especially because some medications don’t exist under the same name in Germany.

Plan ahead for specialist appointments

Wait times to see certain specialists (dermatology, gynecology, psychiatry, orthopedics) can be long:

Use the right numbers

In case of doubt, three numbers are enough to remember:

– 112: life-threatening emergency, ambulance, fire department;

– 110: police;

– 116 117: medical on-call service for non-life-threatening emergencies outside office hours.

Familiarize yourself with a few German terms

Even if your doctor speaks English, many documents will be in German. Knowing a few keywords (“Hausarzt”, “Facharzt”, “Rezept”, “Krankenhaus”, “Notaufnahme”, “Impfung”, “Krankengeld”) helps you navigate, for example on insurance forms or appointment booking sites.

Conclusion: A demanding but protective system

Healthcare for expats in Germany is based on a strict legal framework, mandatory insurance, and a dual public/private system that can be confusing. But once these rules are decoded, the expat gains access to:

The key is to plan ahead: choose your scheme upon arrival, understand the long-term implications, anticipate the language barrier, and don’t underestimate mental health or vaccination. Well-supported — by an independent broker, a GKV fund used to expats, or a specialized service — an expat can turn this complex system into a real asset for their quality of life in Germany.