Health insurance in Germany

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Everyone who lives in Germany is required by law to have health insurance. People who come to Germany from abroad – to study or work, for example – must get this insurance too. You can find answers to important questions about the costs, services and guiding principles of health insurance here.

To avoid financial problems if you get ill, it is obligatory to have health insurance if you live in Germany. Almost 87% of the population – more than 70 million people – have public ("statutory") health insurance.

Everyone who has public health insurance in Germany is entitled to the same health care if they get ill – regardless of how much they pay for their insurance each month (the premium). The premium is determined solely by income level. Public health insurance (gesetzliche Krankenversicherung, GKV) is based on the principle of solidarity. So people who earn more money pay more than those who earn less, and healthy and ill people pay the same amount. That way, if people get ill, the costs of their medical care and loss of earnings are shared by everyone with that insurance.

Under certain circumstances, it's possible to get private health insurance instead. There are different rules here concerning the premiums and reimbursement of costs.

Who has public health insurance?

Generally speaking, everyone who works and whose annual income doesn't exceed a specific level must have public health insurance. Known as the Versicherungspflichtgrenze, this annual income level was 73,800 euros in the year 2025. If you earn more than that, you can get private health insurance or choose to have public health insurance anyway.

Freelance artists and journalists, students, unemployed and retired people usually have public health insurance too.

Spouses, partners living in a civil union, and children can also be insured at no extra cost (family insurance), as long as they don't earn any money, or earn too little. The income limit here is adjusted regularly. In the year 2025 it was 535 euros per month (or 556 euros per month for people who have a "Minijob"). Children are covered by the family insurance up to the age of 18. If they're still in education or vocational training, they can be covered up to the age of 25. Children who aren't able to care for themselves due to a disability can always be insured through their parents, no matter how old they are.

You can get more information on income limits and age restrictions for children on the website of the Federal Ministry of Health (in German).

How much does public health insurance cost?

The basic health insurance premium is the same across all public insurers: 14.6% of your gross income, but only up to a certain income level (Beitragsbemessungsgrenze). In 2025, this annual income level was 66,150 euros. Anyone who earns more than that pays the same maximum premium. On top of that, each insurer charges extra fees (a Zusatzbeitrag) if the insurance premiums and other funding sources are not enough to cover their costs. Just like with the insurance premium, insured people share these extra fees equally with their employers (paying half each) and the fees are deducted directly from their monthly salary. Once people have retired, their pension fund pays half of the fees.

Students who no longer have free health insurance through their family pay a lower premium up to the age of 30 (in 2025: usually 105 to 120 euros per month). Students above the age of 30 usually have to pay more than that. Those who receive "BAföG" (financial support from the German government) also get money for their health insurance.

If you receive unemployment benefits (Arbeitslosengeld), citizen's benefit (Bürgergeld), social benefits (Sozialhilfe) or basic income support (Grundsicherung), the responsible authority will pay for your health insurance.

Which insurer should you choose?

There are about 100 public health insurance providers in Germany. You are free to select one of your choice. All of the public insurers basically have the same comprehensive catalog of standard medical treatments and healthcare services, known as Regelleistungen.

On top of that, each insurer offers various additional benefits or special optional tariffs (see below). Comparing these additional offers can help you to choose a suitable insurer for you.

It is also worth comparing the different insurers' additional fees (Zusatzbeiträge) because these can vary. In 2025, they are between 1.04% and 4.4% of insured members' gross income.

Standard benefits (Regelleistungen): What is covered by public insurers?

Most of the treatments and healthcare services covered by public health insurers are a part of the standard catalog, and are compulsory for all of the public insurers. These standard benefits include:

  • treatment by family doctors, specialists and psychotherapists in practices, hospitals and – under certain circumstances – in rehabilitation facilities
  • tests and medical check-ups for preventive purposes
  • dental check-ups, dental treatment, gum treatment, and orthodontic treatment
  • health care related to pregnancy and birth
  • medication that has been prescribed by a doctor (with a few exceptions)
  • necessary vaccinations (not travel vaccinations)
  • certain kinds of therapy known as "Heilmittel" (like physical therapy or speech therapy) and certain medical aids known as "Hilfsmittel" (like prosthetic devices or hearing aids) – as long as they are medically necessary and have been prescribed by a doctor. The Hilfsmittel aids have to be listed in the official catalog of approved aids known as the Hilfsmittelverzeichnis.
  • certain digital health applications (DiGAs)
  • the costs of medically necessary transportation (for example, to get to a hospital or a dialysis appointment)

For many of these standard benefits, you have to pay a certain amount yourself, known as a co-payment (Zuzahlung in German). This amount is fixed by law. It ranges from 5 to 10 euros for prescribed medications, depending on their price. But there's a limit to the co-payments you are expected to make each year: you only have to pay up to 2% of the gross annual income of all the family members living together in your household. This limit (known as the Belastungsgrenze in German) is 1% for people who have a severe chronic illness. Once it has been reached, you no longer have to pay any co-payment costs that year. In general, no co-payments are needed for medications that are prescribed for children and teenagers under the age of 18.

When it comes to dental prosthetics, public health insurers pay a fixed amount. Before any dental work involving prosthetics is started, your dentist makes a treatment and cost plan which must be submitted to your insurer. The insurer then decides what costs it will cover, giving you a better idea of how much you will need to pay yourself.

What's more, if you usually work but are prevented from working for longer than 6 weeks in one go due to illness, your public health insurer will pay sickness benefit (Krankengeld, which is 70% of your gross salary). In the first 6 weeks of illness, your employer will continue to pay your usual salary. The sickness benefit is paid for a maximum of 18 months. If you're still unable to work after that, other forms of financial support may be possible.

With the exception of the additional fees mentioned above, all the costs of benefits listed in the standard catalog are paid by the insurer directly to the care provider – this means that you aren't involved in the payment. All you have to do is take your electronic health insurance card along to the doctor's practice or hospital.

If you have special requests not included in the standard benefit catalog – such as a private room in hospital, treatment by a senior consultant or certain dental treatments – you have to pay for them yourself. Private health insurance companies offer separate policies for some of these. Different private insurers may have different reimbursement rules for some treatments and healthcare services, so it's worth asking about that beforehand.

What about additional benefits or special optional tariffs?

As well as covering the required standard benefits, health insurers can offer various add-ons (Satzungsleistungen). These may include reward schemes (Bonusprogramme), where you receive money or gifts as a reward for regularly taking part in prevention programs or exercise classes. Or the insurer may cover the costs of additional medical benefits, such as other vaccinations, health classes or alternative medicine treatments.

As well as this, different public health insurers offer different special optional tariffs (Wahltarife), like:

  • Disease management programs (DMPs): DMPs are structured treatment plans for people who have certain chronic diseases. In German, they're also sometimes called "Chroniker-Programme." They involve things like the close coordination of different treatments, regular check-ups, and classes to learn how to manage the disease.
  • Family doctor program (Hausarztmodell): Here you agree to always go to your family doctor first. They can then refer you to a specialist if necessary. That way, your family doctor has an overview of all your medical issues and treatments. People who participate in this program often get rewards or discounts but have a limited choice of doctors.
  • "Special care" program (besondere Versorgung): In this program, public health insurers draw up contracts with doctors, therapists or hospitals regarding special, innovative treatment concepts for certain diseases.
  • Paid sick leave for freelancers (Krankentagegeld)

It can be worth comparing the additional offers of different public health insurers – particularly if you have a chronic illness or a disability.

Can you switch insurers?

You can switch public health insurers at any time with two months’ notice. If you join a new insurer, they will automatically take care of canceling your old insurance.

You would then typically have to wait at least 18 months before switching to a different insurer again, though. People who have opted for a Wahltarif (special tariff) are usually tied to that health insurer for 1 to 3 years. But if your insurer increases their Zusatzbeitrag (extra fees) during those 18 months, you're allowed to leave sooner – as long as you give the required two months’ notice.

Private health insurance

About 10% of German residents have private health insurance (PKV). Only people who fulfill certain criteria can have private health insurance. For example, your gross income must be above a certain level for at least one year. This level is adjusted regularly. In 2025 it was 73,800 euros per year. Many self-employed people, freelancers, public officials, judges and soldiers can have private health insurance too. If you earn enough but would prefer not to have private health insurance, you can opt for public health insurance instead. Once you have private health insurance, you may no longer have the option of switching to public health insurance. This is only possible in certain situations.

The amount you pay for private health insurance each month (the premium) isn't based on your income, but on your age, general health and the requested healthcare services.

These services may include treatment by a senior consultant, a private hospital room, and special medical, dental or naturopathic treatments. The insurance benefits that are included are documented in an individual policy.

People with pre-existing medical conditions usually pay more than healthy people do, and older people usually pay more than younger people do. As you get older, your premium may increase quite a lot too. Family members aren't automatically covered, and have to be insured separately with additional premiums. You generally have to pay for diagnostic procedures, treatments and medication yourself at first. You then send the bill to your insurer, and the costs are reimbursed.

All private health insurers offer a standard basic insurance policy that you can opt for if specific requirements are met. The basic private policy can't cost more than the most expensive public health insurance policy. It must include the compulsory standard medical services covered by public health insurers. People who currently have a private policy with additional services can sometimes switch to the basic policy under certain circumstances.

What about people from other countries?

If you come to Germany from another country, you also need to have health insurance. Depending on the situation, the health insurance you have in the other country might be accepted in Germany. If not, you have to join a German health insurance provider or get travel health insurance. That will mainly depend on what country you come from and what you're doing in Germany.

Studying in Germany

Before enrolling in a German university, you have to prove that you have health insurance. The rules and regulations here depend on which country you come from:

  • People from EU countries and several other countries have a European Health Insurance Card (EHIC) as part of their insurance there. This is often already printed on their normal health insurance card, or they can simply contact their health insurer and apply for one. In Great Britain, the EHIC card was replaced by the Global Health Insurance Card (GHIC) after Brexit. People who have an EHIC or GHIC card are entitled to the same medically necessary health care as people with German public health insurance. Important: Treatments are only paid for if they must be carried out before you can return to your home country. But you can also increase your insurance coverage with an S1 form. These forms are issued by your health insurer in your country. You can submit one to a public health insurer of your choice in Germany.
  • A number of other countries, including Tunisia and Turkey, have a social security agreement (Sozialversicherungsabkommen) with Germany, where the health insurance from those countries is accepted in Germany. A German health insurance provider will then issue you with a certificate of entitlement (nationaler Anspruchsnachweis), which allows you to get certain types of health care in Germany. To find out exactly which healthcare services are covered and how they're paid for, contact your health insurance provider in your home country or your public health insurer in Germany.
  • People from other countries who come to study in Germany have to get German health insurance. Those who need a visa to enter Germany will already have to prove they have health insurance in order to get the visa. Most students will have to get public health insurance. But the following groups of people usually have to get private health insurance instead: students over the age of 30, PhD students and visiting scholars who don't have a German employment contract. There is also a special kind of travel health insurance known as incoming insurance, which can be used for stays of up to five years.

Students who have a part-time job generally have to get German public health insurance, regardless of which country they're from. But they don't have to do this if the job is an internship that's a compulsory part of their studies.

Working in Germany

If you only (or mainly) work in Germany, you have to get German health insurance – even if you don't live in Germany. Depending on your profession and salary, you may be able to choose between public or private health insurance. If you're self-employed and have been privately insured up until now, you will have to get private health insurance in Germany too. If you've had public health insurance up until now, you can get public health insurance in Germany.

People who have a European Health Insurance Card (EHIC) – and have been temporarily posted to Germany by their employer – don't need to get German health insurance.

Good to know:

You can get further information and individual advice from any of the public health insurance providers in Germany.

The German government's website "Make it in Germany" offers useful information for people who would like to work or study in Germany, covering a wide range of issues.

How can people from other countries apply for German public health insurance?

Most public health insurers give you the option of filling out an online application form. But you can also go to your local branch and apply in person there. You will generally need a passport photo, a certificate of residence (Meldebescheinigung) and proof of your financial situation – for example: proof of income, proof of scholarship, or a statement from the Jobcenter (employment agency) or Sozialamt (social welfare office). Students must also submit their certificate of university enrollment (Immatrikulationsbescheinigung), or hand it in as soon as they have received it.

After registering with a public health insurance provider, you will receive your insurance card in the mail.

Bundesministerium für Gesundheit (BMG). Migration und Gesundheit. 2024.

Bundesministerium für Gesundheit (BMG). Ratgeber Krankenhaus. 2024.

Bundesministerium für Gesundheit (BMG). Ratgeber Krankenversicherung. 2024.

Bundesministerium für Gesundheit (BMG). Schaubild „Unser Gesundheitssystem" – der Staat setzt den Rahmen. 2023.

Bundeszentrale für politische Bildung (bpb). Dossier Gesundheitspolitik. Das Gesundheitswesen in Deutschland – ein Überblick. 2017.

Busse R, Blümel M, Spranger A. Das deutsche Gesundheitssystem: Akteure, Daten, Analysen. Berlin: Medizinisch Wissenschaftliche Verlagsgesellschaft; 2017.

Europäische Kommission. Die Europäische Krankenversicherungskarte. 2024.

GKV-Spitzenverband. Deutsche Verbindungsstelle Krankenversicherung – Ausland. 2024.

GKV Spitzenverband, Deutsche Verbindungsstelle Krankenversicherung – Ausland (DVKA). Going to Germany with your European Health Insurance Card (EHIC). 2023.

Gleichbehandlungsstelle EU-Arbeitnehmer. Krankenversicherung. 2024.

Kassenärztliche Bundesvereinigung (KBV). Service für die Praxis – Auslandskrankenversicherte: So funktioniert die Abrechnung bei Patienten, die im Ausland krankenversichert sind. 2024.

Klemperer D. Sozialmedizin – Public Health – Gesundheitswissenschaften. Göttingen: Hogrefe; 2020.

Statista. Anzahl der Mitglieder und Versicherten der gesetzlichen und privaten Krankenversicherung in den Jahren 2017 bis 2023. 2023.

IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. informedhealth.org can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.

Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.

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Please note that we do not provide individual advice on matters of health. You can read about where to find help and support in Germany in our information “How can I find self-help groups and information centers?

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Updated on December 18, 2024

Next planned update: 2027

Publisher:

Institute for Quality and Efficiency in Health Care (IQWiG, Germany)

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