Health Insurance in Germany

Health insurance isn’t optional in Germany — it’s a legal requirement for everyone living there, and you’ll need proof of it before you can get a visa, register your address, or start a job. Here’s what expats need to know for 2026.

The Two Systems: GKV vs PKV

Germany runs two parallel insurance tracks:

GKV (gesetzliche Krankenversicherung) — statutory/public insurance, covering around 90% of the population. Premiums are income-based, not health-based, and cover dependents (spouse and children) for free through Familienversicherung as long as their own income stays below a set threshold.

PKV (private Krankenversicherung) — private insurance, with premiums based on your age and health at entry rather than your income. It’s only open to certain groups: high earners, the self-employed, freelancers, and civil servants.

Who can choose PKV in 2026

You can generally opt into private insurance if:

• You’re an employee earning above the compulsory insurance threshold (Versicherungspflichtgrenze), which rises to €77,400 a year in 2026, up from €73,800 in 2025
• You’re self-employed or freelance
• You’re a civil servant (Beamte)
• You’re a student over 30, or in certain visa categories (au pairs, some visitors) where public insurance isn’t available at that stage

Everyone else — the large majority of employees — is required to be in the GKV.

GKV Costs in 2026

Public insurance costs a flat percentage of your gross salary rather than a fixed euro amount:

• General contribution rate: 14.6% of salary, split evenly — 7.3% paid by the employee and 7.3% by the employer
• Additional contribution (Zusatzbeitrag): set by each individual insurer on top of that, and this is the part that’s risen sharply for 2026. Techniker Krankenkasse’s rate rose from 2.45% to 2.69%, while DAK-Gesundheit’s rose from 2.8% to 3.2%. The health ministry set the average additional contribution at 2.9 percentage points for 2026, though actual rates charged by insurers are expected to exceed 3% on average
• Contribution ceiling (Beitragsbemessungsgrenze): income above €69,750 a year (€5,812.50/month) isn’t factored into your contribution — so your GKV cost is capped even if you earn well above that

Put together, a typical employee pays somewhere around 17.5–18% of gross salary total (split with their employer) in 2026, meaning your personal share is roughly half that, deducted straight from payroll.

Self-employed / freelance example: someone earning €100,000/year could expect a monthly GKV contribution of around €1,226, since freelancers pay the full rate themselves without an employer share — though this varies by insurer and income.

PKV Costs in 2026

Private premiums depend on your age, health status, and chosen coverage level rather than income, so they vary far more widely:

• Premiums can start much lower for young, healthy applicants — the same €100,000-earning freelancer might pay only around €805/month for a comprehensive PKV plan, versus €1,226 in GKV
• Students often see private options in the roughly €35–€70 per month range, far below the standard public student rate
• The catch is retirement: PKV premiums climb with age, and switching back to GKV later is often difficult or impossible. Extra retirement-year costs for the same example could add roughly €1,932/month compared with staying on GKV
• Unlike GKV, each family member needs their own separate PKV policy — there’s no free family coverage

This trade-off (lower costs now, higher and less predictable costs later) is the central reason financial advisors usually recommend expats think carefully before opting into PKV, especially if they plan to stay in Germany long-term.

How to Apply

If you’re an employee: your employer typically handles most of the registration. You choose a Krankenkasse (insurer), and registration happens through your employer once you have a contract.

If you’re a freelancer, self-employed, or arriving before securing a job: you’ll need to apply directly. You must have valid health insurance before applying for a visa, before starting employment, or immediately after arrival if you enter visa-free — delaying coverage can result in retroactive payments.

Typical steps:

1. Determine your eligibility — GKV by default, unless you qualify for PKV (income above €77,400, self-employed, etc.)
2. Choose a provider. Major GKV insurers popular with expats include TK, AOK, and Barmer — compared on things like English-language support and digital tools
3. Gather documents — typically your passport or ID, visa or residence permit details, proof of address in Germany, and employment or income information
4. Apply online — most major insurers let you register digitally, often even before you land in Germany
5. Get your confirmation of coverage (Versicherungsbescheinigung) — you’ll need this for your visa application, residence permit, and (if applicable) university enrollment

For visa purposes specifically, note that the insurance must be of unlimited duration with no expiry tied to age, employment status, or change in your residence purpose — a common reason travel-style policies get rejected by immigration offices.

Special Cases

• Students under 30 in a degree program are generally required to take public health insurance, at roughly €120/month
• Students over 30 or in language/prep courses typically use private insurance instead
• Au pairs, volunteers, and visitors usually can’t access public insurance and need a private plan recognized by German authorities

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