Understanding health insurance in Germany

Health insurance is not optional in Germany: you cannot register your address, sign an employment contract, or enrol at university without proof of coverage. The system splits into two tracks, and which one you're allowed to choose depends mostly on your income and employment status.

Public insurance (GKV)

The gesetzliche Krankenversicherung (GKV) is the default for almost everyone who is employed. Premiums are a fixed percentage of your gross salary (around 14.6% plus a fund-specific supplement, split roughly evenly between you and your employer), not your health risk. Coverage is broad and standardised across providers: doctor visits, hospital stays, prescriptions, and maternity care are all included regardless of which public fund (Krankenkasse) you pick, such as TK, AOK, or Barmer.

Private insurance (PKV)

The private Krankenversicherung (PKV) is only open to employees earning above the annual income threshold (roughly €73,800 gross in 2025, adjusted yearly), the self-employed, freelancers, and civil servants. Premiums are based on your age and health at the time you enrol, not your income, which can make PKV cheaper when you're young and healthy, and considerably more expensive later, since switching back to public cover gets harder with age.

Choosing between them

• Employees under the threshold must use GKV: there's no choice.
• Employees above the threshold can pick either; once you switch to PKV, moving back to GKV later usually requires a change in employment status.
• Freelancers and self-employed can choose either from the start.
• Students get a discounted student rate through GKV until age 30 (or the 14th semester), after which regular rates apply.

How to enrol

1. Pick a fund before or immediately after arriving. Your employer needs the fund's name to register you for payroll.
2. Provide your passport, Anmeldung confirmation (once available), and employment contract.
3. You'll receive a digital insurance card (elektronische Gesundheitskarte) within a few weeks; a temporary confirmation letter covers you in the meantime.

Family co-insurance (Familienversicherung)

A spouse or registered partner and children can often be co-insured for free under GKV, provided their own income stays below a low monthly threshold (around €505 in 2025) and they aren't otherwise required to have PKV. This is one of the most valuable, and most overlooked, benefits of public insurance for relocating families.

What's covered

Both tracks cover the essentials: GP and specialist visits, hospital treatment, most prescription medication (with a small co-pay under GKV), and maternity care. PKV plans often add private hospital rooms, faster specialist appointments, and broader dental or vision coverage, but the specifics vary enormously by tariff, so always request a full benefits schedule (Leistungskatalog) before signing.

What it costs

• GKV: roughly 14.6–16.3% of gross salary, split with your employer; a minimum contribution applies even for low earners.
• PKV: highly variable, from around €150/month for a healthy 25-year-old freelancer to €600+/month for older applicants or those with pre-existing conditions.