Health Insurance in Germany: What Newcomers Need to Know

Health insurance is mandatory in Germany from day one – your visa, your residence permit and even your employer's payroll depend on it. The system has two worlds, public (GKV) and private (PKV), and most newcomers belong in the first. This guide covers who goes where, what it costs in 2026, and the one mistake that delays residence permits: relying on travel-style "expat insurance".

Public insurance (GKV): the default

Roughly 90 % of residents are publicly insured. As an employee you are automatically GKV-insured if your gross salary is below the 2026 threshold of €77,400 per year. Contributions are 14.6 % of gross salary plus a fund-specific supplement (2026 average: around 2.9 %), split evenly with your employer and only charged up to the contribution ceiling (€69,750 in 2026). On a €50,000 salary, your share is roughly €365 per month before long-term care insurance.

The big advantage: non-working spouses and children are covered free of charge (Familienversicherung). All public funds offer the same core benefits – doctor visits, hospital stays, medication, maternity care, basic dental – and differences lie in extras and English-language service. Funds popular with internationals include TK (excellent English service and app), Barmer, DAK and the regional AOKs. As an employee you simply pick a fund; it confirms your membership electronically to your employer.

Private insurance (PKV): only for some

Private insurance is an option above the income threshold or for the self-employed. Premiums depend on age and health rather than income – often €400–900 per month – each family member costs extra, and returning to the public system later is difficult, especially after 55. For most relocating employees with families, public insurance is the sensible default; private cover suits well-paid singles who plan long-term and compare tariffs carefully.

Why "expat insurance" packages are a trap

Searching for insurance for expats in Germany surfaces countless incoming and travel-style policies. They have a legitimate role: bridging the period between arrival and the start of employment, and satisfying visa requirements for job seekers (e.g. on the Opportunity Card). But they do not fulfil Germany's permanent insurance mandate. Immigration offices routinely reject incoming policies when a residence permit is extended, and uncovered time in the regular system can mean back-payments. The rule of thumb: travel policy until your job starts, regular GKV or substitutive PKV from the first day of employment.

The enrolment timeline

Ideally you choose a fund before your first working day; the employer reports you, and cover starts with the employment. Gaps are a problem: Germany requires seamless insurance, and uncovered periods can trigger back-payments. Incoming EU citizens can bridge with the EHIC card; most non-EU visas already required travel cover for the entry period. Enrolment itself is simple: application (many funds offer English forms), confirmation to your employer, and the electronic health card (eGK) arrives by post within a few weeks.

What it means for your visa and daily life

Proof of health insurance is required for residence permits, and the right order matters: entry → city registration (Anmeldung) → health fund → residence permit. Once enrolled, doctor visits are cashless and you can pick any GP or specialist. We help newcomers choose a fund, complete enrolment and connect the paperwork to payroll, banking, registration and the residence permit in the right order.

Frequently asked questions

Is health insurance mandatory for expats in Germany?

Yes, without exception. Everyone living in Germany must hold health insurance from day one – it is required for your visa, your residence permit and your payroll. Uninsured periods can trigger retroactive contributions.

How much does health insurance cost in Germany in 2026?

Public insurance (GKV) costs 14.6 % of gross salary plus a fund-specific supplement (on average around 2.9 % in 2026), split evenly with your employer. On a €50,000 salary, the employee share is roughly €365 per month plus long-term care insurance. Private premiums typically range from €400 to €900 per person per month.

Is "expat insurance" enough for Germany?

Usually not. Travel-style expat or incoming policies only bridge the entry period. Once you are employed and resident in Germany, you must join the regular public (GKV) or substitutive private (PKV) system – immigration offices routinely reject incoming policies when extending residence permits.

Can my family be insured for free?

In the public system, yes: non-working spouses and children are covered at no extra cost (Familienversicherung). In private insurance, every family member needs their own paid policy – a key reason most relocating families choose GKV.