GUIDE
Health insurance: the one thing Germany will not let you skip
Health insurance in Germany is not optional — it has been legally required since 2009, and uninsured months generate back-payments that catch up with you later. Employees are enrolled semi-automatically; freelancers, students and newcomers between jobs must act themselves. The system splits into public (GKV) and private (PKV) — and which one you can and should choose depends on your status and income.
How to get covered
- 1 Employed with gross salary under the threshold (2026: ≈ €6,450/month): you belong in GKV — pick a Krankenkasse (TK, AOK, Barmer…), your employer handles the rest.
- 2 Freelancer or high earner: you choose — voluntary GKV (contribution based on income, ~15–20% incl. care insurance) or PKV (premium based on age and health, often cheaper when young).
- 3 Just arrived and between statuses: get proper expat/incoming cover immediately — every uninsured day accrues debt in GKV later.
- 4 Get your insurance certificate (Mitgliedsbescheinigung) — your employer, university or Ausländerbehörde will ask for it.
English-speaking options to start with
- Feather Insurance
Insurance built for expats, fully in English: liability, health, contents.
- ottonova Insurance
Digital private health insurance (PKV) with full English service — built for expats and freelancers.
Calculate your contribution with the official 2026 figures and check whether you qualify for private insurance.
Frequently asked questions
Can I stay on my travel insurance after moving to Germany?
Only very briefly. Travel and incoming policies are not substitute cover (§ 193 VVG) once you are resident — for employment, visa extensions and Anmeldung-linked matters you need GKV or full PKV. Incoming insurance is a bridge for the first weeks, not a solution.
How much does health insurance cost a freelancer in Germany?
Voluntary GKV: roughly 15–20% of your profit (including nursing care insurance), with a minimum around €250/month even at low income. PKV: age- and health-based — a healthy 30-year-old often pays €350–550/month with modern digital insurers. Above ~€6,000/month profit PKV is frequently cheaper than GKV.
What is the difference between GKV and PKV?
GKV (public): income-based contributions, family members co-insured for free, switching back is easy. PKV (private): risk-based premiums, better services and faster appointments, but returning to GKV after 55 is nearly impossible and premiums rise with age. Rule of thumb: employees and families → GKV; young, high-earning singles and many freelancers → compare seriously.
I had uninsured months in Germany — what happens now?
GKV charges retroactive contributions for uninsured periods when you join (Nachzahlung), sometimes reduced via the emergency tariff. The debt does not disappear by waiting — joining sooner is always cheaper.
Is health insurance required for a freelance visa or Aufenthaltstitel?
Yes. The Ausländerbehörde requires proof of adequate health insurance for residence permits. Travel insurance is routinely rejected; PKV policies must be "substitutive" (Pflege included). This is one of the most common visa-extension pitfalls.
How much do students pay for health insurance in Germany?
Student GKV rate under 30: about €130–145/month including care insurance. Over 30 (or after the 14th semester) the student rate ends and voluntary GKV rates apply. EU students can often use EHIC instead — but not for work above mini-job level.
Can my spouse and children be insured for free?
In GKV yes — Familienversicherung covers a non-earning spouse and children at no extra cost. In PKV every person pays their own premium. Families are the classic case where GKV wins economically.
Which Krankenkasse should I pick as an English speaker?
All GKV Kassen provide ~95% identical benefits; they differ in Zusatzbeitrag (0.8–2.2 p.p.), bonus programs and English support — TK is the usual expat recommendation. For PKV, digital insurers like ottonova operate fully in English, and brokers like Feather compare both worlds for you.
Transparency: some links on this page may be affiliate links — if you sign up through them we may earn a commission. The price does not change for you. We do not collect any user data. Figures are approximate as of 2026 and are not insurance advice.