Of the myriad of things you will need to deal with during your first weeks after arrival, health insurance in Germany will probably be THE most confusing task as a newcomer.

So, this is a topic which has lots of facets and nuances.

We’ve therefore published separate articles which cover:

This article will tackle everything in the box below!

Note that we don’t cover incoming health insurance here for those entering the country on a job seeker visa, or those seeking to apply for a residence permit for self-employment (the “freelancer visa”) from within Germany.


The German Healthcare System Explained


This article will give you a thorough grasp of:

– The major differences in the German healthcare system vs. healthcare in the UK and the US

– The eligibility criteria for private health insurance

– What does health insurance in Germany typically cover?

– How contributions work (Employer vs. the Individual)

– The process of visiting a doctor in Germany

– Making appointments to see specialists

– Common watch-outs and pitfalls

– A brief summary of positives and negatives of the German system

What Options Are Available To Me?


Freelancers & Self-Employed

You automatically have the option of whether to take public health insurance or whether to opt out and take a private health insurance policy.



You don’t automatically have this choice. It depends on how much you earn before tax i.e. your gross salary. In 2020, the threshold is €62,550 before you can opt out of public insurance and select to go private. Anyone earning below this threshold is automatically obliged to take out a public insurance policy.


Private Insurance is subject to acceptance by the insurer

While you may theoretically be eligible for private insurance, it does not necessarily guarantee that a private medical insurance company will offer you insurance. This very much depends on the level of risk they perceive you to be as an individual…

Our Recommended Private Health Insurance for Freelancers, plus Employees Earning Above €62,550 Gross Per Annum



Gesetzliche Krankenversicherung (GKV)

Public Health Insurance

You pay a percentage of your gross salary each month. This is capped for any earnings above €6,900 gross per month (states belonging to former West Germany) or €6,450 (former East Germany)


Private Krankenversicherung (PKV)

Private Health Insurance

You pay a monthly premium which is calculated by the insurance company, based on their perceived risk of insuring you as a patient. Usually the key factors are your age, history of pre-existing conditions and your occupational health risk.

How is the German healthcare system different?


Let’s start with the nuts and bolts of the system:

How does it work in practice and how does it differ from what you are used to in your home country?


The British healthcare system (National Health Service)

This is a fully government / taxpayer-funded single-provider model. 

Healthcare professionals such as doctors and nurses in the UK are public sector employees. In fact, the NHS is the biggest single employer in Europe.

Hospitals, clinics and doctors’ surgeries are all administered by the government. Whilst these services are decentralised and are administered locally, the budget itself comes from central government and is funded entirely by the state.

The British system is free at the point of entry. It means that pretty much anyone can turn up in Accident & Emergency at a British hospital, or go to the doctor, and they will be treated unconditionally without having to confirm any valid health insurance.


The US healthcare model (private, insurance-based)

If your insurance policy doesn’t cover you for a certain health complaint, or if you have taken out inadequate insurance, then you as an individual are in most cases liable for your treatment costs.

The Medicare and Medicaid systems provide a basic safety net to cover those most in need i.e. older people, welfare recipients and certain low earners who otherwise would not be able to pay for healthcare, but both of these still rely on an insurer-based model.

Hospitals, doctors’ surgeries, clinics, rehabilitation centres and so forth are private, for-profit business