Expat health insurance in Germany refers to the health coverage options available to foreign nationals living or working in Germany. Every resident, regardless of nationality, must have health insurance from day one. As an expat, you have two options: public health insurance (gesetzliche Krankenversicherung) or private health insurance (private Krankenversicherung). Which one you can access, and which one saves you money, depends on how you're employed and what you earn.
This guide explains the system in plain English, with specific guidance for expats navigating it for the first time.
How health insurance works for expats in Germany
Germany's health insurance system is one of the oldest and most comprehensive in the world. It covers GP visits, specialist appointments, hospital stays, prescription medicine, dental, and more. Unlike many countries, there is no uninsured period; coverage must be in place before you start work or register your address.
As a foreign national, you have the same rights as German citizens. There is no nationality requirement, no language requirement, and no minimum residency period before you can access either system. The only criteria that matter are your employment type and, for employees, your salary.
Available to all residents. Contributions are a percentage of your salary (~18–21% split with employer). Free family coverage. Mandatory if you earn under €77,400/year as an employee.
Available to employees earning over €77,400/year, all self-employed, and civil servants. Flat premium based on age and health, not income. Often €200–450/month regardless of salary.
Private vs public health insurance for expats
The practical difference between private and public health insurance matters more for expats than it does for German nationals, because expats are more likely to be in the salary range where private insurance is both accessible and significantly cheaper.
| Public health insurance (GKV) | Private health insurance | |
|---|---|---|
| Who can join | Everyone; mandatory below €77,400/year | Employees above €77,400/year; all self-employed |
| Premium calculation | ~9% of gross salary (employee share) | Flat rate based on age and health, not income |
| Monthly cost (€80k salary) | ~€520/month (employee share) | €200–380/month |
| Employer contribution | ~50%; employer pays equal share | Up to €421/month subsidy (2026) |
| Coverage | Standardised, legally mandated basket | Broader: dental, vision, private room, chief physician |
| Family coverage | Free for non-earning spouse and children | Each family member needs own policy |
| English support | TK and DAK have English service | AXA, Ottonova, Feather have English support |
| Specialist waiting times | Often weeks for non-urgent appointments | Typically days; priority access |
For most expats earning over €77,400/year: private health insurance saves €200–500/month compared to public health insurance, with better coverage. The younger you are when you join, the lower your premium stays for life.
Who qualifies for private health insurance as an expat?
Private health insurance eligibility works the same for expats as for German nationals. There is no citizenship or residency requirement. The rules are based entirely on employment type and salary:
- Employees with gross salary ≥ €77,400/year (2026 threshold)
- All freelancers and self-employed, regardless of income
- Civil servants (Beamte)
- Students (special tariffs available)
- Employees earning under €77,400/year
- Apprentices (Auszubildende)
- People receiving unemployment benefits
The €77,400 threshold is called the Jahresarbeitsentgeltgrenze (JAEG). It increases slightly each year. Employees must exceed it for the current and prior calendar year to opt out of GKV, except if you're newly employed with a contract already above the threshold.
For a full breakdown of eligibility rules including edge cases: Who qualifies for private health insurance in Germany →
What does private health insurance cost for expats?
Private health insurance premiums in Germany are based on your age at the time you join and your health history, not your income, not your nationality. This is what makes private insurance so attractive for working-age expats: your premium stays flat as your salary grows.
As a rough guide, a healthy expat joining in their early 30s pays around €240–320/month, compared with roughly €510/month on public insurance at an €80k salary. Your employer covers up to €421/month either way, so the net out-of-pocket cost for a young, well-paid expat can be surprisingly low. The younger you join, the wider the gap stays for life.
Full cost breakdown by age, salary and employment type: Private health insurance costs in Germany →
Best private health insurance providers for expats
Germany has over 40 private health insurers. For expats specifically, three criteria matter more than price: English-language support, international coverage if you might relocate again, and claims-handling reputation. On the English-support front, expats most often end up with AXA (international network), Ottonova (fully digital, English app) or Feather (English-first, zero German paperwork). Traditional insurers like Hallesche or Debeka can be cheaper or offer broader coverage, but expect German-language processes.
Important: Never go directly to one insurer, as they only show you their own products. A broker who accesses the full market will find options a single provider never shows you. This costs you nothing; brokers are paid by the insurer.
For the full provider-by-provider comparison: Best private health insurance in Germany →
How to get private health insurance as an expat
Confirm you meet the threshold (€77,400/year as employee, or self-employed). If you're newly employed above the threshold, you can start immediately; you don't need to wait a year.
A broker who compares the full market will run quotes from 10–15 insurers for your exact age, health history, and required coverage. Look for one with English-language service, as this process involves medical questionnaires and policy documents.
Private insurance requires disclosure of your health history for the last 5–10 years. Answer honestly; undisclosed conditions can void coverage. Most healthy people under 45 pass without complications or exclusions.
Wait for the insurer's written acceptance before doing anything else. This is your Versicherungsschein (policy document). Never cancel public health insurance before this arrives.
Submit written cancellation to your GKV with the private insurance confirmation attached. GKV requires 2 months' notice from end of month; plan the timing carefully. To start January 1, cancel by October 31.
Your employer needs to know you're switching so they can adjust their payroll contribution. They'll pay you the employer subsidy (up to €421/month in 2026) directly as part of your salary.
Just arrived in Germany?
If you've just moved to Germany, health insurance needs to be sorted before or alongside your Anmeldung (address registration). Your employer will usually handle GKV enrollment automatically on your first day, but if you qualify for private insurance and want to use it from the start, you need to act before your employment begins.
Timeline for newly arrived expats:
- Before first day of work: If you want private health insurance from day one, have the policy confirmed before your contract starts. Your employer needs to know you're privately insured before they process your first payroll.
- Within 3 months of arriving: If you do nothing, you'll be enrolled in GKV automatically. You can still switch later once you've completed the qualifying period.
- Registering as self-employed: You can choose private insurance immediately; there is no waiting period and no income threshold for freelancers.
New to Germany? Before your health insurance, you'll also need to register your address (Anmeldung) and open a German bank account; both are required for most insurance applications.