Public Health Insurance in Germany
Everything expats need to know about GKV (gesetzliche Krankenversicherung) in Germany, costs, coverage, providers (TK, AOK, Barmer, DAK), and how to sign up.
Reviewed by MyHealthcareBroker, licensed German insurance broker · 2026-03-01
GKV, gesetzliche Krankenversicherung, or statutory health insurance, is Germany's public health system. About 87% of the population is covered by it, and for most people who move to Germany, it's where you land by default.
GKV is a solidarity-based system: everyone pays a percentage of their income, and everyone gets the same core coverage regardless of how much they earn or how often they visit the doctor. It's a good system. But it's not always the best option for every expat, especially those on higher salaries.
This guide explains exactly how GKV works, what it costs, which provider to choose, and when it might make sense to look at alternatives.
How much does GKV cost?
GKV contributions are calculated as a percentage of your gross salary, not as a flat fee. The total rate in 2026 is approximately 16.3% of your gross monthly income, split roughly 50/50 between you and your employer.
Your share as an employee is around 8.15% of gross salary (plus Pflegeversicherung, nursing care insurance). The rate is made up of:
- Base KV rate: 14.6% split, you pay 7.3%, employer pays 7.3%
- Zusatzbeitrag (supplemental rate): set by each Krankenkasse individually, split 50/50 between you and employer. TK's rate in 2026 is 2.69% total (1.345% each)
- Pflegeversicherung (nursing care): 3.4% total, you pay 2.3% (or 2.9% if you have no children); employer pays 1.7% (some states vary)
There is a contribution ceiling called the Beitragsbemessungsgrenze (BBG). In 2026 it is €5,812.50/month (€69,750/year). You pay GKV contributions on salary up to this ceiling, income above it is not subject to additional contributions.
Important: GKV rates went up again in 2026. Many Krankenkassen raised their Zusatzbeitrag at the start of the year. If your insurer raised rates, you have a special right to switch providers (Sonderkündigungsrecht).
| Situation | Your monthly GKV cost | Notes |
|---|---|---|
| Employee, €80,000/year gross | ~€620/month | Employer pays another ~€570/month on top |
| Self-employed, €60,000/year | ~€900–1,100/month | You pay both employer and employee share, no subsidy |
| Student (under 25) | ~€130/month | Subsidised student rate via Studierendenwerk |
| Unemployed (ALG I/II) | €0 (covered by Jobcenter) | You must register with your Krankenkasse |
Which GKV provider should I choose?
All GKV providers offer the same legally mandated core benefits. What varies between them is the Zusatzbeitrag rate, digital services, English-language support, and a small number of optional extras.
For most expats, the choice comes down to convenience and language access. Here's how the major providers compare in 2026:
- ✓ English-language app and website
- ✓ Excellent digital services (e-AU, digital card)
- ✓ Online-only registration, no branch visit needed
- ✓ One of the lower Zusatzbeitrag rates nationally
- ✓ Huge member base, accepted everywhere
- ✓ Regional, strong local network
- ✓ Rate varies massively by Bundesland (AOK Bayern vs AOK NordWest differ significantly)
- ✗ No English support
- ✗ More bureaucratic than TK in most regions
- ✓ National, branches across Germany
- ✓ Decent digital services
- ~ Partial English content online
- ✗ Fewer English-speaking staff than TK
- ✓ National coverage
- ✓ Good app
- ✗ No English support
- ✗ Slightly higher rate than TK
- ✓ Lower Zusatzbeitrag than most
- ✓ National coverage
- ✗ Originally for craft trades (Handwerk), less suited for office workers
- ✗ No English support
Our recommendation: For the vast majority of expats, TK (Techniker Krankenkasse) is the best GKV option. The English-language app, digital services, and competitive rate make it the clear choice if you don't speak German fluently. Sign up at techniker.de.
What does GKV cover?
GKV covers all medically necessary treatments. The benefits catalogue is set by law, every GKV insurer must cover the same core services.
- GP and specialist visits
- Hospitalization (shared room, ward doctor)
- Prescription medications (co-pay max €10)
- Mental health therapy (psychotherapy)
- Maternity care and childbirth
- Preventive check-ups (Vorsorge)
- Basic dental check-ups and fillings
- Physiotherapy and rehab
- Emergency care anywhere in Germany
- EU-wide emergency coverage (EHIC card)
- Private or chief physician (Chefarzt)
- Single room in hospital
- Dental implants and crowns (only partial)
- Vision correction (glasses/contacts for adults)
- Alternative medicine (homeopathy, osteopathy)
- Most cosmetic procedures
- Long-term worldwide travel coverage
Pros and cons of GKV
- Family members insured free (spouse, children with no income)
- No health questionnaire, pre-existing conditions covered
- Simple: one rate, automatic enrollment
- Income-independent coverage, if you lose your job, you stay covered
- Guaranteed acceptance for everyone
- Long-term cost stability, no age-based increases
- Expensive for high earners, up to €620+/month your share
- Very expensive for self-employed, up to €1,300+/month
- Longer wait times for specialist appointments (3–8 weeks typical)
- Shared rooms in hospital by default
- Ward doctor, not your choice of physician
- Rates went up again in 2026
How to sign up for GKV
Signing up for GKV is straightforward, especially with TK, which handles the whole process online in English.
For most expats, TK is the best starting point. You can also choose AOK, Barmer, DAK, or IKK classic, all offer the same core coverage. You can switch once per year (or immediately if your insurer raises rates).
TK's online application takes about 10 minutes and is available in English. You'll need your Anmeldung confirmation (address registration), passport or ID, and your employer's details.
Upload your employment contract, your Anmeldebestätigung (residence registration), and your Steuer-ID if you have it. TK can usually process this in 1–3 business days.
Your electronic health card (eGK) arrives by post within 1–2 weeks. In the meantime, your insurer will give you a provisional coverage confirmation letter you can use immediately.
Send your employer the Mitgliedsbescheinigung (membership certificate) from your Krankenkasse. They'll start deducting and paying contributions from your next payroll cycle.
Is GKV the right choice for you?
GKV makes sense if you're new to Germany, if your salary is below the PKV threshold, or if you have a family with a non-working spouse and children (whose coverage is free under GKV).
But if you're earning above €77,400/year as an employee, or you're self-employed, there's a strong case for comparing GKV against private health insurance (PKV). The savings can be significant: typically €240–300/month for an employee at €80k salary.
Earning above €77,400/year? You may qualify for PKV, which is often significantly cheaper and includes better access to specialists. Compare GKV vs PKV in detail →