What are the German health insurance requirements and costs for expats in 2026?

Health insurance is mandatory in Germany for everyone - no exceptions. Understanding the system is crucial as you must have it before arrival for most visas.

Two-Tier System:

1. Public Insurance (Gesetzliche Krankenversicherung - GKV)

Who must use it:

• Anyone earning under €69,750/year (2026 threshold)
• Employees (unless high earners)
• Most visa holders

Costs (2026):

• Contribution rate: 14.6% of gross salary + 1-2% surcharge
• Split 50/50 between employee and employer
• Employee pays: typically €400-800/month depending on salary
• Maximum monthly contribution: Over €1,000 (for first time in history)

What's included:

• Unlimited doctor visits (€0 copay)
• Hospital stays (€10/day max)
• Prescriptions (€5-10 copay)
• Dental (basic covered, cosmetic 50%)
• Mental health care
• Preventive care
• Maternity care (fully covered)
• Family coverage at no extra cost (spouse + children!)

Popular providers:

• TK (Techniker Krankenkasse) - Excellent English support
• AOK
• Barmer
• DAK
• All legally required to provide same basic coverage

2. Private Insurance (Private Krankenversicherung - PKV)

Who can use it:

• High earners (€69,750+ annually)
• Self-employed/freelancers
• Certain professions

Costs:

• Based on age, health, coverage selected
• Typically €150-600/month
• Young/healthy: Cheaper than public
• Older/families: Often more expensive
• Each family member needs separate policy

Benefits:

• Faster appointments
• Private hospital rooms
• More treatment options
• Direct billing

Drawbacks:

• Can't easily switch back to public after 55
• Premiums increase with age
• Pre-existing conditions excluded
• Family not free (each person pays)

For Different Visa Types:

EU Blue Card holders:

• Must have insurance from day one
• Usually public (unless earning above threshold)
• Employer arranges upon starting work

Freelance visa (Freiberufler):

• Can choose public or private
• Must pay full cost (no employer contribution)
• Public: ~€400-800/month
• Recommendation: Start with public for predictability

Students:

• Special student insurance until age 30
• Cost: €110-120/month
• After 30: Must switch to regular insurance
• Mandatory for visa approval

Job seekers (Opportunity Card):

• Must have insurance for visa
• Travel/expat insurance initially
• Switch to public/private when employed

Getting Insurance Before Arrival:

• Get confirmation/quote from German insurer

1. Required for visa application
2. Activate upon arrival
3. TK offers pre-arrival quotes in English

Switching Between Public and Private:

Public to Private:

• Possible if income exceeds €69,750
• Can switch annually
• Think carefully - hard to go back!

Private to Public:

• Nearly impossible after age 55
• Must drop below income threshold AND be under 55
• Very difficult, intentionally designed this way

Family Considerations:

Public insurance:

• Spouse covered free if not working
• All children covered free
• Huge savings (€500-1,000/month value)

Private insurance:

• Each person pays separately
• Can be €300-500/month per person
• Expensive for families

2026 Changes:

• Income threshold for public: €69,750 (up from €66,150 in 2025)
• Maximum contribution exceeds €1,000/month for first time
• Prices rose 3-4% across board

Common Questions:

Q: Can I use my home country insurance?

A: No. Must have German or EU-recognized insurance.

Q: What if I'm between jobs?

A: Must continue insurance. Can get unemployment to cover costs.

Q: Is dental included?

A: Basic yes, but cosmetic/advanced treatments 50% or extra insurance needed.

Q: Can I see English-speaking doctors?

A: Yes, especially in cities. Use Jameda.de to find them.

Recommendations:

• Most expats: Choose public insurance
• Family coverage free
• No pre-existing condition exclusions
• Stable, predictable costs
• Can't be denied

• Young, single, high earners: Consider private
• Cheaper when young
• Better service
• BUT difficult to reverse

• Freelancers: Start with public
• Easier to budget
• Better for long-term
• Family planning flexibility

• Always get TK if choosing public
• English support excellent
• Easy app
• Expat-friendly

Pro Tips:

• Never let insurance lapse - can cause visa issues
• Get insurance confirmation before visa interview
• Public insurance covers family at no extra cost - massive benefit
• Once you go private after 55, you're stuck - choose wisely
• TK has English website and customer service

Bottom Line:

For most expats, public insurance (GKV) is the better choice: comprehensive coverage, family included free, no coverage denials, and you avoid being locked into private insurance later in life.