Germany's healthcare system consistently ranks among the best in the world, and as an expat you get access to the full thing from day one. The system runs on its own logic — two parallel tracks, mandatory enrolment, and a few quirks that trip up newcomers. Here's a plain-language breakdown of how it works.
Healthcare in Germany: Key Facts at a Glance
| Detail | 2026 Figure |
|---|---|
| GKV base contribution rate | 14.6% of gross salary |
| Average supplementary levy | 2.9% (varies by provider) |
| Your share (employee) | ~8.75% of gross |
| PKV income threshold | €77,400/year gross |
| Contribution assessment ceiling | €69,750/year (€5,812.50/month) |
| Long-term care insurance | 3.6% (4.2% if childless, 23+) |
| Prescription copay | €5–€10 per medication |
| Hospital copay | €10/day (max 28 days/year) |
| Annual copay cap | 2% of gross income (1% if chronically ill) |
| Preventive check-up (35+) | Free, every 3 years |
The Two-Track System: Public (GKV) vs. Private (PKV)
Germany runs a dual model for health insurance. Most employees land in public health insurance — GKV (gesetzliche Krankenversicherung). If your gross salary exceeds €77,400/year (the 2026 Versicherungspflichtgrenze), you have the option to switch to private insurance — PKV (private Krankenversicherung).
Both are legitimate. The right choice depends on your age, income, family situation, and how long you plan to stay in Germany.
Public Insurance (GKV)
The base contribution rate is 14.6% of your gross salary, split equally between you and your employer (7.3% each). On top of that comes a provider-specific supplementary levy — the national average is 2.9% in 2026, though individual providers range from 2.18% to 4.39%. Your total employee share comes to roughly 8.75%.
Contributions are capped at the Beitragsbemessungsgrenze of €69,750/year (€5,812.50/month). If you earn more than that, your contributions don't increase further — the cap applies.
The big advantage of GKV: your spouse and children are covered at no extra cost through family insurance (Familienversicherung) if they have no significant income of their own. For families, this is often the deciding factor.
Well-known public insurers include TK (Techniker Krankenkasse), AOK, Barmer, and DAK. Shopping between them is worth doing — while core benefits are identical by law, supplementary services and the Zusatzbeitrag rate vary. Switching between GKV providers is straightforward and you can do it after 12 months with your current insurer.
Private Insurance (PKV)
Premiums are set by your age at entry, health status, and the level of coverage you choose — not your salary. You typically get faster specialist access, private hospital rooms, and broader coverage for dental, vision, and alternative treatments.
The trade-offs are real though. Costs rise significantly with age, family members each need their own separate policy, and switching back to GKV later is very difficult — essentially, you need to get your gross salary below the threshold again before age 55, or it becomes nearly impossible. For young, high-earning singles, PKV can make financial sense. For families or anyone planning to stay in Germany long-term, GKV usually wins.
Before committing to private insurance, model the costs for 10, 20, and 30 years out — not just today's premium. The age-related increases are the part that catches people off guard.
Long-Term Care Insurance (Pflegeversicherung)
This one is mandatory alongside your health insurance and often overlooked in expat guides. Long-term care insurance covers the costs of nursing care if you can no longer care for yourself — at home or in a care facility.
The contribution rate is 3.6% of gross salary, split roughly equally between you and your employer. If you're childless and over 23, you pay an additional 0.6% surcharge entirely out of your own pocket, bringing your total to 4.2%. Parents with multiple children under 25 get a reduction — 0.25% off per child from the second child onwards, up to a maximum discount of 1%.
The contribution assessment ceiling is the same as for health insurance: €69,750/year.
Health Insurance Is Legally Required
This is not optional. If you're employed in Germany, your employer automatically enrols you in GKV unless you actively opt out into PKV. If you're self-employed, a freelancer, or arriving on a visa before starting work, you need to sort coverage yourself — and you'll need proof of insurance before you can complete your city registration (Anmeldung).
No insurance, no registration. Sort this early.
For the arrival period before your employment starts, you'll typically need private travel health insurance or an incoming expat policy. Once your job begins, your employer handles the transition to statutory insurance. We cover all three must-have policies in our insurance guide for newcomers.
Your Health Card (eGK)
Once you're insured, your provider sends you an electronic health card — the eGK (elektronische Gesundheitskarte). This is your proof of insurance and what you hand over at every doctor's appointment.
Keep it with you. Without it, practices may bill you directly and you'll have to claim reimbursement later. It's a minor headache you can easily avoid.
Seeing a Doctor in Germany
One thing that surprises most expats: you don't need a GP referral to see a specialist in Germany. You can book directly with a dermatologist, cardiologist, or orthopaedist without going through a general practitioner first. Referrals are only required for radiologists, nuclear medicine specialists, and doctors in certain integrated care networks.
That said, having a regular Hausarzt (family doctor) is useful — especially in your first year. They handle prescriptions, sick notes (Arbeitsunfähigkeitsbescheinigung), and referrals when you do need them. Think of it as your healthcare anchor.
For finding doctors, Jameda.de is the main review platform. For English-speaking doctors, searching "English-speaking doctor [city]" turns up expat-friendly practices quickly in most major cities. Doctolib is widely used in Germany for online appointment booking.
Wait Times
GKV patients sometimes face longer wait times for specialist appointments than PKV patients — this is one of the real advantages of private insurance. If you're in GKV and need a specialist appointment urgently, call the Terminservicestelle at 116 117. By law, they must arrange an appointment within four weeks (one week for urgent referrals).
Sick Pay (Krankengeld) — What Happens When You Can't Work
If you get sick, your employer continues to pay your full salary for up to 6 weeks (Entgeltfortzahlung). After that, your GKV insurer steps in with Krankengeld — roughly 70% of your gross salary (capped at 90% of net), for up to 78 weeks per illness.
You'll need a doctor's note (Arbeitsunfähigkeitsbescheinigung) from day one of your illness — or from day three, depending on your employer's policy. Since 2023, these are transmitted electronically (eAU) directly to your employer and insurer, so you don't need to send paper copies anymore. Just make sure you visit your doctor and they file it.
If you're on PKV, sick pay works differently. Private insurance doesn't include Krankengeld by default — you need to add a Krankentagegeld rider to your policy. Without it, you're only covered for 6 weeks through your employer and nothing after that. This is a commonly missed detail.
What You'll Pay Out of Pocket
Public health insurance covers the vast majority of treatment — doctors, hospitals, prescription medications, mental health care, and rehabilitation. Copayments exist but are capped:
- Prescriptions: €5–€10 per medication (10% of the price, with a minimum of €5 and maximum of €10)
- Hospital stays: €10/day for up to 28 days per calendar year
- Annual maximum: 2% of your gross household income, or 1% if you're chronically ill. Once you hit the cap, you can apply for exemption from all copays for the rest of the year
Children under 18 are exempt from copayments entirely.
What's Not Fully Covered
A few areas where you'll likely pay out of pocket or want supplementary coverage:
- Dental work beyond basic treatment: crowns, implants, and adult orthodontics involve significant copays. GKV covers about 60% of the cost of standard treatment (Regelversorgung), rising to 70% if you've attended annual dental check-ups for 5 years (the Bonusheft system) and 75% after 10 years of consistent check-ups
- Glasses and contact lenses: only covered for children or adults with severe vision impairment (over 6 diopters). Most adults pay out of pocket
- Alternative treatments: homeopathy, osteopathy, and acupuncture are covered by some GKV providers as supplementary benefits — check with yours
- Private hospital rooms and chief physician treatment: not covered under GKV
Supplementary Insurance (Zusatzversicherung)
Many expats in GKV add a supplementary dental insurance policy (Zahnzusatzversicherung) — typically €15–€40/month depending on age and coverage level. This bumps dental reimbursement to 80–100% and covers cosmetic treatments. It's one of the most popular add-ons and worth considering, especially before you need any major dental work (policies have waiting periods).
Mental Health Coverage
Germany covers psychotherapy through GKV, which is something many expats coming from the US find remarkable. Cognitive behavioural therapy, depth psychology, and psychoanalysis are all covered with no copay once approved.
The catch is access. Wait times for a therapist spot can be 3–6 months in major cities. You can call 116 117 for help finding a therapist with availability, or use the Psychotherapeutenkammer directory for your state. In acute situations, you're entitled to up to 12 emergency sessions (psychotherapeutische Akutbehandlung) with much shorter wait times.
English-speaking therapists are available in most major cities but the pool is smaller. Platforms like Therapify and HelloBetter can help bridge the gap.
Preventive Care and Check-Ups
Germany takes prevention seriously. Your GKV insurance covers a comprehensive set of preventive screenings at no cost:
- Ages 18–34: one general health check-up (Gesundheits-Check-up)
- Ages 35+: general health check-up every three years, including blood work and cardiovascular screening
- Skin cancer screening every two years from age 35
- Cervical cancer screening annually for women from age 20
- Mammography screening every two years for women aged 50–69
- Colon cancer screening from age 50 (stool test annually; colonoscopy from age 55)
- Dental check-ups: twice per year — and attending them matters because of the Bonusheft system (see dental section above)
These check-ups are thorough. They're worth booking — don't wait until something is wrong.
Emergency Numbers
Save these in your phone before you need them.
- 112 — ambulance and life-threatening emergencies (equivalent to 911 in the US)
- 116 117 — on-call medical service (ärztlicher Bereitschaftsdienst) for urgent but non-life-threatening situations, evenings and weekends
The 116 117 line is underused by expats. It's free, connects you to a doctor by phone, and can arrange a home visit if needed. It's for exactly those situations that are too urgent to wait for a regular appointment but don't warrant an ER visit. Use it.
Frequently Asked Questions
How much does health insurance cost in Germany? For employees in public insurance (GKV), the total rate is about 17.5% of gross salary (14.6% base + 2.9% average supplementary), split equally with your employer. Your share is roughly 8.75%. On a €60,000 salary, that's about €437/month from your paycheck. Private insurance premiums vary widely — €300–€700/month depending on age, health, and coverage level.
Can I choose between public and private insurance? Only if your gross salary exceeds €77,400/year (the 2026 threshold). Below that, you're in GKV by law. Self-employed individuals, freelancers, and civil servants can choose PKV regardless of income. The decision is significant — switching back to GKV from PKV is very difficult after age 55.
Is my family covered under my insurance? In GKV, yes — your spouse and children are covered at no extra cost through Familienversicherung, as long as they earn less than €565/month. In PKV, each family member needs their own separate policy, which adds up quickly. This is often the strongest argument for staying in public insurance.
Do I need insurance before I arrive in Germany? Yes. You'll need proof of health insurance to complete your Anmeldung (city registration) and for your visa application. For the period before your employment starts, private travel health insurance or an incoming expat policy works. Once your job begins, your employer handles the transition to GKV or PKV.
How do I find an English-speaking doctor? Jameda.de lets you filter by language. You can also search "English-speaking doctor [your city]" or check your city's expat Facebook groups for recommendations. Doctolib is widely used for booking appointments online. In larger cities (Berlin, Munich, Frankfurt, Hamburg), finding English-speaking practitioners is straightforward.
What if I need care while travelling in the EU? Your GKV insurance includes a European Health Insurance Card (EHIC) — the blue card on the back of your eGK. This gives you access to state-provided healthcare in all EU/EEA countries and Switzerland under the same conditions as local residents. It doesn't cover private treatment or medical repatriation, so separate travel insurance is still worth having for trips.
Once you're enrolled and have your eGK, day-to-day healthcare in Germany is straightforward. The quality is high, the infrastructure is solid, and the admin burden is lower than most expats expect going in. Understanding the GKV vs. PKV decision, setting up your Bonusheft, and knowing the 116 117 number covers most of what you need for a smooth start.
If you're still sorting out the logistics of your move — insurance, visa, taxes, the full timeline — that's exactly what we help with at Move2Europe.
Book a free consultation and let's map out what you need to get sorted before you arrive.
Official sources:
- Make it in Germany — Health Insurance — Federal government portal on insurance requirements for newcomers
- gesund.bund.de — Co-payments and Exemptions — Official guide to copay rules and caps
- gesund.bund.de — Health Check-up for Adults — Preventive screening schedule and eligibility
- TK — Contribution Rates 2026 — Detailed breakdown of all social contribution rates
- GKV-Zusatzbeitrag.de — Comparison of supplementary contribution rates across all GKV providers
- 116 117 — On-Call Medical Service — Appointment booking and emergency medical helpline