Health Insurance in Germany for Foreigners: What You Need to Know

Looking for health insurance in Germany? You may be surprised to know that if you come from the European Union, you may already be covered.

If not, you still have plenty of options for public and private health insurance in Germany.

But your choices for insurance depend on your case.

Retirees may have different needs than exchange students. And the same holds true for professional workers and expats.

By the end of this guide, you’ll know which insurance is right for you, what kind of coverage you can get, and where to look for it.

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Summary of this Post

If you want to get right to the point, here’s what you should know about health insurance options in Germany. 

International health insurance is available for anyone who’s living in Germany that wants global health coverage, where you can fly back to your home country and get treatment, or keep the plan when you move to a new country. 

If you are working in Germany and make less than 5,062.50 Euros a month, get public health insurance. On the other hand, if you are making over that amount, it might be better to get private health insurance from Cigna.

If you are self-employed or retired in Germany, get private health insurance from a provider such as Cigna. However, if you are EU citizen, you can check out public health insurance.

In case you are a US citizen, you can check out Geoblue. It’s the international health insurance that comes with US coverage at a good price.

If you recently moved to Germany and is still unemployed or in a language school, check out Expat health insurance. You can use it to apply for a visa. 

Before You Come to Germany

It’s important to know that if you get sick or injured while living, working, or traveling in Germany, you can get emergency medical care without proving you have insurance first.

No one asks you who’s paying the bill before they help you.

But don’t worry, you will get the bill eventually. And someone has to pay it.

That someone is you. Unless, of course, you have health insurance that covers you in Germany.

Check Your Existing Insurance

Here are a few ways to check if you have coverage for your time spent in Germany.

Traveling to Germany

Anyone traveling to Germany and European Union, or EU, has to have valid medical insurance.

While traveling the requirements are less strict and for all countries within the EU the same.

Travel insurance has to cover you with a minimum of 30,000 Euros.

Now, this amount is usually covered by most private medical insurance plans in any emergency out of area coverage.

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But you may have insurance with worldwide coverage and therefore Germany might be covered within the limits of your existing insurance plan.

If you have local insurance, it’s worth checking for any existing emergency coverage you may have on your policy while traveling outside your area of coverage.

Also, many banks these days include travel insurance in their credit card packages.

And all countries in the EU have an intergovernmental agreement that covers anyone with existing public health insurance from any other country in the EU.

This may only apply to coverage for accidents and emergencies.

It’s worth checking with your home country’s social security health insurance for any coverage you may have while traveling in the EU, if you’re an EU citizen.

But to get treatment while traveling, you may have to get your European Health Insurance Card.

Moving to Germany

If you move to Germany your situation is a bit different.

Anyone living in Germany must have a valid health insurance through a licensed health insurance provider, not just travel insurance.

There is however a gray area for foreigners in Germany who plan to live there for up to 5 years.

In this case, you can use your existing health insurance if it covers Germany and covers inpatient and outpatient care and emergency assistance and evacuation.

Any violation against these regulations can lead to a fine of up to 10,000 Euros enforced by German regulating authorities.

You can read more about the options within Germany’s health care system and decide to keep your existing health insurance plan or sign up for a new plan.

Remember that you can only keep your existing insurance if you don’t work in Germany and stay in the country no more than 5 years.

Your two choices in Germany are social insurance or private insurance. Private insurance is a good choice if you can’t get public health insurance.

How Does Health Insurance in Germany Work?

Are you an expat, exchange student, EU citizen, retiree, freelancer, or business owner living in Germany?

If so, you must have either public health insurance or private health insurance.

You don’t have a choice in this matter. You have to proof that you’re insured.

The only question is if you’re insured compulsory or voluntarily under public health insurance or you’re entitled to get private health insurance.

Without going into too many details, basically if you’re employed you are insured automatically through the social security scheme.

If you’re freelancer, self-employed, or business owner, you must choose between voluntary getting public health insurance or signing up for private health insurance.

There are some exceptions for certain occupations.

Social Health Insurance

We talk about public health insurance in Germany because it’s a valid option and for many people, even expats, as it’s compulsory for most people.

Some people have a choice. So why would you want to join any public health insurance scheme if you have the option of getting private health insurance?

Generally speaking, it’s because public health insurance in Germany covers mainly everything, without restrictions on pre-existing or chronic conditions.

And social medical care in Germany is well organized and you get the right treatment when you need it.

Of course nothing is perfect and the same is true for public health insurance in Germany, otherwise people wouldn’t need private health insurance.

Now the question is: Do you want to buy private health insurance if you can get full coverage through public health insurance?

For instance, with public health insurance you may have to wait for an appointment at a specialist if it’s not an emergency.

But this doesn’t apply to all regions and for all specialist and treatments.

Also, some doctors are only available for private insured patients, but overall there are a variety of doctors available in the public health insurance system.

If you have public health insurance you’re supposed to first go to a general practitioner, who then refers you to a specialist if needed, but this isn’t mandatory anymore.

You can sign up for public health insurance yourself using this link. 

Working in Germany

If you or a family member work in Germany you are automatically enrolled into Germany’s Social Security system.

Social Security in Germany is compulsory for any employment and is non-negotiable.

Therefore you don’t have to worry about what kind of insurance to get if you work in Germany. You get public health insurance straight away.

The only exception is if you make a certain amount of money.

In general, employers deduct 14.6% of your salary for public health insurance and 3% for long term care insurance.

Another 18.6% goes to your pension and 2.5% goes to unemployment insurance.

You pay 50% of the costs for health insurance and your employer pays 50%.

But only the employer pays for liability and statutory accident insurance.

Now, if you or a family member works in Germany the other members of your family are insured for free.

This is called familienversicherung in German.

It means all family members are covered under one policy, including kids up to the age of 25 if they’re students or have no income.

However, if your partner or perhaps your child is earning money on their own, they need to be insured separately.

We mentioned that your income can be ab exception when working in Germany and getting insurance.

If you make more than 5,062.50 Euros as of 2019 you can choose to get private health insurance.

However, there are advantages and disadvantages to choosing private health insurance, which we talk about in the next section.

Also, even if you get private health insurance you still have to pay into your pension and unemployment insurance if you make up to 6,700 Euros.

If you make anything above that amount and have private health insurance, no other deductions are taken from your income.

Self-Employed

If you’re self-employed in Germany you can enroll in public health insurance if you had public health insurance in your home country before moving to Germany.

This goes for everyone, not just EU citizens.

If you had private health insurance in your home country then you need to get private health insurance in Germany as well.

Depending on age, public health insurance in Germany might be more expensive than private health insurance.

This is because rates for the public health insurance are based on income rather than age and personal medical history.

Each year your statutory health insurance company checks your income by checking your income tax report.

If you’re self-employed and make 5,062.50 Euros a month, 14% of your income goes to health insurance and 3% goes to long term care insurance.

You have to choose coverage for sick days separately at another 0.6% of your premium.

Or you can get insurance for sick days separately through a supplementary medical insurance plan.

There are no minimum premiums for voluntary public health insurance.

In 2019 the minimum premium was set to 171 Euros a month, which can be very attractive, especially for small business owners and startup entrepreneurs.

Public health insurance might be the best choice for you if you have a family in Germany because they get free coverage.

You can sign up for public health insurance here. 

Retiring in Germany

If you want to retire in Germany you must have health insurance.

If you have private health insurance that covers you for inpatient and outpatient care, this might be enough, even if your policy isn’t licensed in Germany.

Nobody expects you can cancel your existing policy and apply for a new one when you retire.

EU Retirees

If you’re insured through Social Security in your home country, you could get your European Health Insurance Card.

But this card is only for emergency care and you may have to travel back and forth to your home country for any other treatments.

This may not be convenient for you. So you may want to switch your existing public health insurance from your EU home country to Germany.

To do this, fill out Form S1 from the health insurance company in your home country and send it to the health insurance company of your choice in Germany.

You don’t cancel the public health insurance in your home country. You just let them know you moved to Germany and that’s it.

If you’re not insured you need to get a private health insurance.

Unfortunately, you can’t join Germany’s public health insurance system while retired in Germany if you didn’t have public health insurance before you retired.

Non-EU Retirees

Unfortunately, if you’re not a EU citizen you can’t get public health insurance when you retire in Germany.

If you have private health insurance, keep it. If you don’t have insurance, you need to get some.

Skip to the Private Health Insurance section to find out more.

Studying in Germany

If you study in Germany you must have insurance.

As we said earlier, students can be insured through family packages for free up to the age of 23 if their parents are insured through Social Security.

Most likely, you can’t do this if you’re an exchange student in Germany.

But if you come from within the EU you can prove your existing public health insurance through the European Union Health Insurance card.

If you come from outside the EU, you have to check if there’s a intergovernmental social security agreement between your country and Germany.

If there’s no agreement, you can apply for student health insurance under the public health insurance system.

You get the same benefits as everyone else, except you pay less.

The current premium rate in 2019 for student public health insurance is about 70 Euros plus 20 Euros for long term care insurance.

But these rates depend on each health insurance company.

You can get this reduced insurance rate if you study in Germany for a maximum of 14 semesters or you’re no older than 30.

You can find the student rates from all different health insurance companies on Krankenkassen. But the website is only available in German.

You can find more info on student health insurance on the official website of Germans Academic Exchange Service. This website is in English.

Private Health Insurance

Individual Private Medical Insurance, or IPMI, is mostly better than public health insurance and has some advantages, but it can be more expensive.

You may come across people in Germany who recommend private health insurance over public health insurance, but be careful.

In regards to pre-existing conditions and also costs for additional family members, private health insurance may not be the right choice for you.

The advantages for private health insurance in comparison to public health insurance are:

• higher dental coverage
• easier access to medication
• better treatment if hospitalized in semi-private rooms

Also, private health insurance offers you a wider range of access to doctors that only treat privately insured patients.

With private health insurance you don’t usually have to wait to get treatment and you can get an appointment with a specialist much quicker.

It’s possible that private health insurance is much cheaper than public health insurance.

If you make over 5,062.50 Euros a month or you’re a young startup entrepreneur, private health insurance may be a good choice.

For example, if you make 6,000 Euros a month you have to pay 380 Euros as an employee or about 760 Euros if you’re self-employed for public health insurance.

If you get private health insurance and you’re healthy and younger than 30, you can get private health insurance for under 250 Euros a month.

But this leads to the disadvantages. Under IPMI you don’t get free coverage for family members. You have to pay extra for each of them.

This means you may end up paying over 1,000 Euros each month to insure your family.

For some people it’s worth the money. For others, they’d rather stick with public health insurance.

Also, under private health insurance pre-existing conditions could be an issue.

IPMI rates are based on your individual age, medical history, benefits, deductibles, and area of coverage.

If you have any pre-existing conditions you may end up with an extra fee or even an exclusion.

Private health insurance companies increase their premiums once in a while as well.

But once you’re insured you technically stay in your age bracket. We explain this further down the guide.

If you want to get private insurance, enter your details on International Citizens Insurance and get quotes for the health insurance plans that are most suitable to you. 

IPMI and Working in Germany

If you can get private health insurance, keep in mind that your employer still has to pay half of the premium of any standard plan.

But you can’t buy a premium plan and expect your company to pay for it.

If you get a premium plan then your employer has to pay the maximum amount they would have to pay for public health insurance.

Also, the shared premium is just for you, the employee, not for your family members.

IPMI and Studying in Germany

If you study in Germany you can get IPMI as well.

This private insurance is cheaper for students and can even be cheaper than public health insurance.

If you’re an exchange student enrolled in a university in Germany, you must have either private or public health insurance.

But there are cases in which you can get student travel insurance, which is offered by many companies.

You can buy these plans for one semester or up to five years. They cover mainly everything too, but can cost around 50 Euros a month.

Supplementary Private Health Insurance

If you have public health insurance, supplementary private health insurance can be a cost effective way to cover what your public health insurance doesn’t.

Benefits of supplementary private health insurance are usually already covered under any IPMI plan.

For example, such insurance can cover you for:

• More sick days
• Better dental coverage
• Long term care
• Hospital stays
• Daily hospital benefits
• More outpatient coverage
• Travel insurance

You can choose to buy all add-ons or just the ones important to you. Some make more sense than others.

Sick Days

Sick-day allowance insurance limits you to 70% of your last income under public health insurance and applies to employees and self-employed voluntary members.

If you’re self-employed, this insurance can be a good way to get income protection in case of any long term inability to work.

These insurances can be set with different deferment periods. The less waiting time, the more expensive it becomes.

Dental Coverage

You get limited dental coverage under public health insurance for major dental treatments like crowns or prostheses.

Also, for routine and minor treatments like fillings you may have to pay if you wish to receive better filling material.

Basically, the coverage for major procedures is only 50% of any standard treatments.

This means if you wish to have an inlay instead of a crown you may end up with an 80% copayment.

Supplementary dental insurance is a good way to minimize the financial risk for costly dental treatments.

Long term Care

Long term care can be very expensive, especially if you have no family members to help you.

Additional long term care insurance gets you better coverage than public health insurance and can help lower your financial burden in such a case.

Hospital Stays

Supplemental insurance for hospital stays gives you better benefits for admissions in semi-private or private rooms, specialists, and medical treatment, and more.

Daily Hospital Benefits

Daily hospital benefits provide you a daily allowance and can cover additional costs you may have while admitted.

Outpatient Coverage

Supplemental outpatient insurance covers treatments that are limited under most public health insurance plans.

These treatments include Chinese traditional medicine or other alternative medicines, but can also include classes and other medical aid.

Usually this kind of insurance is not worth the money, because the coverage is very limited but costs a lot.

Travel

You should have travel insurance if you travel abroad once in a while.

If you move to Germany, get travel insurance from a company in Germany because the coverage usually includes all areas except your country of residence.

But it’s not a must to buy in Germany.

Normal annual travel insurance for trips of up to six weeks are extremely cheap in Germany and cover much more than you usually get on the international market.

Public health insurance provides sufficient coverage in the EU, but not for any other countries.

IPMI plans on the other hand may give you sufficient coverage while traveling anywhere in the world. But you need to check them carefully when applying.

Depending on your needs and situation, supplementary medical insurance may or may not make sense for you.

But if you’re employed then you may check with your company if they have a supplementary medical group policy in place.

More and more companies in Germany offer additional employee benefits through such group policies these days.

Private Medical Group Insurance

Apart from supplementary group medical insurances, private medical group insurances are very rare, but possible to get if you run a company in Germany.

To get private medical group insurance at your company you need at least ten employees who can get private medical insurance instead of public health insurance.

So only big companies with enough high-income employees can get a group policy.

Another issue can be that for small groups, all employees need to have the same benefits, which can be challenging to set up.

But some companies have these policies in place and cost about 10% less than comparable individual policies.

Travel Insurance

If you travel to Germany and you’re not covered by any of the insurance mentioned above, then getting travel insurance is a must.

If you don’t have insurance, you may be denied your Schengen Visa for Germany.

But also it’s just careless to travel anywhere in the world without proper insurance.

As mentioned, the minimum coverage requirement for Germany is 30,000 Euros, but you can get coverage for over one million US Dollars.

You may want a higher limit for at least two reasons.

First, the premium difference between 30,000 Euros and 100,000 Euros in coverage is not as much as you may expect.

And more importantly, 30,000 Euros may not be sufficient enough if you have a major accident or get seriously sick.

You can buy Schengen travel insurance online or through an insurance broker of your choice anywhere in the world.

But check the details before buying.

Travel insurance covers you for delayed and cancelled flights and loss of luggage, but some don’t focus on the important part—health insurance.

Travel insurance that does focus on health insurance are usually much more expensive than your average travel insurance plans.

Offshore Private Medical Insurance

If you’re an expat who works in Germany, your have limited choices for insurance and most likely you’ll be insured through Social Security.

If you’re not employed and plan to stay in Germany up to five years, you can get insurance through an offshore company if it meets the standards of Germany’s laws.

If you move to Germany temporarily and have insurance that covers you in Germany for inpatient, outpatient, and emergency evacuation, you can keep this plan.

If you don’t have insurance you can buy any offshore plan you like as long as it covers the benefits mentioned in the last paragraph.

But there is no guarantee that in your particular case German authorities will accept the coverage you have. They may even force you to buy licensed insurance.

You can enter your details on International Citizens Insurance and get quotes for the offshore insurance plans that meet the standard of German laws. 

Insurance Plans Explained

Before you buy any insurance plan, be aware that prices aren’t the only thing to consider.

Take the time to read through the fine print of any insurance plan you’re interested in buying.

No matter where in the world you’re buying insurance for, there are some general things to be aware of.

We’ve listed each of them in a separate guide. Click on any of the links for more info.

• Add-ons
• Age restrictions
• Areas of coverage
• Cancellations or non-extensions
• Claims
• Coverage limits
• Exclusions
• Paperwork
• Premiums
• Pre-existing conditions
• Prior authorizations

Finding the Best Insurance Plan

The choices you have depend on your personal circumstances. So before you pick an insurance plan, let’s recap.

Employed

If you work in Germany you get public health insurance through Social Security. The costs are shared equally between employer and employee.

Employed with High Income

If you have uninsured family members, compare prices between IPMIs and public health insurance, where family members are covered for free.

Also find out if human resources at your company has a private medical group policy for managers, which could be a good alternative.

Either way, your employer has to pay 50% of the costs.

Also, if your employer offers supplementary private health insurance in addition to public health insurance, then this might be worth considering.

Self-Employed

If you’re self-employed, your choice of insurance depends on the health insurance you had before you moved to Germany.

You’re either allowed to enroll into the Social Security system or apply for private health insurance. Either way, no one splits the costs with you.

Retirees

If you retire in Germany and have had public health insurance within the EU before moving to Germany, then you can switch to Germany’s public health insurance.

If you come from a non-EU country, then you need to get private health insurance.

Students

You can enroll in a student health insurance plan under public health insurance or get private health insurance for students.

Tourists

Get travel insurance before traveling to Germany, which you need to get a German visa anyway.

Expats

If you don’t have to work but want to spend your time in Germany, you still need health insurance.

If you’re a EU citizens, you can prove your insurance through the European Health Insurance Card.

But if you’re not a EU citizen, you need private health insurance.

You can buy insurance through a licensed German insurance broker or offshore company if you plan to stay less than five years.

If you’re interested in private health insurance search online comparison portals like PKV Vergleich to find the best German health insurance for your case.

Online portals are good for getting a reference or overview of options. But they can’t give proper explanations and advice for your particular case.

You may want to check with a licensed and experienced international broker like Hofmann-vers.

Even though the website is in German, English inquires are okay.

You can find a list of all 45 private health insurance providers in Germany on Krankenkassenzentrale.

The most commonly known companies are probably Allianz and DVK, but these are also some of the more expensive.

Allianz, even though a bit more expensive, has a good reputation when it comes to paying debatable claims.

All other insurances companies are very reliable too, even if you’ve never heard of them.

All licensed private health insurance companies in Germany are safeguarded through a protection fund for private health insurers.

If you’re looking for public health insurance, Krankenkassenzentrale has a list of insurance companies.

The popular ones are AOK, TK, and Barmer.

However, smaller insurance companies usually offer more benefits and can be slightly cheaper.

Which one you choose also depends on the region you live in, because not all companies are available throughout Germany.

Freelancers 

If you are a freelancer in Germany, you can choose between local private insurance and international insurance.

Simply put, local private insurance is better if you plan to stay in Germany for many years. If you plan to move out eventually, it’s better to get international insurance. 

Family

If you are with family, your spouse and children can be added to your public insurance plan without additional cost if they are unemployed and/or make less than 450 euros a month. 

If it’s private insurance, you need to pay extra for each family member. However, some insurance companies may offer a group discount of 10%-20% when there are at least three family members in your plan. 

Insurance Plan Comparison

You won’t find any real differences in price with public health insurance companies and only minor differences in benefits.

As a result, recommending a specific company for public health insurance is difficult.

However, not all companies can offer customer service in English.

If you’re an expat, can’t speak German, and rather have long-term health insurance that you can take with you wherever you may move next in the future, then we recommend private international medical insurance.

If you plan to get an IPMI plan, you have many choices as an expat apart from the standard private health insurance plans.

These plans offer better rates than most private medical insurance plans do.

You can get quoted for these plans from International Citizens Insurance.

Health insurances for temporary stays of up to five years are available through many insurers in Germany for less than 100 Euros per month.

Technically, anyone can buy these plans: students, retirees, freelancers, and so on. But not everyone is eligible.

One easy and straight forward option for expats is to get travel insurance through Hanse Merkur.

But you do have other choices through ERV, for example.

Resources

If you move to Germany from another EU country, you may need to fill out Social Security forms or other important paperwork.

You can download all the important forms on Europa.

Since this article is about health insurance in Germany, we didn’t cover other topics too deeply.

But it’s worth mentioning one thing about Social Security in Germany: If you work in Germany for more than five years you get a pension.

Don’t start making big plans, because the pension isn’t much.

Also, many countries have intergovernmental agreements with Germany.

This means you can transfer your pension the Social Security system of your home country if you have public health insurance in your home country.

You could also get a refund on part of your pension if you work in Germany for less than five years.

If you work in Germany temporarily, you can apply for a refund on part of your pension after 24 months have past since the last payment was been made.

For either of the transfer or refund options above, you must apply for it but your former company may help you.

In addition, you may wonder if it’s necessary to speak the language in Germany.

The answer is mostly yes, as you may have noticed after visiting the websites we link to in this guide.

If you move to a bigger city like Berlin, Munich, Frankfurt, Cologne, or Hamburg, you can survive speaking English.

If you move to a smaller city, which are mostly very charming and beautiful, fewer people speak English. So think about learning German.

But if you are not sure about moving to Germany, you can check out our insurance guides for other countries including Thailand, Malaysia, Vietnam, and China.

Can I Live in Germany Without Health Insurance? 

Germans laws require those who live in Germany — including citizens from EU countries — to have health insurance. 

If you are a non-EU citizen, you are required to present proof of health insurance when applying for a visa. 

If you don’t have health insurance, you’ll need to pay a back charge for the entire period when you were uninsured. 

The back charge rate is usually around 50% of the insurance premium you needed to pay at the time. For example, if you were uninsured for two years and your average premium per month was 400 euros, then you need to pay a back charge of around 4,800 euros.

The government will find out that you are uninsured and you will need to pay a back charge as soon as you sign up for public insurance, such as when you become employed or self-employed. They will perform a background check on you and find out that you have been uninsured for a certain period of time. 

If you decide to get private insurance, chances are that they will do a background check on you and consequently ask you to pay a back charge. 

To avoid paying back-change, it’s recommended to get health insurance upon moving to Germany. 

Regardless of the reason for your stay, the type of insurance you should have doesn’t need to be health insurance; it could be travel or student health insurance.. 

What Happens If I Don’t Have Health Insurance in Germany?

Living in Germany without some form of health insurance is considered illegal. The main penalty is paying a back charge as mentioned in the previous section. 

Who Pays for Health Insurance?

If you are employed, you split half the cost of insurance with your employer. Please note that your employer only shares the cost for your insurance. 

If you have a family, you need to pay for their private health insurance. 

If you are self-employed, you need to pay health insurance on your own. 

How Can I Get Private Health Insurance in Germany?

You can get it directly from private insurance companies or insurance brokers. You get the same policy with the same coverage at the same price. 

If you want to go with international private health insurance, you can get in touch with internationalinsurance.com. They specialise in international insurance for expats. 

For local health insurance plans, check out getpopsure.com. 

Public Insurance or Private Insurance?

Choosing public insurance or private insurance depends on the following factors:

• Whether you are employed in Germany
• How much your income is
• Willingness to share a room with other patients when hospitalised
• Capacity to wait in getting healthcare services

Public health insurance is ideal if you are employed in Germany and make less than 5,062.50 euros a month. It includes coverage for pre-existing conditions, but  comes with longer waiting time when getting healthcare and you may not be entitled to have a private room when confined at a hospital. 

If you make more than 5,062.50 euros a month, whether you are employed or self-employed, it might be better to get private health insurance because it’s cheaper and might have better coverage. 

If you plan to leave Germany at some point in the future, it might be a good idea to get international health insurance from the start since it provides coverage in many countries, including your home country, and you can keep the plan after you move out. 

International health insurance might also be cheaper than local insurance, especially if you are below 50 years old. 

Note that your employer might not help you pay for international health insurance.

Now, on to You

Now it should be clear what direction you need to look at in terms of health insurance for Germany.

Either way it’s always possible to reach out to any insurance broker to get advice for your particular case.

Whatever you decide, make sure you get the best protection for you and your family in Germany.

Featured image by 9966 Media.