The Health Insurance System in Germany (2023)

Health insurance
in Germany

Since 2009, every person with a permanent place of residence in the Federal Republic of Germany has been obliged to take out health insurance. Health insurance is required even for short-term stays in Germany; otherwise no visa will be issued.

GermanyStatutory health insurancePrivate health insuranceStudentsGuest workersGuest scientistsAsylum seekersApprentices / Au PairsTips / Links

Particularities of the German health insurance system

German health insurance is characterised by a dual system consisting of statutory health insurance (SHI) and private health insurance (PHI). While SHI is accessible to the most People, certain conditions apply to private health insurance.

Citizens from countries of the European Economic Area¹(EEA) and foreign nationals from countries with which Germany has a social security agreement²can be insured in the health insurance system of their home country. The insurance benefits of other countries can differ considerably compared to Germany. The insured party may thus have to make a financial contribution or take out supplementary insurance.

Statutory health insurance (GKV/SHI) and the solidarity principle

Statutory health insurance contributions are dependent on income. The basis is the total gross income, from which a uniform contribution rate of 14.6 percent (as of 2020) is levied. This is divided equally between the insured party and the employer, i.e. 7.3 percent each. Each health insurance company also levies a different amount of additional contribution, which is paid in half by the employee and the employer. Students, self-employed and insured persons without income pay the full additional contribution.If the contribution assessment ceiling (2020: € 4,687.50 per month) is exceeded, income above it plays no role in calculating the contribution. Statutory health insurance allows children and spouses to also be insured free of charge with a family insurance policy.

Some groups of persons must be members of a statutory health insurance fund. They include:

Employees (gross income below the income threshold for compulsory insurance)

Pensioner (if the pre-insurance period is fulfilled)

Recipient of unemployment benefit I

Statutory health insurance GuideStatutory health insurance ListStatutory health insurance TestStatutory health insurance Comparison

Individual benefits in private health insurance(PKV/PHI)

Membership in a private health insurance (PHI) scheme is not possible for everyone. Employees can be insured in the PHI scheme if their gross income is above the income threshold for compulsory insurance (2020: € 5,212.50 per month). Persons concerned have to apply for exemption from compulsory insurance. Private health insurance companies often require a minimum period for permanent residence in Germany. Foreign policy holders must prove a long-term insurance period. Many private insurance companies offer special rates for this group, which are adapted to the needs and length of stay.

If you apply for a private health insurance scheme, you will be asked detailed questions about your state of health (health check). German insurance cover expires as soon as the policy holder returns to his or her home country.

(Video) How Germany's Universal Health-Care System Works

The following groups of people are often privately insured:

Employees (gross income above the income threshold for compulsory insurance)

Public servants

Self-employed persons and freelancers

Private health insurance contributions depend on state of health, age and scope of benefits, regardless of income. The premiums are different for each individual policy holder.

The benefits offered by PHI are hardly subject to any state regulations and are often more extensive than with statutory insurance. The benefits can also be precisely adapted to the policy holder. The policy holder initially pays any treatment costs in advance. The insurance company reimburses these costs upon submission of an invoice (cost reimbursement principle).

Supplementary insurance

Supplementary insurance is used to fill care gaps in health insurance. It is concluded with a private insurance company, regardless of income. Important types of supplementary insurance include, for example, supplementary nursing care insurance, supplementary dental insurance or supplementary hospital insurance.

Private health insurance GuidePrivate health insurance ChangeDental insurance GuidePrivate health insurance TestSupplementary health insurance GuideDental insurance Test

Health insurance for foreign students in Germany

Health insurance in the country of origin

Insurance possibilities in German

Additional requirements

Statutory health insurance

Recognition by a statutory health insurance fund

European Health Insurance Card (EHIC) from the health insurance in the home country

Private health insurance

Private health insurance

Confirmation of the home country’s health insurance fund; invoice of benefits and medication with your own health insurance fund

No health insurance

Statutory or private health insurance

Only private insurance is possible from the age of 30

Attention: Foreign students who are privately insured in Germany but who are not yet 30 years old often need a certificate of exemption from the statutory health insurance for enrolment. SHI admission within the study stay is no longer possible after that.

Insurance for foreign students

Health insurance contribution

Nursing care insurance contribution

Total contributions

Students without a child (from 23 years)

As of 1 october 2020:



77,57 euros*

24,55 euros**

25,05 euros**

100,59 euros*

102,62 euros*

Students up to 23 or with child

As of 1 october 2020:



77,57 euros*

22,69 euros**

23,15 euros**

98,73 euros*

100,72 euros*

**Nursing care insurance contributions amount to 3.05% for students with children, and 3.30 percent for students from the age of 23 without children.

Foreign students should seek advice from the relevant student services or the International Office before starting a study programme.

Working in Germany–
Health insurance for guest workers

In principle, an employee is insured in the country in which he or she is working. It is necessary to join a German health insurance scheme even in the case of a short-term work stay.

Health insurance coverage for EU citizens

(Video) Healthcare in Germany

Guest workers from EEA Member States¹and from countries that have signed a social security agreement with Germany²need health insurance in Germany regardless of whether they are employees or self-employed. This also applies if the employed person resides in another Member State or the employer is domiciled in another Member State. There are only two exceptions:

a person is simultaneously working as an employee in one Member State and as a self-employed person in another Member State -> Social security coverage is possible in both countries

temporary posting abroad (maximum 12 months) -> Health insurance in the country of origin (this requires the E 101 form)

Health insurance coverage for non-EU citizens

Regardless of their length of stay, employed persons outside the EU are subject to compulsory German health insurance, provided that they have a residence permit in addition to the work permit. Third-country nationals can apply for this at the German embassy abroad or at a foreigners’ registration office in Germany.

Working and researching in Germany–
Health insurance for guest workers and guest scientists

Regulations for guest scientists

obligatory for guest scientists (researchers) and accompanying family members. It is thus urgently necessary for third-country nationals to inquire about insurance options before departure: A residence permit is issued only upon presentation of health insurance.Legal regulations at a glance:

Origin/type of stay

Health insurance regulations

Guest scientists from EEA countries¹and countries with social security agreements²

Health insurance in the home country is also valid in Germany (European Health Insurance Card).Form number 1 or 101 from your home country’s health insurance fund or social security office is required

Foreign scientists resident in Germany (for longer stays)

Compulsory health insurance with an insurance company licensed in Germany
Existing health insurance from the home country can be converted to entitlement tariff for the duration of the stay in Germany

Guest scientists with employment contract

Compulsory German health insurance required for statutory or private health insurance

Guest scientists with fellowship

Only private health insurance possible

Health insurance for immigrants in Germany

Persons who wish to immigrate to Germany and thus seeking permanent residency must take out health insurance. Otherwise they will not be issued with a German visa.

Right of residence for EU citizens

In principle, citizens of a Member State of the European Union have the right to live in any EU country, even if they are not working there. The right of residence is nevertheless subject to two conditions:

Immigrants must demonstrate sufficient “means of subsistence” to earn a living in the relevant EU country

Health insurance taken out in the “new” EU country

Regulations for non-EU nationals

Immigrants from countries requiring a visa to enter Germany must already have health insurance coverage at the time of entry. Depending on whether or not an immigrant is gainfully employed, different conditions apply to both statutory and private health insurance.

(Video) Explaining the German Health Care System - An Overview

Special regulations for asylum seekers in Germany

Persons seeking protection against political or other persecution in Germany are granted special status. In principle, asylum seekers are not covered by statutory health insurance. In the event of illness, they are entitled to benefits under the Asylum Seekers Benefits Act (AsylbLG). Depending on the status and duration of the stay, different levels of benefit apply.

Entitlement under § 4 AsylbLG includes:

In case of acute illness: medical treatment, including provision of dressings and medicines as well as other benefits that aid in recovery

Nursing and medical care, including midwife assistance and provision of medicines and dressings for pregnant women and women who have recently given birth

Use of check-ups and vaccinations

German health insurance for students, apprentices and au pairs

Compulsory insurance limit

Exchange students, foreign apprentices and au-pairs who work in Germany must have health insurance and accident insurance for the period of their stay. Foreign apprentices and au pairs are only subject to compulsory health insurance by law if they earn more than 450 euros per month. However, they can take out private health insurance tailored specifically to the needs of foreign guests and visitors from the European Economic Area¹as well as countries with a social security agreement².

Health insurance from the home country or in Germany?

Visitors from EEA¹Member States can receive health care in Germany with the European Health Insurance Card (EHIC). If the home country has concluded a social security agreement²with Germany, including health insurance regulations, under certain circumstances benefits may be claimed in Germany. The range of the benefits is determined by the respective agreement. If the country of origin is not in the EEA¹and there is no social security agreement², private health insurance must be taken out. For au pairs, the costs for private health insurance and accident insurance are borne by the host family.

Age restrictions for au pairs:

Generally: 18 to 27 years

When applying for a visa: 18 to 26 years

Coming from non-EU counties: 18 to 24 years

Maximum insurance period: 12 months

(Video) How Health Insurance in Germany works: Beginners Guide

It is advisable to seek independent advice in your home country or country of residence before a stay abroad. This can be done, for example, at the relevant embassy abroad, the relevant foreigners’ registration office or, in particular, at the insurance companies.

Attention: The rates and benefits offered differ depending on the provider – prices and benefits should therefore be thoroughly reviewed in advance. There are also rates for persons who are in Germany for a short time as part of a Work & Travel programme.

Useful tips for foreigners in Germany

What to do in an emergency? Especially when you need medical care in an emergency, it is important to know who to contact and how to obtain such assistance.

1. Important telephone numbers in emergency situations

The following emergency numbers are necessary if medical treatment is needed quickly and directly or in case of a different emergency situation:

112 →Ambulance and/or fire brigade (applies throughout Europe)

110 →Police

(All emergency numbers can be reached free of charge.)

2. Medical on-call service

Ways to receive medical care outside of office hours:

  • 116117→ Medical on-call service by the Association of Statutory Health Insurance Physicians
  • Emergency department of the municipal hospital or the local university hospital

Educational institutions


Federal Foreign Office

Federal Office for Migration and Refugees

Federal Commissioner for Foreigners


The National Refugee Councils

German Academic Exchange Service (DAAD)

Association of German Student Services (DSW)

Foundation for the Promotion of the Rectors’ Conference


Secretary of the Standing Conference of the Ministers of Education and Cultural Affairs of the Länder
Central Office for Foreign Education

Goethe Institute

Society for Academic Study Preparation
and Test Development
TestDaF Institute

Federal Ministry of Education and Research

Federal Social Insurance Authority


Federal Agency for Civic Education (bpb)

German Liaison Office for Health InsuranceAbroad(DVKA)

Health care facilitiesAddress

Federal Ministry of Health (BMG)


Federal Centre for Health Education (BZgA)

Federal Association for Prevention and Health Promotion (BVPG)

Independent Patient Counselling Germany (UPD)


German Red Cross (DRK)

Diakonie Germany

Caritas Germany

Federal Association of Non-statutory Welfare (BAGFW)

German AIDS Service Organisation

German Centre for Addiction Issues (DHS)

German STI Society – Society for the Promotion of Sexual Health

German Nutrition Society

The Healthy Cities Network

Visa Guide Insurance



/EAA countries

: EU Member States and Liechtenstein, Norway, Iceland + Switzerland

Countries that have signed a social security agreement with Germany:

(Video) The Healthcare System in Germany: 8 Things I DIDN'T know 🏥

Bosnia-Herzegovina, French overseas territories (French Guiana, Guadeloupe, Martinique, Mayotte, Reunion), Israel³, Croatia, Morocco, Macedonia, Montenegro, Serbia, Turkey and Tunisia

³ The agreement applies exclusively to maternity assistance within the health insurance scheme.


How is Germany's healthcare system? ›

Health insurance is mandatory in Germany, with nearly universal coverage. The statutory health insurance (SHI) system consists of 110 sickness funds (acting as third-party payers) covering around 88% of the population.

How does health insurance in Germany work? ›

In Germany, there is a robust public healthcare system whereby members pay social security insurance contributions via their salary and employers match their contribution. Some individuals in Germany are able to apply for private health insurance, usually those in the highest wage brackets.

What is health insurance like in Germany? ›

The majority of German citizens and residents are enrolled under the state-run public health insurance scheme, which is funded by taxpayers' own national contributions. In turn, everyone has access to high-quality and affordable healthcare, regardless of income or status.

How is the healthcare system in Germany different from the US? ›

The benefits of the German healthcare system are decreased number of prescription dependencies, does not have a 100% socialized single-payer system that most Americans fear, reasonable cost for hospitals and prescription drug co-pays, ability to purchase private insurance, no penalty for switching from public to ...

Are Germans happy with their healthcare system? ›

In an OECD wide comparison, German citizens are particularly satisfied with their health care system. 85% express satisfaction, compared to a 71% OECD average, though satisfaction has slightly declined in Germa- ny since 2007, from 87% to 85%.

Is the German healthcare system free? ›

Yes, all Germans and legal residents of Germany are entitled to free “medically necessary” public healthcare, which is funded by social security contributions. However, citizens must still have either state or private health insurance, covering at least hospital and outpatient medical treatment and pregnancy.

How does Germany control healthcare costs? ›

Tax subsidies are used to finance approximately 10 percent of health care services. In addition, patients are required to make out-of-pocket copayments for many services, including drug prescriptions; employers underwrite the cost of a few services; and there are a handful of other, minor sources of funding.

How much people pay for health insurance in Germany? ›

All public health insurance providers in Germany charge the same basic premium of 14.6 per cent of your gross income, plus a supplemental charge that is an average 0.9 per cent of your gross income, to a maximum monthly income of €4,425. If you earn more than this, you will not pay a higher insurance premium.

Does Germany have good healthcare? ›

Germany's health care system is often regarded as one of the best health care systems in the world, offering its population universal health insurance coverage and a comprehensive benefits basket with comparably low cost-sharing requirements.

What's health insurance in German? ›

You may still have to pay for some services or to use some parts of the healthcare system. German residents join a health insurer called a 'Krankenkasse' and pay monthly insurance contributions. Around 90% of residents join a 'statutory' health insurer (gesetzliche Krankenkasse).

What are some of the problems currently facing the German system of health care? ›

The COVID-19 pandemic has thrown a spotlight on two major weaknesses of the German healthcare system: First, the glaring lack of digitization, leading to a lack of data and prevention possibilities (such as warning particularly vulnerable groups).

What are the health issues in Germany? ›

In addition to the high mortality burden caused by cardiovascular diseases and lung cancer, musculoskeletal problems (including low back and neck pain), dementias and mental health problems (including depression), are some of the leading contributors to disability-adjusted life years2 (DALYs) lost in Germany (IHME, 2.

Why do you need health insurance in Germany? ›

It is mandatory by law for all residents and visitors in Germany to have some sort of healthcare cover, whether that's statutory public healthcare, private healthcare, or some other valid form for short-term visitors. You must have health insurance in Germany, no matter whether you are unemployed or employed.

What country has the best healthcare system and why? ›

South Korea tops the list of best healthcare systems in the world. It's been praised for being modern and efficient, with quality, well-equipped medical facilities and highly trained medical professionals. Generally, treatment in South Korea is affordable and readily available.

How many people in Germany are uninsured? ›

365 of 15 September 2020. WIESBADEN – In 2019, roughly 61,000 people in Germany (grossed) had neither health insurance nor any other entitlement to health care. The number of people without health insurance was down by 23% on 2015, when the figure was roughly 79,000.

Is healthcare free in Germany for US citizens? ›

Public Healthcare

All German residents can access healthcare through public health insurance; however, non-residents must have private insurance coverage to access healthcare. Temporary visitors usually need to pay for treatment and claim reimbursement later.

What happens if you don't have health insurance in Germany? ›

Yes, in Germany you will be treated even if you go to the doctor without health insurance – at least in serious or even life-threatening cases or if you are in severe pain. However, if you want to see your family doctor for less serious illnesses, for example, you will have to pay the costs yourself.

Is healthcare cheap in Germany? ›

Overview of healthcare in Germany

Healthcare in Germany is funded by statutory contributions, ensuring free healthcare for all. In addition, you can also take out private health insurance (Private Krankenversicherung or PKV) to replace or top up state cover (gesetzliche Krankenkasse or GKV).

What is the biggest issue with the health care system? ›

1. The High Cost of Health Care. The problem: Perhaps the most pressing issue in health care currently is the high cost of care. More than 45% of American adults say it's difficult to afford health care, according to a survey by the Kaiser Family Foundation, and more than 40% have medical debt.

What is the biggest problem in Germany? ›

The Germans' greatest fears in 2022
  • Rising cost of living (67 percent)
  • Unaffordable housing in Germany (58 percent)
  • Worsening economic situation (57 percent)
  • Tax increases / benefit decreases due to COVID pandemic (52 percent)
  • Taxpayers having to pay for the EU debt crisis (51 percent)
Oct 14, 2022

Is insurance important in Germany? ›

In Germany, health insurance is indispensable and is one of the kinds of insurance that are obligatory. Everyone who lives and works in Germany must have health insurance. Exceptions apply only to those who stay in Germany for less than three months. All others must take out German health insurance.

Where does the United States rank in healthcare? ›

Overall Ranking of Health Care System Performance in 11 Industrialized Nations
United States11
7 more rows

Who is #1 in healthcare in the world? ›

The latest Best Countries rankings examined how people around the globe perceive the quality of the healthcare system in their countries of residence, and found Denmark to be perceived as having the most well-developed public healthcare system in the world.

How much is healthcare in Germany compared to USA? ›

For comparison, Germany was the second highest-spending country with about $7,383 in healthcare costs per capita, while the average for wealthy OECD countries, excluding the United States, was only $5,829 per person. Such comparisons indicate that the United States spends a disproportionate amount on healthcare.

Can you live without health insurance in Germany? ›

In Germany, you are required to take out health insurance. We will give you an overview of the types of health insurance and their services. In Germany, you must take out health insurance as an employee. A distinction is made between statutory and private health insurance.

Can we stay in Germany without health insurance? ›

German health insurance is mandatory by law meaning that every resident must be medically insured. No visa will be issued for internationals without sufficient health insurance coverage and no residence permit will be allowed unless there is proof of sufficient medical coverage for the duration of the stay.

Is Germany good for medical treatment? ›

Germany's healthcare system is a dual public-private system, dating back to the 1880s – making it the oldest healthcare system in Europe. Today its medical and healthcare professionals make it one of the very best healthcare systems in the world.

Is medical good in Germany? ›

German doctors and patients are lucky enough to have access to private and public hospitals and clinics that are some of the best in the world. Germany has been ranked as one of the best healthcare systems in the world!

Which country has the best healthcare system? ›

The Top 10 Healthcare Systems in the World 2022
  • South Korea. South Korea tops the list of best healthcare systems in the world. ...
  • Taiwan. Taiwan is second in the best healthcare systems in the world. ...
  • Denmark. ...
  • Austria. ...
  • Japan. ...
  • Australia. ...
  • France. ...
  • Spain.
Jul 21, 2022

What country is #1 in healthcare? ›

1- Denmark

All permanent residents are entitled to a national health insurance card, and most examinations and treatments are free of charge.

Is healthcare expensive in Germany? ›

All public health insurance providers in Germany charge the same basic premium of 14.6 per cent of your gross income, plus a supplemental charge that is an average 0.9 per cent of your gross income, to a maximum monthly income of €4,425. If you earn more than this, you will not pay a higher insurance premium.

How much do Germans pay for healthcare? ›

The majority of people, even international students, will need to register for public healthcare insurance, however, some individuals are eligible to choose a private insurance plan. The cost of healthcare coverage can range from 80 to 1,500 euros per month, depending on your circumstances and insurance premium.

Why is Germany's healthcare system so good? ›

The German public health care system is based on the principle of solidarity. All people insured by a public health insurer receive the same medical care regardless of their financial status. This is achieved through an income-based common fund where everyone contributes to.

Can I go to doctor in Germany without insurance? ›

What if I don't have health insurance in Germany? If you're visiting Germany and don't have health insurance in the country, you can still see a doctor. You will, however, have to find a private doctor and be responsible for the cost of the visit — a GP consultation without medical insurance costs from €30 to €60.

Can Americans get healthcare in Germany? ›

Expats have access to the same number of providers as citizens. In summary, a private health insurance plan will provide you with access to the highest-quality doctors and hospitals in Germany and throughout the world.

Is it hard to see a doctor in Germany? ›

Fortunately, making an appointment with a doctor in Germany is a straightforward process. You can call the practice directly, or, if the surgery offers it, book an appointment online via Doctolib, Jameda, or Doctena. You can also book a follow-up appointment directly with the receptionist.

Do doctors live good in Germany? ›

German doctors earn a lot and are well respected in Germany. The average doctor makes about $136,000 a year before taxes. In addition, there are many perks of being a doctor in Germany such as free healthcare and a very comfortable lifestyle. How much do German doctors earn?

Are doctors highly paid in Germany? ›

A doctor's salary in Germany varies widely by speciality. HOW? A surgeon's average annual salary is €103,000, while a general practitioner is €65,944. Specialists are paid the same regardless of whether they work nights or weekends or have supervisory responsibilities, thanks to collective bargaining agreements.

Is the US the best healthcare system? ›

Roughly six-in-ten say health care in this country is average (32%) or below average (29%) compared with other industrialized countries. Conservative Republicans stand out in their positive assessments of U.S. health care. Two-thirds (66%) say America's health care is either the best in the world or above average.

Do other countries have better healthcare than the US? ›

US spends more on health care than peer countries

Life expectancy at birth in the US in 2020 was 77 years – three years less than the OECD average – and early data suggests that US life expectancy dropped even further in 2021.


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