Health insurance in Germany
Health insurance in Germany is mandatory, and the rules confuse almost everyone at the start. This guide explains the difference between public and private insurance, roughly what it costs, what happens between jobs, and the bills that surprise internationals most.
Is health insurance mandatory, and what are my options?
Yes. Everyone living in Germany must have health insurance. Most people are in the public system, the gesetzliche Krankenversicherung (GKV), through a Krankenkasse such as TK, AOK, or Barmer.
Higher earners, the self-employed, and some others can choose private insurance, the private Krankenversicherung (PKV).
Public or private: how do I choose?
Public insurance (GKV) is based on income: you pay a percentage of what you earn, family members can often be covered at no extra cost, and you can change Krankenkassen fairly freely.
Private insurance (PKV) is priced by age and health. It can be cheaper when you are young and single, but it is harder to leave later, and each person pays their own premium. For most employees, public is the sensible default.
- GKV: income-based, family cover possible, easy to switch.
- PKV: priced by risk, one premium per person, hard to reverse later.
How much does it cost?
In the public system you pay roughly 15 to 17 percent of your gross income, up to an income ceiling. If you are employed, your employer pays about half. If you are self-employed, you usually pay both halves.
Private premiums vary widely by age and the cover you choose, so compare carefully before switching.
What happens to my insurance between jobs or while unemployed?
You must stay insured even without a job. If you receive unemployment benefits, the employment agency (Agentur für Arbeit) usually covers your contributions.
If you have no income and no benefits, you still owe contributions, often at a minimum rate based on an assumed income. That is why some people get bills while earning nothing. Tell your Krankenkasse your situation quickly, because they can often adjust the rate.
Why am I being billed for a gap, or after I was not signed off properly?
Public insurance does not simply switch off. If an employer did not deregister you correctly, or a period was not reported, the Krankenkasse can bill you for the gap.
Contact them with the dates and proof, such as your termination and your new job start, so they can correct the record. Do not ignore the bill, but do not assume it is right either.
My old employer wants health insurance money back. What do I do?
Get the facts in writing: your last working day, the date you were deregistered, and when your new cover started. Give these to your Krankenkasse and to the employer so the periods line up.
You should only pay for time you were genuinely covered through them, so ask for a clear breakdown before paying anything.
Do I need extra insurance, like liability insurance?
Health insurance covers medical care, not damage you cause to other people. Most people in Germany also take private liability insurance (Haftpflichtversicherung), which is inexpensive and widely recommended.
Students usually need proof of health insurance to enrol, and can often choose a student rate in the public system.
I got a medical or dental bill months later. Is that normal?
Yes, billing can be slow, especially with private insurers and dentists, so a late bill is usually still valid.
Check it against what you were told, keep your insurance details handy, and ask your insurer what they cover before you pay. Unpaid medical bills can eventually affect your credit record (SCHUFA), so do not let them sit.
This guide is general information for internationals in Germany. It is not legal or tax advice, and the exact rules, amounts and deadlines can change and can depend on your situation and your Bundesland. Always check the details on your own letter or with the relevant office.