Public Health Insurance (GKV) for Expats Explained

Key Takeaways

• Coverage is mandatory before work, study, or a residence permit.
• GKV funds are nonprofit with broadly similar core benefits.
• Eligibility depends on income, employment, and visa status.
• Statutory costs are income-based; private plans use risk-based pricing.
• Start with temporary cover if needed, then transition to the correct scheme.

How Germany’s public healthcare system works today

Before you can use local medical services or take up a job, your coverage must be confirmed. The law requires every resident to hold either statutory or private cover so they can access medically necessary treatments.

Mandatory coverage and main pathways

Everyone must be covered. That means either joining the statutory scheme managed by non‑profit funds or taking a private health plan when eligible. Those who do not qualify for the statutory route must secure private options based on income, job type, and residence status.

How Krankenkassen operate

More than 100 non‑profit funds collect contributions and pay doctors, hospitals, and pharmacies. Core benefits are set by the state, so most funds offer similar treatments.

• Employees usually enroll via payroll once they give their chosen fund to their employer.
• Contributions are split through payroll, with the employer paying part.
• After a minimum membership period (commonly 18 months) members can switch funds; notice periods matter.

Practical example: at a doctor’s visit you present your e‑card; the provider bills your fund directly, so you rarely pay up front.

Large funds such as Techniker Krankenkasse are popular among internationals for English support, but core cover is comparable across most insurers. Insurancy can explain how these mechanics apply to your case and help you weigh service differences without bias.

Eligibility: who can and must join GKV as an expat

Your job type and salary usually determine if you fall under the statutory fund or need a private plan. Below are clear rules to help you map your situation to the right path.

Employees under the annual threshold (€73,800 in 2025)

If your gross salary is below €73,800 (2025), you are generally covered by the statutory scheme. Above that level you may be eligible to opt for private health insurance, subject to other criteria such as employment type and prior cover.

Students, apprentices, and unemployed residents

Students under 30 typically join the discounted student tariff at university. Students over 30 often cannot access the standard student public tariff and may need private or incoming plans unless an exception applies.

Apprentices (Azubis) are usually enrolled in the statutory scheme. If earnings are €325/month or less, the employer pays the full premium; higher pay uses normal employee/employer contribution split.

Unemployed residents may receive state-paid premiums if they get certain benefits; otherwise they must keep continuous coverage and may face minimum contributions.

Non‑EU self‑employed and switching rules

Many non‑EU freelancers cannot newly join the statutory system and often use private or incoming options unless a prior link to statutory cover exists. These cases are complex and need tailored advice.

Members can switch funds after a common minimum period of 18 months. Observe notice deadlines to avoid gaps or retroactive bills.

Tip: Keep proof of continuous cover and any EU statutory documents—these can affect eligibility and avoid delays with residence authorities.

Insurancy can assess your visa, job start date, and prior coverage to find the correct path into the statutory system or suitable alternatives before you move.

What GKV costs: contributions by status and income

Monthly contributions depend largely on your job status and declared income level. Here is a clear, neutral breakdown so you can plan cash flow during your first year.

Employees

Statutory rate plus fund surcharge are calculated from gross pay and split roughly 50/50 with your employer. Long‑term care insurance is also shared and appears as a monthly payroll deduction on your payslip.

Self‑employed

Contributions are based on assessed income with statutory minimums. Payments are usually set as monthly SEPA transfers. Amounts adjust after tax assessments, so expect mid‑year revisions.

Students, apprentices and low earners

Students under 30 pay a discounted student tariff that includes care cover; over‑30 students generally lose this rate and move to adult contributions or private options.

Apprentices earning €325/month or less get employer‑funded coverage. Above that threshold they contribute like other employees.

Tax relief and timing: Contributions and care premiums are tax‑deductible, lowering net cost. Employees see deductions on the monthly payslip; non‑employee payers must plan monthly bank transfers.

What public health insurance covers (and what it doesn’t)

Statutory coverage generally pays for medically necessary doctor visits, hospital stays, and prescribed medicines. This includes GP and specialist care, inpatient and outpatient treatments, surgeries, and standard maternity and postpartum services.

Preventive and mental healthcare

Routine prevention is part of the offer. Standard vaccinations, evidence‑based cancer screenings, and access to psychotherapy are available. Note that referrals and limits can apply for some treatments.

Dental and common exclusions

Basic dental check‑ups and necessary restorative work are covered. High‑end prosthetics, implants, and cosmetic dental upgrades usually need supplementary dental cover.

Typical exclusions include cosmetic procedures, many alternative therapies, and most glasses or contact lenses except strict medical cases. Travel vaccinations are sometimes excluded unless a fund offers extra coverage.

How access and costs work

Show your card at the doctor or hospital; providers bill the fund directly so you rarely pay up front. Expect small prescription co‑pays and an income‑based annual cap to protect people with chronic needs.Tip: Consider targeted supplementary policies for dental, travel vaccines, or private hospital rooms if these benefits matter to you and your budget.

Enrollment and your health insurance card

Getting officially registered with a fund is the step that activates your coverage and issues your card. Follow the right process early to avoid billing surprises when you see a doctor.

Employee enrollment

Choose a fund before your first payslip. Give HR your chosen fund name and membership confirmation. Your employer registers you and starts payroll deductions, so contributions begin from your first month on salary.

Direct enrollment (students, job‑seekers, freelancers)

Apply online or by post with a fund. You must send ID, proof of address (Anmeldung if available), and your university, job, or prior coverage documents. Approval brings a member number and an insurance card in the mail.

Using the electronic card at appointments

The plastic insurance card contains data used to bill providers automatically. Bring the card to every doctor or hospital visit. If the card is not yet issued, a membership certificate will usually cover interim visits.

Tip: Freelancers set up monthly SEPA payments and inform the fund of income changes to prevent retroactive charges.

Insurancy can help time your enrolment, prepare documents, and ensure dependent cards are issued so your family has continuous coverage.

Choosing a Krankenkasse: service, add‑ons, and English support

When core benefits are uniform, member services and add‑ons decide which fund fits you best. Picking a fund means checking what extras matter to your life and budget.

What’s largely the same across funds

Core coverage and contribution rules follow statutory standards, so medical basics, billing logic, and most rates are comparable across most funds.

Where funds differ

Differences show up in digital tools, wellness programs, and reimbursements for extras like dental cleaning or travel vaccinations.

• Customer service: hotline hours, English support, and response speed.
• Member apps: telemedicine, online claims, prevention courses.
• Extra reimbursements: sports checks, specialist fees, or vaccines.

Techniker Krankenkasse as an example

Techniker Krankenkasse is a large option known for an English portal, prevention programs, and wide partner networks. Many internationals value TK’s clear guidance and fast digital tools.

Tip: List any regular medical needs (dental work, vaccines) before you pick a fund. A small surcharge can be worth better service.

Insurancy compares insurers objectively and helps time any switch after the minimum membership period to avoid gaps.

Family coverage and life events

When a partner stops working or a child is born, your membership rules may let you add them without extra cost. This family co‑insurance is a major advantage of the statutory system: dependent children and a non‑working spouse can join if their earnings stay below set limits.

Free co‑insurance for children and non‑working spouses

Dependent family members are usually covered without additional monthly premiums when their income is low or they do minor work (mini‑job rules apply). Check exact thresholds with your fund as small changes to monthly pay can affect eligibility.

Job loss, Bürgergeld, and short‑term continuation

If you lose a job your coverage generally continues. If you receive Bürgergeld or similar benefits, the state typically pays premiums on your behalf.

A short one‑month continuation (nachgehender Leistungsanspruch) can apply automatically after employment ends. Use this to bridge to a new role or benefit claim and avoid gaps.

Tip: Notify your fund immediately about marriage, birth, or job changes and add newborns fast so they get an e‑card and pediatric care from month one.

• Document the life event and send proof to your fund right away.
• In private plans every family member needs a separate policy and premium—this can raise costs compared with statutory family co‑coverage.
• Plan ahead around parental leave or reduced hours to keep family coverage stable over the next years.

Insurancy can check eligibility, explain mini‑job interactions, and help file the paperwork so your family’s access to care stays uninterrupted.

EHIC, travel health insurance, and care abroad

An EHIC is useful for short stays but should not replace formal long-term cover when you relocate. It lets visitors use state-run services during brief trips and covers medically necessary treatment while you are away from your home country.

Using EHIC from your home country: scope and limits

EHIC definition: The european health insurance scheme gives temporary access to public care when visiting another participating country. It is not meant for people who move and take up work long term.

The card covers emergency and necessary treatments under local rules. It usually does not cover planned procedures, repatriation, or private-clinic fees.

Emergency treatment in other EU countries with your GKV card

If you hold a German statutory card, it often carries EHIC functionality. Show the insurance card at a public doctor or hospital; billing follows the host country’s rules and may include co-pays.

Carry a confirmation letter if your card is pending. Check acceptance with the provider before non-urgent care.

When you need separate travel insurance

Buy travel insurance to cover evacuation, private treatment, lost luggage, or long-term gaps. Short-term arrival with an EHIC can bridge a month or two until payroll starts, but do not rely on it longer.

Tip: Treat EHIC as a short-term safety net and add travel or incoming policies when you need broader coverage or visa proof.

Public vs private vs expat insurance: how to decide

Choose with a horizon view. Compare monthly cost, long-term flexibility, and family needs before you pick a path.

Who can opt for private cover and cost drivers

Eligibility: Private health insurance is generally available to employees above the annual salary threshold, self‑employed people, certain students, and civil servants.

Pricing depends on age at entry, medical underwriting, chosen benefits, and deductibles. Employers often pay a capped share for employees on private plans.

Pros and cons by situation

High earners may see lower premiums and faster access to specialists. Families often prefer statutory funds because dependent coverage is included and costs scale predictably with income.

Older adults face rising private premiums; long-term cost can outgrow early savings and limit mobility years later.

Incoming (expat) policies and switching risks

Incoming plans are useful for visa proof and short stays. They are cheaper upfront but commonly exclude pre‑existing conditions and have time limits, so they are not ideal long term.

Tip: Moving from statutory to private can be easy; returning later is hard. Plan around career moves and family growth before you switch.

Read benefit lists closely to ensure desired treatments are included and compare multiple insurers. An independent adviser can show realistic costs and help you select the best option for the next years.

Typical expat situations and practical guidance

First weeks usually mean balancing emergency cards, enrollment forms, and university letters to lock in regular care.

Arriving with EHIC and starting a job

Use your EHIC only as a short bridge. It covers necessary treatment briefly while you finalize an employment contract and select a fund.

Timing is key: aim to get a membership confirmation before your first workday so payroll can start deductions and your e-card can be issued that month.

International students choosing between paths

Students under 30 usually find the student tariff the simplest and most affordable option. Have your university enrollment letter ready when you apply.

Students over 30 or on prep programs should compare private health insurance and expat plans carefully. Expat policies help with visas but tend to be temporary and may not suit multi‑year study plans.

Freelancers from non‑EU countries assessing options

Many non‑EU freelancers cannot join the statutory route anew. Evaluate private plans by deductible, outpatient and inpatient treatments, and realistic doctor days per year.

Budget for the first year: expect one or two months of overlap between previous and new plans and keep a cash buffer for reimbursements or advance payments.

• Documents to prepare: passport, visa/residence proof, Anmeldung, employment or university confirmation, prior coverage certificate from your home country, and bank details.
• If you need care before your e-card arrives, present the membership certificate and confirm the clinic accepts public patients if applicable.
• Calendar annual reviews: students and freelancers should check policies each year as income, study status, or visa terms change.

Tip: Insurancy can map these steps, align paperwork with start dates, and help prevent gaps so you access care from day one.

Conclusion

Arranging the right policy early prevents billing surprises and keeps you able to see a doctor from day one.

This guide has shown how statutory funds cover most people with standard benefits and family inclusion, while private plans offer tailored access and different pricing logic. Decide by status, income, and plans in the country and think beyond the first year when switching can become limited.

Arrange membership and your card before your first month of work or study. Keep documents ready, track life events, and add travel cover for trips abroad—EHIC helps short EU stays but has limits.

Insurancy gives independent, neutral advice and can map a low‑effort path to compliant health insurance this month. Share your start date and family details and we’ll outline the next steps.

FAQ

What is the difference between GKV and private plans like PKV?

GKV is the statutory system based on income-related contributions and family co-insurance for non-working dependents. PKV is a private contract with individual premiums based on age, health, and coverage. High earners and some civil servants may opt for PKV, but switching back can be hard later.

Who must join a statutory fund (Krankenkasse) when moving to Germany?

Employees earning below the annual threshold (€73,800 in 2025), most students under 30, apprentices, and many unemployed residents must join a statutory fund. Self-employed non‑EU nationals and older students may face limits and often need private alternatives.

How do non‑German students enroll and what are the age rules?

Many international students under 30 use the student tariff with reduced contributions. Students over the age limit must compare private student plans or regular GKV if eligible. Universities often require proof of coverage for enrollment.

How are GKV contributions calculated for employees?

Contributions are a percentage of gross salary shared between employer and employee. Funds add a small additional surcharge and a separate long‑term care contribution applies. Employers handle payroll deductions and payments.

What do statutory funds cover as standard?

Core benefits include general practitioner and specialist visits, hospital stays, prescribed medicines, maternity care, vaccinations, mental health services, and basic dental care. Coverage focuses on medically necessary treatments.

Which common treatments are not covered or partially covered?

Items often excluded or limited include most glasses and contact lenses, cosmetic procedures, some travel vaccines, and many alternative therapies. For broader dental or vision care, supplementary plans are recommended.

How do I enroll if I start a job in Germany?

Employers typically register employees with a chosen Krankenkasse and deduct contributions automatically. New hires should provide proof of prior coverage and their tax ID to complete registration.

What if I’m a freelancer or job seeker—how do I join?

Freelancers and unemployed residents can enroll directly with a fund. Contributions are income-based for freelancers, with minimum payments. Job-seekers may get coverage through the Federal Employment Agency in some cases.

How does the electronic health insurance card (eGK) work?

The eGK is your proof of coverage at doctors and hospitals. Present it when you receive care; providers bill the fund electronically. Keep your card current and report address changes to your fund.

Can I change Krankenkasse and how often?

You can switch funds after a minimum membership period (usually 12 months) plus a notice period. Switching is simple online or by letter; core benefits remain the same but extras and service levels differ.

How do I choose a fund—what really differs between them?

Cost and core benefits are similar. Funds differ in supplementary services, digital tools, customer service language options, preventive programs, and dental add-ons. Techniker Krankenkasse (TK) is known for strong English support.

Are family members covered under one policy?

Yes—non-working spouses and children often receive free co-insurance under a member’s statutory coverage. This makes GKV attractive for families where one partner does not earn a salary.

What happens to coverage if I lose my job or receive Bürgergeld?

Short-term continuation is usually possible. If you receive unemployment benefits or Bürgergeld, the Federal Employment Agency or the state may cover contributions. Notify your fund promptly to avoid gaps.

Can I use my EHIC from another EU country in Germany?

Your home-country EHIC gives access to necessary, state-provided care during a temporary stay. For long-term residence or employment, you must register with a German fund. EHIC scope and reimbursement rules vary by country.

Does GKV cover emergencies or planned care abroad?

Emergency treatment in EU/EEA countries is generally covered, but planned care abroad often requires prior authorization. For travel outside Europe, separate travel insurance is usually necessary.

When should I consider supplementary dental or private supplemental plans?

Consider extras if you want higher-quality dental prosthetics, orthodontics, or better outpatient dental coverage. Supplements also help with vision, private hospital rooms, or faster specialist access.

What are the tax implications and payment mechanics for contributions?

Employee contributions are pre-tax and paid via payroll. Self-employed people pay directly and can often deduct contributions as special expenses on their tax return. Rules vary—consult a tax advisor if needed.

Can high earners always choose private coverage instead?

Employees above the income threshold may opt for PKV, but families with non-working dependents should weigh costs carefully—GKV allows free family coverage, while PKV charges each person separately.

What should arriving expats do if they only have an EHIC and need to start work?

Use your EHIC for initial care if visiting from the EU, then register with a statutory fund after securing employment. Employers often help with registration and provide guidance on fund selection.

How do students decide between GKV, PKV, or special expat plans for visa purposes?

Students should check university and visa requirements. GKV usually meets enrollment and visa rules. Some may use private student plans temporarily, but long-term implications and cost should be compared carefully.

What options do freelancers from non‑EU countries have?

Non‑EU freelancers may be required to take private coverage initially. If they later qualify for statutory coverage (e.g., through employment), switching is possible. Assess income-based contributions and minimums when planning finances.

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