German Insurance Requirements

Understanding German insurance can seem tricky, but the main rule is simple: everyone living in Germany must have health insurance. This is not just a suggestion; it is the law. The goal is that all residents get equal access to good healthcare, no matter their income or health. Besides health insurance, other types also matter in daily life, from mandatory long-term care to optional but strongly recommended liability insurance. Knowing these rules helps you move smoothly and live safely in Germany.

Germany aims for universal healthcare, and almost all residents are insured. According to the German Federal Statistical Office (Destatis), fewer than 0.1% of people are uninsured. This very high coverage rate reflects a strong system built over more than 100 years, going back to reforms under Otto von Bismarck in the late 1800s.

German Insurance Requirements: Key Facts

Who Must Have Insurance in Germany?

Almost everyone living in Germany needs health insurance. This includes employees, students, the self-employed, expats, and visitors staying for a longer time. This rule helps the system serve everyone and helps stop people from facing very high medical bills, which also supports public health.

The exact type you need depends on your job, income, age, and residence or visa type. Most employees are covered by statutory health insurance, while high earners and freelancers can often choose private health insurance. If you apply for a visa, you usually need to show proof of health insurance before you are approved.

What Types of Insurance Are Mandatory?

Health insurance (Krankenversicherung) is the main mandatory insurance, but there are others:

• Health insurance (GKV or PKV)
• Long-term care insurance (Pflegeversicherung) – normally bundled with health insurance
• Motor vehicle liability insurance (Kfz-Haftpflichtversicherung) – required if you own a car

Personal liability insurance (Haftpflichtversicherung) is not required by law, but many people treat it as necessary because it protects you if you accidentally cause damage or injury.

Penalties for Non-Compliance

If you do not follow the rules, you may have to pay backdated health insurance contributions for the time you were uninsured and possibly fines. You may also run into problems with visa renewals, residence permits, or getting medical care.

Being uninsured is risky. You would have to pay for doctor visits, hospital stays, medicine, and other services yourself, which can cost a lot. In a country with broad access to care funded by all, skipping insurance is a bad bet.

Why Is Health Insurance Mandatory in Germany?

Purpose of Mandatory Coverage

Germany wants every resident to have equal access to medical care. Making health insurance mandatory helps avoid a two-track system where only higher earners get good care. It protects people from financial ruin due to illness and supports a healthier, safer society.

Requiring coverage also keeps the system stable. When many people pay in, hospitals, clinics, and doctors have steady funding. This helps with ongoing spending on research, technology, and buildings. Shared responsibility is a key part of German social policy.

Legal Basis for Compulsory Health Insurance

Germany’s system goes back to the 1883 Health Insurance Bill by Chancellor Otto von Bismarck. It started with required payments from certain workers into a state fund. After World War II, the Federal Republic set up the Gesetzliche Krankenversicherung (GKV), which covers most people.

Since 2009, the rule has covered all residents, including expats. Health insurance is both a right and a duty. The system is mainly financed through payroll contributions from employees and employers, and income-based payments for the self-employed. This creates a strong and fair funding model.

Types of Health Insurance in Germany

There are two main paths: public statutory insurance (GKV) and private insurance (PKV). You cannot always choose freely; eligibility depends on income, job type, and residence. Knowing how each works helps you pick what fits you best.

Statutory Health Insurance (Gesetzliche Krankenversicherung – GKV)

The Gesetzliche Krankenversicherung is the base of German healthcare and covers about 90% of residents. It is non-profit, regulated by the state, and run by public funds called Krankenkassen.

Eligibility and Enrollment

Most employees who earn below the annual income limit must join GKV. In 2025, the limit is €73,800 per year. Almost all long-term legal residents can join, with a few exceptions, such as international students over 30 who may need other options. Employees are usually signed up automatically, and employers handle much of the paperwork.

Students under 30 can get public insurance at a low, subsidized rate. There are around 97 public funds. All must cover the same core care, but some, like TK (Techniker Krankenkasse) and BARMER, offer strong support in English, which helps expats.

Coverage and Benefits

GKV offers broad cover: inpatient and outpatient care, specialist visits (often with a referral), prescription drugs, basic dental care (check-ups, simple fillings, extractions), medical aids, medically needed rehab, and maternity care. Preventive services and mental health care are included too.

A big plus is direct billing. Doctors and hospitals charge the insurer, so you usually do not pay upfront for needed care. Basic dental and vision are included; for complex dental work or extra vision benefits, you can add private supplemental cover.

Costs and Contributions

GKV costs depend on your gross salary. In 2025, contributions are about 17.05% of gross pay: a 14.6% base rate plus an average extra premium of about 2.5%, which varies by fund. The cost is split between you and your employer, so most employees pay about 7.3% plus half of the extra premium. There is a cap: above €66,150, monthly premiums can reach up to about €602 for the employee share.

Freelancers and the self-employed pay the full contribution themselves. This can be pricey for higher earners, with payments up to about €1,174 per month, depending on income. Even with low income, the minimum is usually around €180 per month.

Family Coverage Options

GKV offers free family cover. Non-working spouses and children can be added at no extra cost. This saves money and gives the same broad care to the whole family under one policy. In private insurance, each family member needs their own plan.

Private Health Insurance (Private Krankenversicherung – PKV)

Private health insurance (PKV) runs alongside GKV. It is for certain groups and sets premiums based on personal risk, not income.

Who Can Choose Private Insurance?

PKV is open to specific groups, such as:

• Employees who earn above €73,800 per year (2025)
• Self-employed people and freelancers (often with at least about €30,000 income)
• Civil servants
• International students over 30
• Some visa holders who are not yet residents

For freelancers, especially non-EU/EEA citizens without recent public insurance in the EU/EEA, private plans may be the only option. Young, healthy, higher earners often find PKV cheaper than GKV.

Premiums and Cost Structure

PKV premiums depend on age, health (including pre-existing conditions), chosen benefits, and job. Young and healthy people may pay less than in GKV. A big point to watch: premiums tend to rise with age. For families, PKV can cost more because each person needs their own policy, unlike GKV family cover.

Some people find PKV cheap at first but more costly later. Those with low income or certain health conditions may be turned down by private insurers.

Coverage Differences from Statutory Plans

PKV plans can be highly customized and may include shorter waiting times, private hospital rooms, access to very experienced specialists, broader dental and vision care, and full payback for many treatments, therapies, and some alternative care.

Billing is different: private patients usually pay first and then file claims. This takes some admin work, though many insurers now offer apps for claims. While GKV covers basic dental and vision, PKV can offer a much wider range of care in these areas.

Switching Between Public and Private Insurance

Choosing PKV needs careful thought. Moving back to GKV later can be hard, especially after age 55. Even before that, it can be difficult unless you meet certain conditions, like taking a job below the GKV income limit. Leaving GKV can make rejoining later tough, so think long term.

Switching between providers inside the same system (GKV to GKV, or PKV to PKV) is usually simple. The new provider handles most steps. Moving between GKV and PKV has strict rules and more paperwork.

Long-Term Care and Other Mandatory Insurance in Germany

Long-Term Care Insurance (Pflegeversicherung)

Long-term care insurance (Pflegeversicherung) is mandatory and is normally part of your health insurance. This very important cover supports people who cannot manage daily life due to illness, disability, or age. It is a key part of Germany’s broad social safety net.

Who Is Required to Have Long-Term Care Insurance?

Anyone with health insurance in Germany also has long-term care insurance, whether in GKV or PKV. Contributions are part of your health insurance payments. The goal is that help is available if major care needs come up.

When you apply for care benefits, the Medical Service of the Health Insurance Funds (MDK) carries out an evaluation and sets one of five care grades (Pflegegrade). It looks at mobility, mental and communication skills, self-care, and handling health needs. Benefits are then matched to your situation. These can include home care (Ambulante Pflege), full inpatient care (Vollstationäre Pflege), partial inpatient care (Teilstationäre Pflege), short-term and respite care, and grants for home changes. Because public benefits may not cover everything, many people add private long-term care insurance, especially expats who may not have nearby family support as they get older.

Other Compulsory Insurance Types

Other mandatory insurance can apply based on what you do:

• Motor vehicle liability insurance (Kfz-Haftpflichtversicherung) is required to register and drive a car. It covers damage you cause to others in an accident.
• Employees pay into unemployment insurance (Arbeitslosenversicherung) and pension insurance (Rentenversicherung) through payroll deductions. Employers pay for work accident insurance (Unfallversicherung).

Personal liability insurance (Haftpflichtversicherung) is not required by law, but most residents have it to protect against claims for damage or injury you cause by accident.

Key Terms in German Insurance Policies

Learning common insurance terms helps you choose and use your cover with confidence. These terms explain how costs are shared and what you get.

Optional and Mandatory Tariffs

In GKV, “mandatory tariffs” are the basic services every public fund must offer. This gives a standard level of care across all funds.

“Optional tariffs” are extra programs that go beyond the standard. Examples include:

• Cost reimbursement tariffs: you pay first and get reimbursed (like private patients)
• Premium refund tariffs: you get a bonus if you do not visit the doctor for a year (preventive check-ups do not count)
• Integrated care tariffs: coordinated treatment networks
• General practitioner tariffs: you agree to see your family doctor first

Deductibles, Co-Payments, and Limits

A deductible (Selbstbehalt) is a fixed amount you pay out-of-pocket before the insurer pays. In exchange, you may get a lower premium or a bonus. If you pick a deductible in GKV via an optional tariff, you usually must stay with that fund for three years. Deductibles are common in PKV and sometimes offered in GKV.

Co-payments (Zuzahlung) are small fixed amounts for certain items. In GKV, for prescription drugs, you pay 10% per package, with a minimum of €5 and a maximum of €10. If a drug costs less than €5, you pay the full price. You pay these at the pharmacy. Children under 18 and pregnant people are exempt from some co-pays. There are annual caps for low-income or chronically ill patients.

Limits are maximum amounts the insurer will pay for certain services or periods. For complex dental work, GKV often pays only part (for example, 60%). Higher coverage is possible after years of regular check-ups. PKV plans may also set limits based on the plan.

European Health Insurance Card (EHIC)

The EHIC helps residents of EU countries, Liechtenstein, Norway, Switzerland, and Great Britain get state healthcare during short stays in those places at the same cost as locals. For GKV members in Germany, the EHIC is on the back of your electronic health card (eGK).

EHIC is not a replacement for travel insurance. It covers only public healthcare and does not pay for private care or non-medical costs like flights or lost items. It works for short visits (usually up to 6 months) but is not enough for long-term stays or visa needs, where German health insurance is required.

Who Needs Proof of Insurance in Germany?

Many people must show proof of insurance to live, work, or study in Germany. This helps make sure everyone can get medical care without heavy costs for themselves or the state.

Employees and German Residents

All employees must have health insurance, usually GKV. Your employer needs your insurance details before you start work so contributions can be set up and you are covered from day one. All long-term residents also need continuous cover, even if not employed.

International Students

Students must have health insurance. Universities require proof before enrollment. Public insurers must cover students under 30 (or until the end of the 14th semester) at low rates. Students over 30, and those in language or prep courses, may need expat or private plans. Student visa applicants must show health insurance.

Expats and Foreign Workers

Expats moving to Germany for work or residence must have health insurance. Your options depend on your income and job type. With an employment contract, most join GKV; higher earners may choose PKV. Many new arrivals pick funds with English support, such as TK (public) or Ottonova (private). You also need proof of cover when you apply for a residence permit at the Ausländeramt.

Self-Employed and Freelancers

Freelancers and the self-employed must be insured and can choose GKV or PKV. Unlike employees, they pay the full cost themselves. For non-EU/EEA citizens without recent public cover in the EU/EEA, PKV may be the only path. Because GKV costs depend on income, many younger freelancers choose PKV as it can be cheaper and set up to fit their needs.

Visitors, Tourists, and Visa Applicants

Short-term visitors who need a Schengen visa must show travel medical insurance. It must last for the whole stay and cover at least €30,000, including repatriation. Longer stays or other visa types need German-compliant health insurance. EHIC can help for up to 6 months but is not a long-term solution.

Au Pairs, Volunteers, and Trainees

Au pairs, volunteers, and trainees must have suitable health insurance. Depending on the program and stay length, options include student-like public rates, expat insurance, or private plans made for these situations. Check the rules before you arrive, as you will need proof for your visa and registration.

Refugees and Asylum Seekers

Refugees and asylum seekers receive healthcare coverage too. The type of cover and access depend on legal status and stage of the asylum process. Early on, care is provided through special programs, later moving into standard public insurance once status is settled.

Insurance Requirements for German Visas

Almost all German visas require proof of suitable health insurance. Missing the exact requirements can delay or block your visa.

Health Insurance for Schengen Visa Applicants

For a Schengen visa (stays up to 90 days in 180), you must show travel medical insurance that covers the entire stay with at least €30,000 in medical costs and repatriation. Many regular policies do not meet these rules, so people often buy special Schengen travel insurance. Make sure your insurer can provide a letter confirming the required coverage.

Requirements for Student, Work, and Family Reunion Visas

For longer stays (student, work, or family reunion visas), you need German-compliant health insurance: either GKV or PKV. Student visas require proof for both the visa and university enrollment. For work visas or EU Blue Cards, your employer will ask for your health insurance details. For family reunion visas, family members need proper cover too. If eligible, they can join GKV family insurance, or they need their own private policy.

Expat health insurance plans, such as those from Feather, meet the minimum rules set by German immigration for visas like Job Seeker or Working Holiday. These plans can be a first step until you move to GKV or a standard PKV plan.

Using EHIC or Foreign Insurance

EHIC is valid for public care during short stays (up to 6 months) for EU/EEA and Swiss citizens. It is usually not enough for long-term visas or residence. It does not cover private care.

Foreign insurance from your home country is also usually not accepted for long stays. German authorities ask for insurance that meets German standards and is often from a recognized German insurer. Some embassies or consulates may have extra rules, so check the exact requirements where you apply.

Frequently Asked Questions About German Insurance Requirements

How Much Does Health Insurance Cost in Germany?

Costs vary a lot. In GKV, employees pay about 17.05% of gross salary in 2025, split with the employer (base rate plus an average extra premium). Self-employed people pay the full amount, which can be over €1,000 per month for higher incomes, with a minimum around €180. Students in GKV often pay about €105 per month at subsidized rates.

PKV premiums are based on age, health, and benefits. Young, healthy, higher earners may pay less than in GKV, but costs tend to rise with age and can become high over time. Families usually pay more in PKV because each person needs a separate policy. You may also have small co-pays for medicines (€5-€10) and, in PKV, you often pay upfront and claim back.

Can International Health Insurance Be Used?

It depends on why you are in Germany and how long you stay. For short trips or a Schengen visa, a good travel medical policy that meets the €30,000 plus repatriation rule is fine. For work, study, or long-term residence, insurance from your home country is usually not enough. German offices usually want GKV or PKV from a recognized provider.

“Expat health insurance” can fill the gap for newcomers who are not yet eligible for GKV or standard PKV, or who hold temporary visas like job seeker or working holiday. Providers such as Feather offer visa-friendly plans that you can use until you move to a permanent German plan. Global plans from international insurers can cover many countries and suit some workers, but they are separate from the mandatory German system.

Is Private Insurance Better Than Public?

It depends on your situation. GKV is often better for families (free family cover), people with pre-existing conditions (cost does not change), and anyone who prefers predictable, income-based pricing and standard benefits. It is simple to use with direct billing.

PKV can suit young, healthy, high earners who want wider treatment choices, shorter waits, private rooms, and custom plans. But PKV costs go up with age, each family member needs a separate policy, and moving back to GKV can be hard. Freelancers often weigh GKV’s income-based cost against PKV’s risk-based premiums. Both systems offer high-quality care, but they fit different needs and budgets.

Do Children Need Separate Insurance?

It depends on the parents’ insurance. In GKV, children and a non-working spouse can be covered for free through family insurance (Familienversicherung), which is a big benefit.

In PKV, children are not covered automatically. Each child needs their own policy, though child rates are usually lower than adult rates. For families with several children, GKV is often the cheaper option.