Health insurance in Germany: how the system works

1. Why health insurance comes first

Proof of health insurance is one of the documents you need for a residence permit, for enrolling at a university and often for signing an employment contract. It is not a formality you can deal with later: without it, other steps stop moving.

Germany runs two parallel systems. The statutory system covers the large majority of people and works on a solidarity principle, where your contribution depends on your income rather than your health. The private system prices individually. Which one you can join is mostly a matter of your employment status and income, not personal choice.

2. Statutory or private

In the statutory system your contribution is a percentage of your gross salary up to an income ceiling, and your employer pays roughly half. Children and a non-earning spouse can usually be covered on your policy at no extra cost, which is the single biggest practical difference between the two systems for families.

Private insurance can be cheaper for a young, healthy, high-earning person without dependants, and it prices each family member separately. Moving back from private to statutory later is restricted, so it is a decision worth taking slowly rather than at an agent’s pace.

• Employees below the income threshold: statutory, with the contribution split with your employer
• Employees above the threshold: may choose private, but do not have to
• Students: usually a reduced statutory student rate, with conditions on age and semesters
• Self-employed: free to choose, and pay the whole contribution themselves

3. Family cover (Familienversicherung)

In the statutory system, an eligible spouse or registered partner and children may be insured without an additional contribution. The current general-income and Minijob limits are shown from the verified fact registry below. Child age limits and other exclusions apply.

Mixed GKV/PKV families need a specific assessment: free cover for a child can be excluded when the non-GKV parent is the higher earner and exceeds the relevant threshold. The dedicated family guide explains the rule and newborn registration.

4. Choosing a Krankenkasse

The core benefits of statutory insurers are set by law, so they are broadly similar. Where they differ is the additional contribution rate, the extra services they choose to offer, how good their English-language support is, and how quickly they answer.

For someone new to Germany, English-speaking service and a working app usually matter more day to day than a small difference in the additional rate.

1. 1

   Pick an insurer and apply

   You can apply online with most insurers. Your employer needs the name of the Krankenkasse to register you.

2. 2

   Get your membership confirmation

   The insurer issues a confirmation of insurance. This is the document other offices ask for.

3. 3

   Receive your card

   The electronic health card arrives by post and is what you show at a doctor’s practice.

5. Seeing a doctor

You register with a general practitioner (Hausarzt) of your choice and can change later. Specialists can often be seen directly, though some require a referral. Practices have their own opening hours and many still work by telephone appointment.

For urgent problems outside opening hours there is an on-call medical service; for emergencies there is the emergency number. Knowing the difference before you need it saves a great deal of stress.

6. What you may pay yourself

GKV does not mean every service is free at the point of use. Adults can owe statutory co-payments for prescriptions, hospital stays, therapies and aids. Exemptions and a household burden limit can apply.

Optional IGeL services and non-prescription medicines may be self-paid. Ask whether a service is covered and request the price before agreeing.

7. Where to check the current rules

The Federal Ministry of Health publishes the authoritative overview of how the system works, including the split between statutory and private cover. Your own insurer is the right place for questions about your specific membership, contributions and benefits.