Health Insurance in Germany for Foreigners and Expats 2026: Public vs Private, Costs and Visa Rules

Written by Steffan Grund · Insurance specialist (Versicherungsfachmann BWV) · Updated October 28, 2026Facts checked: October 28, 2026

How to read this page. This is an information page with no plan recommendation. The long-term international plan we review elsewhere on this site, Care Expat World, is closed to German residents: its terms rule out anyone spending over 180 days a year in Germany and anyone covered by the statutory insurance obligation, and they state that the plan cannot satisfy §193 VVG. People living in Germany need statutory or German private cover, and we name no insurer, broker or comparison service here.

Key facts: health insurance in Germany for foreigners (2026)

Sources: Federal Ministry of Health (Stand 3 September 2026), Sozialversicherungs-Rechengrößen-Verordnung 2026 via Deutsche Rentenversicherung, vdek (19 December 2025), SGB V, VVG, BaFin, German missions, GOV.UK. Full list at the end of the page.

Is health insurance compulsory in Germany for foreigners?

Yes: every person who lives in Germany must have health insurance, and nationality makes no difference. Two laws work together. The social code, book V (SGB V), makes employees below the income threshold, students, trainees and pensioners who meet the qualifying period members of a statutory fund by law; section 5 lists the groups, starting with “Arbeiter, Angestellte und zu ihrer Berufsausbildung Beschäftigte, die gegen Arbeitsentgelt beschäftigt sind”. Everyone else who lives in Germany falls under §193 of the insurance contract law (VVG), which obliges them to take out and keep a private policy that pays at least for outpatient and inpatient treatment.

That second rule has teeth. The deductible of the policy you rely on may not exceed €5,000 per person per calendar year, so an emergency-only plan or a policy with a very high excess does not count. If you apply for private cover more than a month after the duty arose, the insurer adds a surcharge: one monthly premium for each started month without cover, and from the sixth month one sixth of a premium per month. If the gap cannot be established, the law assumes at least five years. Statutory funds can also claim contributions back for the time you should have been a member.

The German missions abroad say the same in plain words. The embassy in London writes: “Under German law, all residents must have sufficient health insurance cover.” The UK government’s guide puts it even more simply: “You must have health insurance cover to live in Germany.” For how Germany’s social insurance model compares with tax-funded systems such as the NHS, see healthcare systems by country.

Public vs private health insurance in Germany: what is the difference?

Public (statutory) insurance charges a share of your income and covers your family for free, while private insurance charges a premium based on your age, health and chosen benefits, with each person paying separately. Around 90% of residents are in a statutory fund and around 10% are privately insured, according to GOV.UK. For an employee the question is decided by law, not by preference: below the income threshold you are in the statutory system.

The table describes the rules, not a verdict. Private cover can offer extra benefits and a premium that does not rise with your salary, while statutory cover protects families and people with health conditions and adjusts to a falling income. Which one fits depends on your income path, family plans and how long you intend to stay, which is why the decision deserves time.

How much does public health insurance cost in Germany in 2026?

Public health insurance costs 14.6% of gross pay plus your fund’s additional contribution, which averages 2.9% in 2026, with employees paying half; long-term care adds 3.6%, also split. The health ministry fixed the 2.9% average for 2026, up from 2.5% in 2025; each fund then sets its own rate, and the association of substitute funds, vdek, expected the rates actually charged to be clearly above 3% on average. Contributions are charged only up to the ceiling of €5,812.50 of monthly pay.

Maximum shares: our arithmetic on the 2026 ceiling of €5,812.50 a month. Exchange rate for reference: 1 euro = 1.1150 USD = 0.83658 GBP (ECB, 27 October 2026), so the maximum health share is about USD 567 or £425 a month.

Co-payments are fixed by law and capped. Adults pay 10% of the price of each prescription medicine, at least €5 and at most €10, and €10 a day in hospital for up to 28 days a year (§§39 and 61 SGB V), so hospital co-payments stop at €280 a year. All co-payments together are capped at a share of household income (§62 SGB V); your fund issues an exemption once you reach it. For how these costs compare with international plans, see what international health insurance costs.

What is the 2026 income threshold for private health insurance?

The 2026 threshold is €77,400 of regular gross pay a year, or €6,450 a month; employees above it are free from compulsory statutory insurance and may choose private cover. The figure (the Jahresarbeitsentgeltgrenze) rose from €73,800 in 2025 and is set each year by regulation. A lower special threshold of €69,750 applies only to people who were already privately insured on 31 December 2002 because of their pay, which does not apply to newcomers who were not privately insured in Germany at that date.

Two details matter. Regular annual pay counts, but not supplements paid because of your family status (§6 SGB V). And if you are already compulsorily insured, crossing the threshold frees you only at the end of the calendar year, and only if your pay also exceeds the next year’s threshold. For a newcomer, the fund assesses the expected regular pay when the job starts; ask it to confirm your status in writing before you sign a private contract. The employer also pays toward private cover: half of what it would pay for statutory cover, at most half of your actual premium (§257 SGB V).

How does private health insurance in Germany work?

A German private health policy is a long-term contract priced on your age and health when you join, which builds ageing reserves to soften later premium rises. German private health insurers are supervised by BaFin, the federal financial supervisor. When you apply, you answer health questions; the insurer may add a surcharge, exclude a condition or refuse you, except in the Basistarif.

1. Premium per person. Each adult and each child has their own premium; there is no free family cover.
2. Benefits by contract. The tariff sets what is paid: for example single or double room, chief physician, dental share, glasses, or a yearly deductible.
3. Deductible limit. The policy you rely on for the legal duty may have a deductible of at most €5,000 a year.
4. Bills and claims. Doctors invoice you under the medical fee scale (GOÄ), and you claim back from the insurer.
5. Switching. BaFin explains that you may move to a similar tariff with the same insurer while keeping your rights and ageing reserves; with contracts since 1 January 2009, a part of the reserves moves with you if you change insurer.
6. Over 60. At every premium rise, the insurer must tell you about the standard and basic tariffs (BaFin).

Because the premium depends on your age at entry, the choice can look cheap at 30 and expensive at 60. Just as important is the way back: from age 55, §6 Abs. 3a SGB V keeps people exempt from statutory insurance if they had no statutory cover in the previous five years and were exempt or self-employed for at least half that time. How the funds treat insurance years spent abroad under that rule is not set out on any official page we read, so ask in writing.

What is the Basistarif, and who can use it?

The Basistarif is a standard private tariff with benefits similar to the statutory system that every private health insurer must offer to certain groups, without surcharges for health, at a premium capped at the statutory maximum, about €1,017.19 a month in 2026. BaFin describes the cap as the highest statutory contribution including the average additional rate; on the 2026 ceiling that is €5,812.50 × 17.5%.

Under §193 Abs. 5 VVG, insurers must accept into the Basistarif, among others, voluntary statutory members and people living in Germany who are not compulsorily insured in the statutory system and have no other cover. An insurer may refuse only in the cases the law lists, for example after fraud in an earlier contract. For a foreign retiree or a self-employed newcomer who cannot join a statutory fund and is refused elsewhere, the Basistarif is therefore the legal safety net. It is not a bargain: its premium can reach the cap.

What health insurance do you need for a German visa?

For a national (D) visa you need cover at least equivalent to the statutory system from the day you arrive, and travel insurance is not enough. The German embassy in London states: “Travel insurance is not sufficient for any D visa application.” It asks for cover that is at least equivalent to the benefits in sections 11(1) to (3) SGB V, and for a letter or certificate that names you and states “the level of insurance cover provided as well as any limitations and/or deductibles/excess”.

The time before statutory cover starts is the gap to plan for. The embassy in Abuja explains that statutory cover “only becomes valid once certain conditions are met”, such as starting your job, and that until then “you are required to provide an incoming health insurance policy”, which “must not include any cancellation clauses for long-term stays”. Missions do not recommend insurers; the Abuja page says it “is not entitled to give advice on a specific insurer or company”. In practice: ask the mission handling your file which policy types it accepts for your visa, buy one that runs from your arrival until the statutory or private German policy starts, and keep the confirmation of the start date of your German cover. The country-by-country picture is on visa health insurance requirements by country.

Which insurance applies to workers, students, freelancers and families?

Employees below the threshold and students under 30 are in a statutory fund by law, freelancers choose between voluntary statutory cover (if eligible) and private insurance, and family members of a statutory member who have little or no income are covered for free.

Workers and Blue Card holders. Your employer registers you with the fund you name and deducts your share from your pay. A Blue Card does not change the health rule: the salary does. Employees with a minijob only (up to €603 a month) are not insured through it and need cover another way; low earnings above that figure carry reduced employee contributions in a transition band.

Students. Statutory student insurance costs €87.38 a month in 2026 plus the fund’s additional rate and long-term care. It is compulsory for students enrolled at German universities, generally until 30. You can apply to be exempted within three months of the start of student insurance to use private cover, but the law says the exemption cannot be revoked (§8 SGB V). Students who also work must check whether the job changes their status.

Freelancers and the self-employed. Full-time self-employed people are not compulsorily insured (§5 Abs. 5 SGB V) but must hold cover under §193 VVG. Voluntary statutory membership after leaving a fund needs 24 months of insurance in the five years before, or 12 months without a break immediately before, and an application within three months (§9 SGB V). EU insurance periods can count under EU coordination rules; whether yours do is for the fund to decide. Voluntary members pay the full contribution themselves, on income of at least €1,318.33 a month and at most €5,812.50. More on cover for the self-employed abroad is on health insurance for freelancers abroad.

Our arithmetic on the 2026 minimum base of €1,318.33 (Bezugsgröße €3,955 ÷ 90 × 30) and ceiling of €5,812.50, with the 2.9% average additional rate; your fund’s rate changes the figures.

Families. A spouse or child who lives in Germany and earns no more than €565 a month (€603 from a minijob) is insured free through a statutory member (Familienversicherung). Private insurers have no family cover, so a privately insured family pays one premium per person; special rules apply to children when one parent is privately insured and earns more. Planning cover for a family abroad in general is covered in international family health insurance.

Can retirees moving to Germany get public health insurance?

Only if they meet a statutory route: the pensioners’ scheme (KVdR) needs statutory insurance for nine tenths of the second half of your working life, so a retiree who worked only outside Germany and the EU cannot meet it and needs private cover. Section 5 Abs. 1 Nr. 11 SGB V counts membership and family insurance between the start of your working life and your pension application. The Bundestag’s research service notes that foreign periods can count where supranational law recognises them, which is the case for EU coordination; the fund decides.

The catch-all statutory rule (§5 Abs. 1 Nr. 13 SGB V) does not open the statutory system to a non-EU newcomer in this position: for non-EU nationals it applies only with a settlement permit or a residence permit for more than twelve months and only where no livelihood condition applies (§5 Abs. 11). Ask the fund whether your residence permit carries such a livelihood condition. Our guides to expat health insurance over 65 and the S1 form cover the age and pension questions in general.

How are EU citizens insured when they move to Germany?

EU citizens are insured like Germans once they live there: through work, study, an S1 from the country paying their pension, or a German statutory or private policy; the EHIC covers only temporary stays. According to the European Commission, the deciding factors are what you do (work, study, pension) and where you live, while your passport plays no role. The EHIC entitles you to treatment that “can’t wait until you get home” on a visit, not to cover while you live in Germany.

• Working in Germany: the German rules above apply from the first day of work.
• Posted for up to two years: you can stay insured at home and show an S1 to a German fund.
• Pension only from another EU country: get an S1 from that country and register it with a German fund.
• Not working: EU law asks for comprehensive health insurance and sufficient resources for stays over three months.

Insurance years from another EU system can help with the voluntary-membership and pensioners’ rules, so collect proof of your periods before you move. Germans and other Europeans moving the other way, out of Germany, will find the reverse questions on health insurance for EU citizens abroad.

Can an international expat plan replace German health insurance?

No: a plan that is not a German substitute health insurance does not meet §193 VVG for a resident, and Care Expat World in particular excludes people who live in Germany. Under its binding German terms, anyone whose actual time in Germany exceeds 180 days within one calendar year is not insurable, and that people who are or become subject to compulsory insurance under SGB V cannot be insured either. They add that the group insurance is not a substitute health insurance and “daher nicht geeignet” to fulfil the insurance obligation. The product sheet states that stays in Germany have only limited cover.

So the plan has a place only for people who live outside Germany: for example a German living in Portugal who visits family, or a Briton in Spain on a trip to Berlin. That is why this page recommends no plan. The general guide to how long-term international plans work is expat health insurance, and the plan itself is reviewed on our Care Expat World overview.

How good is the German healthcare system?

Germany scores 87 out of 100 on the WHO index of health-service coverage (2023), spends USD 6,849 per person on health (2024), has out-of-pocket payments of 10.7% of health spending (2024) and 4.53 physicians for every 1,000 inhabitants (2022), in World Bank and WHO data.

Figures describe the system, not waiting times for a given specialist, which vary by region and are not published in a comparable official form. In daily life you choose a family doctor (Hausarzt), see specialists directly or by referral, and use hospitals that treat statutory and private patients alike. Statutory patients show their insurance card; private patients receive the bill and claim it back. For the comparison with other countries, see healthcare systems by country.

Checklist: getting insured when you move to Germany

• Work out your status: employee below or above €77,400, student, self-employed or not working
• Visa: a policy the German mission accepts from arrival until German cover starts (travel insurance is not enough for a D visa)
• Employees: choose a statutory fund and tell your employer before the first payday
• Compare the additional contribution of the funds you consider (average 2.9% in 2026)
• Self-employed: ask a fund in writing whether you meet the voluntary-membership rules, with your EU insurance records
• Private cover: deductible no higher than €5,000 a year, benefits for outpatient and inpatient care, all health questions answered fully
• Aged 50 or over: think through the 55-plus rule before you choose private cover
• Family: check free family insurance (income up to €565 a month) or a policy for each person
• Pensioners: S1 from the UK or EU pension country, registered with a German fund
• No gap: apply within a month of the duty arising to avoid the late surcharge
• Cancel any international plan that excludes German residents, after the German cover is confirmed

Worked examples: an American, a Briton and an EU freelancer

Daniel, 41, from Texas, moves to Munich on an EU Blue Card with a salary of €60,000 a year and two children. His pay is below the threshold, so he is in a statutory fund by law from his first working day. On €5,000 a month he pays €437.50 for health cover at the average rate and €90.00 for long-term care, €527.50 in total, and his employer pays the same amount. His wife, who does not work, and the children are covered through free family insurance. For the four weeks between arrival and his start date, he buys a policy that the consulate accepts for that gap, because Medicare and his old US plan do not count.

Had Daniel been offered €85,000, he could choose. As a voluntary statutory member his share would stop at the ceiling: €508.59 for health and €104.63 for care, €613.22 a month, with his family still covered free. A private policy would need one premium for each of the four family members; he asks for written quotes and reads the 55-plus rule before deciding.

Helen, 63, from Leeds, moves to Hamburg to live near her son. She does not work and has no German or EU insurance years, so she cannot join a statutory fund, and her son’s family insurance does not extend to parents. Until her UK State Pension is paid she needs a German private policy that meets §193 VVG; if insurers refuse her because of her health, the Basistarif must accept her. Once her State Pension starts, she applies for an S1 and registers it with a German fund, which gives her statutory care paid for by the UK. Care Expat World is not an option either, because its terms exclude people who live in Germany.

Marta, 34, a Polish graphic designer, moves to Leipzig as a freelancer with a profit of about €3,000 a month. She was insured in the Polish statutory system for years. A German fund checks whether those EU periods meet the voluntary-membership rules; if they do, she pays the full contribution herself, about €525.00 for health with sick pay and €108.00 for care at the average rates. If not, she needs a private policy.

Related guides

• Health insurance for Americans living abroad: Medicare and US plans after a move.
• Health insurance for UK expats: the NHS, the S1 and cover abroad.
• Health insurance for EU citizens abroad: leaving the German system.
• Digital nomad health insurance: cover for people without a fixed base.

Where these facts come from

• Federal Ministry of Health (Bundesministerium für Gesundheit): Beiträge, general and reduced rate, average additional contribution 2026 (Stand 3 September 2026)
• Deutsche Rentenversicherung: Sozialversicherungs-Rechengrößen-Verordnung 2026 (threshold, contribution ceiling, Bezugsgröße, minijob limit)
• vdek (association of substitute health funds): changes in the health system 2026 and contribution-rate glossary (19 December 2025)
• Sozialgesetzbuch V, sections 5, 6, 9, 10, 39, 61, 62, 240 and 257 (versions in force in 2026)
• Versicherungsvertragsgesetz (VVG), section 193
• BaFin: private health and long-term care insurance, consumer pages (read 28 October 2026)
• Federal Foreign Office: German Embassy London, health insurance requirements for national visas; German Embassy Abuja, health insurance requirements (read 28 October 2026)
• German Bundestag research services: qualifying periods for the pensioners’ scheme
• European Commission, Your Europe: health insurance cover when living abroad; unplanned healthcare on temporary stays
• GOV.UK: Healthcare in Germany (updated 19 September 2024)
• Medicare: coverage outside the United States
• World Bank / WHO: health spending, out-of-pocket share, doctors, UHC index, life expectancy
• European Central Bank (ECB): euro foreign exchange reference rates of 27 October 2026
• Care Concept: Care Expat World terms (AVB 2026_05, §1 and §16) and product information sheet (read 27–28 October 2026)

The 2.9% additional contribution is the official average; each fund charges its own rate. The visa wording differs between German missions. The law was read in the versions in force in 2026. Ask your fund, the German mission and the insurer before you rely on a figure.