If you want to be told something reassuring about German bureaucracy, here it is: nobody will ask you to prove you are insured when you cross the border. If you want the other side: from the day you live here, you must be insured, and the choice is yours only within limits. Health insurance in Germany is a two-track system, and which track you take depends on your job and income.
How does health insurance in Germany work?
Germany has statutory insurance (gesetzliche Krankenversicherung, GKV) and private insurance (private Krankenversicherung, PKV). Most employees use the statutory system. If you are an employee below the income threshold, you are in it automatically, and you choose a fund (Krankenkasse). The funds are independent bodies, but the benefits are largely set by law, so the main differences are in extras and service.
You may choose the AOK of your work or home area, any Ersatzkasse (such as TK or Barmer), a BKK or IKK open to all, the Knappschaft, or the fund of your spouse. You tell your employer which one you picked, and the employer registers you and deducts your share of the contribution. You then get an electronic health card, the elektronische Gesundheitskarte, which you show at the doctor, hospital and pharmacy.
How much does statutory health insurance cost?
In 2026, according to the Federal Ministry of Health, the general contribution rate is 14.6% of income subject to contributions (14.0% without entitlement to sick pay). On top, each fund adds its own additional contribution (Zusatzbeitrag). The average published for 2026 is 2.9%. For employees, the total is split equally between you and your employer.
Contributions are calculated on income up to a ceiling of €5,812.50 a month (€69,750 a year). Above that, you pay no more. The base rate is the same everywhere, so comparing funds on the additional rate alone is only part of the picture; they also differ in services. You normally stay bound to your fund for twelve months, but you have a special right to leave if it raises its additional rate.
Your own contribution is therefore the general rate plus your fund's additional rate, applied to your gross pay up to the ceiling, with the employer paying half if you are an employee. Your fund publishes its additional rate, and your payslip shows what is deducted. For the rest of your budget, see cost of living in Germany.
What happens if you earn more, or work for yourself?
If you are an employee with an annual salary above €77,400 in 2026 (the Jahresarbeitsentgeltgrenze), you are no longer obliged to be in the statutory system and may choose private insurance. Private premiums are set by the insurer based on age, health and the cover you choose. Ask the insurer whether partners and children are covered, and at what price, because the free family insurance belongs to the statutory system.
The choice is a long one. Returning to the statutory system later can be difficult, so take independent advice before you leave. For freelancers, the picture is different again: you pay the whole contribution yourself, whether statutory or private, with a minimum assessment base in the statutory system (€1,318.33 a month in 2026). Ask your chosen fund how it applies to your situation.
If your situation is not standard (a salary close to the threshold, a job in two countries, a partner who stays abroad), the choice between systems has long consequences. Moovy can lay out the questions to ask a fund or an independent adviser, in plain English. It does not choose your insurer for you.
Are partners and children covered?
In the statutory system, there is a free family insurance (Familienversicherung). A spouse or registered partner and children are covered at no extra contribution when they live in Germany, are not otherwise compulsorily insured, are not mainly self-employed and earn no more than one-seventh of the monthly reference amount (Bezugsgröße), which is €565 in 2026. Children are covered up to 18, up to 23 if not working, up to 25 if in education or training, and without age limit if disabled. There is an exception when the other parent is not in the statutory system, earns more than you and is above the income threshold. Report your family members to your fund.
How do the EHIC and the S1 form fit in?
The European Health Insurance Card is for temporary stays. It covers treatment in the public system during a visit or before you settle, not a life in Germany. Once you live here, you need German cover.
Some people keep their insurance responsibility with another country: a pensioner paid by another EU state, a posted worker, a cross-border commuter. In that case ask your home insurer for the S1 form. You register it with a German fund of your choice, which gives you a card, and your home country pays for the care. Pensioners paid by another EU state should ask their home insurer about the S1. British citizens should read moving to Germany from the UK, since the UK-EU agreement keeps some coordination in place.
Which mistakes do newcomers make?
- Staying on the EHIC after settling. It is not insurance for residents.
- Choosing a fund only on price. The base rate is the same; check services too.
- Going private without advice. The decision binds you for years.
- Forgetting the family. Report your partner and children so they are covered.
- Not telling the employer in time. The employer needs to know your fund when you start.
What does a visit to the doctor look like?
You choose a family doctor (Hausarzt) and book an appointment. Show your health card at reception. Pharmacies hand out prescription drugs on a doctor's prescription. Outside surgery hours, the number 116117 reaches the on-call medical service for things that cannot wait but are not life-threatening, while 112 is for emergencies.
How much is long-term care insurance, and what do mini-jobs cover?
Long-term care insurance (Pflegeversicherung) comes with your health insurance. The Federal Ministry of Health gives a rate of 3.6% for 2026, with a surcharge for people aged 23 or over without children (4.2% in total), and a reduction of 0.25 point per child under 25 from the second to the fifth child. A reform bill in discussion in October 2026 would raise the surcharge for childless people, if passed. Employees share the cost with their employer, while freelancers pay all of it.
A Minijob (a job paying up to €603 a month in 2026) does not give you health cover of your own: the 13% the employer pays into the statutory fund opens no entitlement to care for you, so you need your own insurance. Pensioners in the statutory retirement-insurance scheme (KVdR) pay contributions on their pensions, including foreign statutory pensions, directly to their fund.
What should you do before and after you arrive?
- Before leaving: ask your current insurer about the S1 form if it may apply to you, and keep your EHIC for the first weeks.
- Within the first weeks: register your address (Anmeldung), choose a fund, tell your employer, and ask for your card.
- After the first year: check whether your fund's additional rate is still competitive, and remember you may change if it raises the rate.
- If your family joins you: report them to the fund so they are covered.
Sorting out your health insurance in Germany is one of the first jobs to finish, so make the choice before your first pay day.