This guide is for internationals who have just moved to Germany and need to arrange health cover in their first weeks. After reading it, you will understand why insurance is compulsory, how statutory and private cover differ, how contributions are calculated and how to join a Krankenkasse (health insurance fund).
- Why health insurance is compulsory
- Statutory and private cover compared
- Who may choose private insurance
- What it costs as a share of salary
- How to join a Krankenkasse
- FAQ
Why health insurance is compulsory
Health insurance is obligatory in Germany, as Handbook Germany’s health insurance guide states. It is also tied to residence: anyone applying for a residence permit must be a member of a health insurance fund. The Ausländerbehörde (foreigners’ authority) decides whether a particular policy meets the conditions of a permit. People with a specific residence question can turn to that office or to a migration advice service.
According to Handbook Germany’s overview of social insurance, health insurance is one of the five pillars of German social security. The other four are nursing care, accident, unemployment and pension insurance, and membership of those is automatic. With health insurance, you choose the company. Everyone must be covered, whether or not their job involves social insurance contributions.
Gaps in cover do not save money. Anyone who stops paying their monthly contributions for a period has to pay the whole amount later.
Statutory and private cover compared
Germany has more than 100 health insurance companies. They belong to two systems: gesetzliche Krankenversicherung (statutory health insurance) and private Krankenversicherung (private health insurance). Most people in Germany have statutory insurance.
Statutory contributions depend on salary, so higher earners pay more and lower earners pay less, and the cost is shared across society. One important feature is Familienversicherung (family insurance): under certain conditions, a spouse and children with little or no income can be included at no extra cost.
Private insurers base contributions on individual risk, which they calculate from age, gender, pre-existing conditions and, to some extent, lifestyle. Handbook Germany says private contributions are usually higher. It also says private patients often get appointments sooner and are usually entitled to more benefits. They pay doctors’ and pharmacy bills themselves first, and their insurer pays them back afterwards.
Every company offers several plans. Some cover glasses or alternative medicine and others do not. The Verbraucherzentrale (consumer protection centre) gives guidance, and you can compare policies on krankenkassen.de.
Who may choose private insurance
Statutory insurers accept everyone, whatever their profession or income. Private insurers admit only certain groups: civil servants, self-employed professionals, students and high-income workers. The source pages do not say at what income an employee may choose private cover. Insurers and the Verbraucherzentrale can give the current figure.
People working in art or media can apply to the Künstlersozialkasse (KSK, the artists’ social security fund). Those admitted pay half of their contributions, and the KSK pays the rest.
The choice has long-term consequences. Handbook Germany warns that switching from private to statutory insurance is often very difficult, and sometimes impossible.
What it costs as a share of salary
In a job subject to social insurance contributions, half of the monthly health insurance contribution is deducted from your salary and your employer pays the other half. The employer transfers the full amount directly to the Krankenkasse. Nursing care, pension and unemployment insurance are split the same way, and the employer pays accident insurance alone.
Each insurance provider receives a percentage of gross income, and the rate is adjusted regularly. The source pages do not give the current percentage. The social insurance page refers readers to ihre-vorsorge.de, and each Krankenkasse can confirm its own rate.
The two pages give different earnings thresholds. The health insurance page says a job is usually subject to contributions when it pays more than €556 a month (as of 2025). The social insurance page gives €538. Below that level, a Minijob (marginal employment) is exempt from social security contributions, but health insurance is still compulsory. People with a mini-job, the self-employed and students pay their insurer themselves each month. For people receiving unemployment benefit or social assistance, the Employment Agency, the Jobcentre or the social welfare office pays the cost.
How to join a Krankenkasse
- Choose a provider. Statutory insurers are open to everyone; private insurers only to the groups listed above.
- Apply online on the insurer’s website or in person at a local branch.
- Submit a passport photo, your registration certificate and proof of income. Instead of proof of income, you can submit a certificate of assistance from the Jobcenter or social welfare office.
- Your health insurance card arrives by post. Take it with you every time you visit a doctor or hospital.
You receive the registration certificate when you complete your Anmeldung (address registration) at the local registration office. The city or municipality runs these offices, so procedures and appointment systems vary. The source pages do not describe them.
When you start your first job with social insurance contributions, your employer registers you and you receive a Sozialversicherungsausweis (social security card). The social security number on the card is valid for life.
Some costs remain once you are insured. A hospital stay costs €10 a day, and you pay no more than €10 towards each prescription medicine. If your spending on medication and hospital treatment goes above 2% of your annual gross income, you can apply to your insurer to be exempt from further charges for the rest of the year. For people who are chronically ill, the limit is 1%. Statutory insurance does not pay for cosmetic surgery or vaccinations for private trips abroad, and it covers dentures only in part. A Bonusheft (dental bonus booklet), stamped at check-ups every six to twelve months, increases the share of denture costs the insurer pays later.
FAQ
Is health insurance needed for a residence permit?
Yes. Handbook Germany states that anyone applying for a residence permit must be a member of a health insurance fund. The Ausländerbehörde decides whether a specific policy is enough. Questions about individual cases go to that office or to a migration advice service.
Can I move from private back to statutory insurance?
Handbook Germany says this is often very difficult and can be impossible. The source pages do not set out the conditions, so insurers or the Verbraucherzentrale can explain the current rules.
How much of my salary goes on health insurance?
Statutory contributions are a percentage of gross income. In jobs subject to social insurance, the employee and employer pay half each. The source pages do not give the current rate, which is adjusted regularly. Private premiums depend on age, gender, health and lifestyle rather than income.
Can my family be covered on my insurance?
With statutory insurance, a spouse and children with little or no income can be included through family insurance at no extra cost. Children are covered until their 18th birthday, and until their 23rd if they do not work. They stay covered until their 25th while at school, in vocational training without pay, studying or doing a voluntary social year. Children with a disability are covered for life. The insurer sets the income limit for family members.
Sources: handbookgermany.de · handbookgermany.de
Last verified: 11 October 2026 against the pages linked above. Rules and fees change; the responsible authority always has the final word.
This is general information, not legal or immigration advice. For your own situation, ask the foreigners’ authority (Ausländerbehörde) of your city, a recognised migration advice service or a lawyer (Rechtsanwalt).
Sources
- handbookgermany.de: Health Insurance, accessed 11 October 2026
- handbookgermany.de: Social Insurances, accessed 11 October 2026
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