Health Insurance in Germany for Americans (2026)

Can Americans get health insurance in Germany?

Yes. Citizenship is not an underwriting criterion, and no insurer prices you differently for holding a US passport. What most insurers do require in practice is a residence status that permits you to live here, so the visa or residence permit comes first in the sequence. The two do depend on each other, though: the permit itself requires proof of adequate cover, which is why an incoming policy bridges the gap while the German contract is being set up. After that the ordinary German rules apply to you exactly as they apply to everyone else.

What changes coming from the US system

Five structural differences, in the order they usually surprise people.

There is nothing like a US network. No in-network and out-of-network, no preferred providers, no checking whether a specialist is covered before booking, and no penalty pricing for going outside a list. The limits that do exist work differently. In the public system you choose freely among doctors licensed to treat public patients,[1] which is almost all of them, and private-only doctors are outside that. With private cover you may see any doctor who treats private patients, and the limit is what your tariff reimburses rather than who you may visit.

The insurer cannot drop you or single you out. German substitutive private cover runs for life, and the insurer's right to cancel it is excluded by law.[2] Anything that develops afterwards is covered without your own premium being adjusted for it. There are two narrow exits, and both are about the application rather than about your health later: if you left out something the insurer asked about in writing it may withdraw from the contract, and if you deliberately deceived it, it may void the contract.[3] Falling behind on premiums does not end the contract either. It suspends cover and moves you to an emergency tariff until the arrears are settled. You are not repriced because you claimed, and not repriced because you got sick.

Your age is locked at entry. Private premiums are calculated from the age at which you joined, and that age stays fixed for the life of the contract. There is no annual age band moving you up a tier.

Payment often runs backwards. In the private system you generally receive the bill, pay it, and claim reimbursement. There is no copay at the desk and no insurer standing between you and the practice.

There is no open enrollment window. You are not waiting for a yearly period to act, and changing jobs does not create the kind of coverage gap that US transitions can.

The one American habit worth keeping is reading what a contract actually covers, because tariff scope varies genuinely and meaningfully between them.

Do not plan on keeping your US cover alongside this. Employer plans and marketplace plans are built around US networks and generally stop being useful once you live abroad, Medicare does not pay for treatment outside the United States apart from narrow exceptions,[4] and none of them satisfies the German requirement that residents hold adequate cover.

Which system are you allowed to join?

Employees may choose private cover only once gross salary exceeds the Jahresarbeitsentgeltgrenze, which is €77,400 a year in 2026. Below that line you are compulsorily insured in the public system whatever you would rather pay. For 2027 it is set to rise to €84,150; what changes in 2027 has the new figures.

The self-employed and freelancers sit outside that rule entirely and may choose at any income, which is why the answer often differs sharply between an American on a Berlin tech salary and an American freelancing for US clients. The timing traps around pay rises and job changes are set out in who can get private health insurance in Germany.

If you arrive before your permit is issued, or before a job starts, there is a bridge for the gap rather than a hole: incoming cover is designed for exactly that window. It is temporary by design and not a substitute for either system.

How you actually join, and what an insurer asks for

This is the part almost nobody writes down, and it is where being new to Germany genuinely changes the process.

Joining the public system is largely administrative. You choose a Krankenkasse, they enrol you, and there are no health questions and no medical assessment. Nobody is turned down and pre-existing conditions do not matter.

Joining the private system is an application that can be declined. The documents an insurer expects are:

1. The completed application form.
2. The health questionnaire. This is not optional and not a formality. It is an integral part of every private application and carries a legal duty of disclosure.[3]
3. A copy of your ID, and a SEPA direct debit mandate.
4. Proof that you clear the income threshold, if you are an employee. The standard evidence is your last three payslips, which a new arrival does not have. Many insurers accept a copy of the signed employment contract instead, which is the practical route for someone who started last month.
5. Situationally, a medical certificate. More on that below.

For the self-employed, income evidence is not legally required, though many insurers ask for something in practice as a plausibility check.

The health questions apply to your American medical history too

A medical self-disclosure is always required, and where treatment happened makes no difference to your duty to answer. The questionnaire works on defined lookback windows: commonly three years for outpatient treatment and prescribed medication, five years for inpatient treatment and psychotherapy, and no time limit at all for a few categories such as HIV and cancer. Some insurers use longer windows than the market standard, particularly for psychological treatment.

Two practical consequences for Americans specifically. First, your records sit with US providers, so allow time to obtain them rather than answering from memory; the German equivalent of that step is requesting your file from your GP, and you should do the same with US practices. Second, therapy is common in the US and treated routinely there. In German underwriting, psychotherapy inside the lookback window is the single most frequent reason an application is declined, and that becomes considerably more likely where ongoing medication accompanies it. That is not a reason to conceal it. It is a reason to find out where you stand before you apply.

The assessment produces one of four answers: acceptance on normal terms, acceptance with a risk surcharge, acceptance with a specific condition excluded, or a decline. Most diagnoses are negotiable in the sense that they lead to the middle two rather than the last. The mechanics are covered in detail in how the health assessment works.

Waiting periods, and the certificate that removes them

Private contracts normally carry waiting periods at the start: three months generally, and eight months for childbirth, psychotherapy and dental work. Anyone moving in from German public cover has the time there credited, provided the application follows within two months of leaving it.

For a new arrival from the US the waiting periods are the starting point, and this is one of the few places where coming from abroad genuinely disadvantages you. German law does not settle whether US health insurance counts as prior cover. And a waiver against a medical certificate confirming your state of health exists only in tariffs that provide for it. If you expect dental treatment or a birth in your first eight months, these are the two questions to settle before you apply: does the tariff allow a waiver, and does the insurer recognise your US cover. We put both to the insurers before anything is filed.

Find out where you stand before you apply

Because a declined application is something you must declare on the next one, the sensible order is to test the market anonymously first. An anonymous pre-inquiry describes your medical history to insurers' underwriting departments using only your year of birth, with no name and no address, and comes back with the terms they would offer. It is not binding, and it is normally sent to several insurers at once. The reasoning is set out in what happens to a declined application.

What it costs, in German terms

Public cover is a percentage of gross income, 21.1% with children and 21.7% childless in 2026, both including compulsory long-term care insurance, capped at €1,226 to €1,261 a month. Private cover is priced per person and commonly runs €300 to €400 a month at age 25 to 30 and €450 to €650 at age 35 to 40 for a healthy applicant. Employees have roughly half of either figure paid by their employer.

Two American habits are worth unlearning. There is no deductible you must clear before cover begins; the German deductible is optional and you take it in exchange for a lower premium. And there is no out-of-pocket maximum to track, because no coinsurance stacks behind it.

Where American intuition points the wrong way is family arithmetic. Public cover in Germany insures a non-earning spouse and children at no additional contribution, while private cover charges per person, typically €150 to €250 a month per child. A single earner with three dependants is usually looking at a different answer than a single person on the same salary. The full comparison is in what health insurance really costs in Germany, and the family case in family health insurance in Germany.

One thing that stays American

Moving does not end your US filing obligation, because the United States taxes citizens and green card holders on worldwide income regardless of residence.[5] German health insurance premiums are deductible on the German side, and how that interacts with a US return is a real question with a real answer. It is not one an insurance broker is licensed to give, so ask a US tax preparer who works with expatriates, and ask before you commit rather than after.

If you want the actual numbers for your situation rather than these ranges, book a free 30-minute call. We run an anonymous pre-inquiry as standard, so you can see what the market would really offer you before anything goes on record.