Health insurance for expats in Germany: what you need, from visa to first job

Which health insurance do you need when you move to Germany?

Employees are sorted by salary and start date, the self-employed by their earlier insurance, and students by age. For employees, the income threshold also depends on whether you are already privately insured.[1][2]

• New job above the threshold. Besides private cover, public cover is open to you: you register with a public insurer of your choice within three months of starting your first job in Germany.[3]
• Job starting in 2027. It must pay more than €84,150 a year to open private cover.[4]
• Already private at the end of 2026. If your pay frees you from compulsory public cover and you are fully privately insured on 31 December 2026, a lower threshold of €80,550 applies to you in 2027.[5] A salary of €82,000, for example, keeps you private.
• Pay rise later. A pay rise opens private cover only from 1 January, if your salary is also above the next year's threshold, as our guide to who can get private health insurance explains.[1]
• Self-employed. Voluntary public cover requires earlier statutory cover, which can include time in another EU country, shown with the S041 form.[3] Private cover needs no earlier insurance.
• Student. Under 30 you are in public student insurance. Within three months of enrolment you can apply to be exempt and take private cover instead, and the exemption then applies for your whole course.[6]
• Job-seeker. If you come to look for work, for example with an Opportunity Card (Chancenkarte), you need your own health cover for the residence permit until a job starts.[7]

What cover does your residence permit need?

EU citizens need no residence permit. For everyone else, the permit requires adequate health insurance as part of a secured livelihood.[7] The immigration authority (Ausländerbehörde) accepts membership of public health insurance or a full private policy whose benefits match at least the statutory level. Expat tariffs, also called incoming tariffs, are private policies for people new to Germany; whether one is enough depends on the tariff and your situation.

For the entry visa, a travel policy that covers your trip is usually enough. The Blue Card salary and the threshold for private cover are two different numbers, as our guide to health insurance for the EU Blue Card explains. If your job pays above the threshold, you can take out full private cover before you move, so that it starts on your first working day. Whether and how depends on several factors, and we are happy to help: book a call.

How long can an expat tariff cover you?

Some expat tariffs can be kept for up to 60 months under certain conditions. An employee earning below the threshold is compulsorily insured in public cover from the first day of work, whatever other policy they hold.[1] Whether an expat tariff fits your situation, we check in a free call.

Public or private: which fits your first job in Germany?

For a single employee above the threshold, private cover costs less at every entry age in the table below.[8] Public cover charges about 11% of gross salary, including long-term care insurance, capped at around €648 a month in 2026.[9][10] Our calculator for public contributions works out your own figure.[11][2] An employee joining private cover at 30 pays about €250 to €300 a month after the employer's share.

A very good tariff pays for a single or double room and the senior consultant in hospital, refunds doctors' fees above the standard rate of the official fee scale and covers most dental work. Our page on private health insurance for expats in Germany shows how we find the tariff that fits you in a full market comparison, in English.

Self-employed people pay the full public contribution themselves, about 21% to 22% of their income, up to the maximum of around €1,261 a month. A private premium at 35 costs them about €400 to €550; which deductible fits your income is part of our comparison, and our page on PKV vs GKV for expats sets out the other differences.

The statutory 10% surcharge in a full private premium builds savings for old age.[12] It ends after the year you turn 60, which lowers the premium, and a premium-relief tariff can lower it further, as our guide to private cover in retirement shows. Private premiums are adjusted tariff by tariff, as our guide to premium increases explains, while the public maximum rises every year with the income ceiling.

What changes if your family comes with you?

In public cover, a spouse and children are insured at no extra cost through family insurance (Familienversicherung), as long as their own income stays below €565 a month in 2026.[13] In private cover each person has their own premium, about €200 to €250 a month per child in a very good tariff. A sole earner aged 35 with a spouse without income and two children pays about €230 to €665 a month less in public cover, as our comparison of households on a six-figure salary shows. Your employer's subsidy covers your children and a spouse without income too: half of their premiums, up to €613.22 a month in total, of which at most €508.59 for health cover.[8]

If one parent is in public and the other in private cover, the children usually join the public parent's family insurance at no cost. This changes for married parents: if the privately insured parent earns more than the other and more than €6,450 a month in 2026, the children need private cover.[13]

From 2028, public insurance adds 2.5 percentage points to the member's contribution rate for a spouse insured through family insurance, paid by the member alone. No surcharge applies while a child under 12 lives in the household or once the spouse reaches the standard retirement age, among other exceptions.[14] Private premiums are not affected by it. We calculate both systems for your household, including the 2028 surcharge: book a call.

Does your medical history from home count?

For private cover, yes. Private insurers' health questions cover treatment abroad as well as in Germany, and you have to answer them truthfully.[15] They usually go back about 3 years for outpatient treatment and 5 years for hospital stays and psychotherapy. Medical records from your home country help you answer them completely. An anonymous pre-inquiry shows what insurers would offer before anything is filed in your name.

A new private contract can have waiting periods of up to three months, and up to eight months for a birth, psychotherapy and dental treatment.[16] If the tariff provides for it, the insurer can waive them if you provide a medical certificate about your health.[17] Whether insurance from your home country counts towards them is up to the insurer, and it can depend on whether you are employed or self-employed. We clarify this with the insurer before you apply.

Insurers reply to a health assessment with acceptance, a risk surcharge, an exclusion or a decline. If no insurer accepts you, an insurer has to take you in the basic tariff (Basistarif), without surcharges and at a premium no higher than the maximum public health contribution.[18] Start with an anonymous pre-inquiry: we check the whole market for you.

What should you sort out in your first weeks?

Your employer needs proof of your health insurance to run payroll, while the address registration does not ask for it.[19] In compulsory public cover, the employer registers you with an insurer of its choice if you have not named one within two weeks of starting work.[20]

Your first weeks

• Register your address (Anmeldung) within two weeks of moving in.
• Choose private cover if your salary is above the threshold, or a public insurer, and give your employer the proof for payroll.
• Keep your expat tariff, travel policy or cover from home until the German cover starts, so there is no day without cover.
• Find a family doctor near you with our doctor booking page.
• Save 112 for emergencies and 116117 for the on-call medical service (emergency page).
• Set up your insurer's app and online account with our insurer portals guide.

What happens to your insurance if you leave Germany again?

In public cover, your membership usually ends when you move away and no longer work here. In private cover, an Anwartschaftsversicherung (dormant cover) holds your contract while you are away, for a fraction of the normal premium. The small version keeps your accepted health status; the large version also keeps your entry age and lets your ageing reserves, the savings built into the premium, keep growing. If you cancel instead, a later return means a new application with a health check at the age you are then.

Dormant cover pays no claims, so you need insurance in your new country. Switching between the versions later is usually not possible, so we help you choose the right one when you sign. If you come back under 55 with a job below the threshold, public cover becomes compulsory again; from 55, a return is possible only in exceptions, as our guide to switching back to public insurance explains. If you come back with a job above the threshold, the large version lets your private contract resume as if it had never paused.

How we calculated

Public figures use the 2026 values, the average additional contribution of 2.9% and the rates outside Saxony. Private figures are typical premiums for healthy employees in a very good tariff with a deductible of up to €600 a year, including long-term care insurance and the statutory 10% surcharge. The self-employed figure assumes a deductible of €600 to €1,200 a year. For the couple and the family, a child costs €200 to €250 a month. The employer pays half the premium, but for health cover at most €508.59 a month for the whole family, plus half of the private long-term care premium, assumed at €50 to €120 a month for both adults together (children are covered without a premium).