Health insurance in Germany

Health insurance is based on a “multi-payer healthcare system” that operates in two tiers: publicly funded, statutory health insurance, and private insurance. The public tier is made up of around 100 Krankenkassen, or "sickness funds", which are partially funded by the government. The latter is the private healthcare network, which takes no government funding.

You will need health insurance to obtain a visa. The German consulate requires it.

If you’re employed or have signed an employment contract in Germany, you can choose between public and private health insurance.

If you’re not employed in Germany, expat insurance is your best option because signing up for public or private insurance without employment is almost impossible.

Your health insurance options as an unemployed individual depend on where you’re currently employed.

If you're insured in the EU/EEA, Switzerland, or the UK, you can either:

1. Stay on your home insurance: Use your EHIC/GHIC card until you find work or move your permanent residence in Germany to avoid the €240 monthly fee. You should confirm coverage with your current health insurance provider.

2. Sign up for public health insurance: If moving your residence or your home country’s insurance won’t cover you, you could pay around 19% of your earnings, with a minimum of €240 per month.

3. Sign up for expat health insurance: It is more affordable than public or comprehensive private insurance, but remember that it is a temporary solution and provides limited coverage.

If you're not insured in the EU/EEA, Switzerland, or the UK, you should sign up for expat insurance. It meets the legal requirements for a Chancenkarte (the new job-seeking visa) and provides basic coverage.

Health insurance premiums increase a little with age. Private insurance premiums have risen on average around 3.3% a year since 2014, while public insurance premiums have risen by around 2.8% annually in the same period.

They cannot simply increase the premium, though—they must justify the increase and comply with the law to get an increase approved.

Once you register for a policy, your insurer may not increase your premiums based on changes to your health status or age.

Expat health insurance pricing remains stable until age 65, at which point it increases to a new set amount (€258 for the basic policy or €408 per month for the premium policy). This remains the same until the age limit of 75 is reached.

Public health insurance will never exclude you based on pre-existing conditions. Your insurance will cover any pre-existing conditions if you can join a Krankenkasse or public health insurance provider.

Private health insurance does discriminate based on pre-existing conditions. Based on your medical history form, you could experience either:

1. Risk surcharges (a price increase): It's applied if further treatment is likely, like for a permanently injured knee, or if other health issues are likely to arise. Risk surcharges may be combined with exclusions.

2. Exclusion of coverage (a reduction in coverage): You benefit from a low monthly cost and pay out of pocket for treatments related to your existing condition, like replacing a missing tooth.

3. Denial of coverage (your application is refused): Coverage may also be denied for some diagnoses or if treatments are planned or ongoing.

4. Full coverage at the lowest possible cost (nothing changes): Not all conditions result in changes! And most of the time, you can even save some money compared to public health insurance, which is often more expensive.

Expat health insurance does not cover medical needs related to pre-existing conditions or chronic illnesses. If you get treatment for pre-existing conditions, you’ll have to pay out of pocket.