Health insurance in Germany is not optional. You cannot enrol at a university, register your address at the Bürgeramt, or extend a residence permit without proof of valid cover. It is one of the first things you must arrange — and one of the easiest to get wrong.
This guide explains the two systems, what each costs in 2026, and the one decision that is genuinely difficult to reverse.
The Two Systems
Germany runs a dual system:
- Gesetzliche Krankenversicherung (GKV) — statutory or public health insurance
- Private Krankenversicherung (PKV) — private health insurance
Which one you can join depends on your status: employee, student, self-employed, or civil servant — and on your income.
Public Health Insurance (GKV)
GKV is contribution-based rather than risk-based. Your premium is calculated from your income, not your age or health history. If you are an employee, your employer pays roughly half.
Key features:
- Pre-existing conditions are covered — no medical underwriting
- Non-working spouses and children can often be covered free of charge under family insurance (Familienversicherung)
- Contributions scale with income, so they fall if your income falls
- You can switch providers relatively easily
In 2026 there are more than 90 statutory funds to choose from. They all provide the same legally defined core benefits, but differ in their supplementary contribution (Zusatzbeitrag) and in extras such as dental cleaning subsidies or English-language service.
Private Health Insurance (PKV)
PKV is risk-based. Premiums depend on age, health status and the level of cover you select.
Who is eligible:
- Employees earning above the annual threshold (roughly €73,800–€77,400 gross depending on the measure used in 2026)
- Self-employed people and freelancers
- Civil servants
- Certain categories of student
Advantages: shorter waiting times for specialist appointments, broader benefit options, and potentially lower premiums when you are young and healthy.
The Decision You Cannot Easily Undo
This is the part that catches expats out, so we will be direct about it.
Switching from private back to public is legally restricted, and becomes very difficult with age. For people in normal employment situations, returning to GKV after 55 is practically impossible.
PKV premiums also rise as you age — precisely when your income may be falling. And unlike GKV, private cover does not include free family insurance: every family member is separately underwritten and separately charged.
So a private policy that looks cheaper at 28 with no dependants can look very different at 50 with two children. Take neutral advice before switching. This is not a decision to make on price alone.
Health Insurance for International Students
Students are treated as a special category, and the rules hinge largely on age.
Under 30 / Before Your 14th Semester
You generally qualify for subsidised public student insurance. In 2026 this typically costs in the region of €140–€160 per month including long-term care insurance, depending on the fund’s supplementary contribution.
Well-known funds include TK (Techniker Krankenkasse), AOK, Barmer and DAK. Coverage includes doctor visits, hospital treatment, prescriptions and mental health care.
Over 30, or in a Language/Preparatory Course
Subsidised student rates generally no longer apply. Private student policies become the practical option, and these vary widely — basic plans can start well below public rates, while comprehensive plans sit closer to them.
Be careful with very cheap private student plans. Low headline premiums frequently come with high deductibles (Selbstbeteiligung), dental exclusions, or caps on complex hospital treatment. Read the exclusions, not just the price.
EU Students
Your European Health Insurance Card (EHIC) may cover you, but it does not cover private providers, repatriation, or non-emergency dental work. For a full degree in Germany, enrolling in German public insurance from the start is usually cleaner.
What It Costs: Quick Comparison
| Situation | System | Typical 2026 cost |
| Student under 30 | Public (GKV) | Approx. €140–€160 / month |
| Student over 30 | Private (PKV) | Varies widely by plan and cover |
| Employee below income threshold | Public (GKV) | Income-based; employer pays about half |
| Employee above threshold | Public or private (choice) | Depends on age, health and cover |
| Self-employed / freelancer | Public or private (choice) | You pay the full contribution yourself |
Common Mistakes
- Leaving it to the last minute. You need proof of cover for your visa and enrolment. Arrange it before you travel.
- Choosing private purely on price. The cheapest option at 25 is rarely the cheapest across a working life.
- Assuming travel insurance is enough. It is not accepted for enrolment or residence purposes.
- Cancelling cover between jobs or courses. Gaps create real administrative problems. Continuous cover is required.
- Not checking whether your policy is university-accepted. Some private plans are not, and you will not discover this until enrolment.
Frequently Asked Questions
Is health insurance mandatory in Germany?
Yes. It is a legal requirement for all residents, and proof is needed for visas, university enrolment and address registration.
Can I switch from private back to public?
Only in specific circumstances — for example when your employment status changes, or your income falls below the threshold. It becomes considerably harder with age, and after 55 it is generally not possible in standard employment situations.
Does public insurance cover my family?
Often yes, at no extra cost, through Familienversicherung — subject to income limits for the dependants. This is one of the strongest arguments for GKV for anyone with a family.
What happens when I turn 30 as a student?
Subsidised student rates generally end and you will need to move to an alternative arrangement. Plan for this in advance rather than reacting to it.
We Help You Choose — and Enrol
Tejas Germany works with established insurance providers and helps candidates and students select appropriate cover, complete enrolment, and get the confirmation documents needed for visa and university purposes.
See our insurance support page, or read our guides to study costs in Germany and student tax refunds.
Book a free consultation and we will walk you through the options for your specific situation.
Note: contribution rates, income thresholds and student premiums are revised annually. Figures reflect 2026 and should be confirmed with the provider before enrolling. This article is general information, not individual insurance advice.
