Moving to Germany means adapting to a healthcare system that is mandatory, comprehensive and largely cashless at the point of use.
For Americans, the biggest shift is moving from an employer-centric, market-priced model to a legally mandated system where your insurance status follows you, not your job.
This guide explains the essentials, the key differences from the US, and the practical steps to get covered properly.
Disclaimer
This guide provides general information only. It is not advice. German health insurance eligibility and requirements depend on your status, income, age and medical history. Always seek personalised advice before making decisions about SHI/PHI, visas or coverage for you and your family.
German Healthcare Explained
The German healthcare system is a combination of both public and privately funded services.
Statutory Health Insurance (SHI / Gesetzliche Krankenversicherung, “GKV”)
- Public, non-profit funds (“Krankenkassen”) provide broadly similar benefits.
- Contributions are income-based (up to a capped level) and shared by employer and employee.
- Most residents are in SHI.
Private Health Insurance (PHI / Private Krankenversicherung, “PKV”)
- Risk-based, individually underwritten policies from private insurers.
- Premiums depend on age, health, benefits and deductibles.
- Access is restricted to certain categories (e.g. employees above the annual income threshold, self-employed, some civil servants).
Coverage scope
Both systems cover primary care, specialists, hospital treatment, prescriptions, preventive care and maternity. Many people add supplemental insurance for extras such as private hospital rooms, dental upgrades or alternative therapies.
Long-term care insurance (Pflegeversicherung)
This is mandatory alongside health insurance (statutory or private) and funds support if you need medium- to long-term care. It is often administered by your health insurer and is not the same as standard medical cover.
Cashless access with your eGK
Once insured, you receive an electronic health card (eGK). You show it at the doctor’s surgery or hospital and the insurer is billed directly. You may still pay small co-payments (e.g. some prescriptions or dental work), but there is no US-style “surprise billing”.
How German healthcare differs from the US
Insurance is legally mandatory, not optional
In Germany, you must have continuous health insurance. Gaps can lead to back-dated premiums. In the US, coverage can lapse between jobs without immediate legal consequences; in Germany, it cannot.
Funding and pricing
- Germany (SHI): Income-linked contributions up to a cap; benefits are broadly standardised. Your employer pays roughly half your contributions if you are employed.
- US: Premiums vary widely by employer plan or individual market, with deductibles, co-insurance and out-of-pocket maximums that can be substantial.
Coverage when changing jobs
- Germany: Your insurance is yours. Change jobs and your cover continues (employer cost-share adjusts).
- US: Insurance is often tied to the employer; job changes can trigger plan changes, COBRA or marketplace transitions.
Access to healthcare and referrals
- Germany: You typically choose a Hausarzt (family doctor) who coordinates care and referrals to specialists. You can often self-refer to certain specialists, but the GP-gatekeeper model is common and valued.
- US: PPOs often allow broad self-referral; HMOs rely more on PCP referrals. Network design drives a lot of the access differences.
Hospitals and emergency care
- Germany: Not-for-profit and public hospitals are the norm, with standardised tariffs. Emergency number is 112. Admission is based on medical need, not ability to pay at the door.
- US: Hospital systems are mixed, with pricing and in-network status central to cost and access.
Out-of-pocket costs
- Germany: Predictable co-pays (e.g. for certain prescriptions, medical aids). No large deductibles in SHI. Private policies can include deductibles but are agreed up-front.
- US: Deductibles and co-insurance can be high; out-of-network charges can be unpredictable.
Family coverage
- Germany (SHI): Non-earning spouses and children can often be covered at no additional premium via family co-insurance (subject to rules). This surprises many Americans.
- US: Family coverage typically increases premiums substantially.
Long-term care
- Germany: Mandatory long-term care insurance sits alongside health insurance.
- US: Long-term care cover is usually separate and optional, with high costs if uninsured.
Private insurance works differently
- Germany: PHI is medically underwritten, age-rated and contractually detailed. Re-entering SHI after moving to PHI can be difficult. You must think long-term.
- US: Private insurance is often employer-sponsored and community-rated in ACA markets, with different switching constraints.
Choosing between SHI and PHI as an American
Who must join SHI?
Employees under the statutory annual income threshold are generally compulsory members of SHI. Students, many trainees and certain other groups also fall into SHI by default.
Who can choose PHI?
Employees over the annual income threshold, the self-employed and some public servants can opt for private cover. This decision has long-term consequences for premiums, family cover and your ability to return to SHI later.
Key considerations
- Family situation: SHI’s free family co-insurance can be cost-effective. PHI usually requires separate premiums for each family member.
- Income trajectory and age: PHI premiums reflect risk and benefits; they may be attractive when young and high-earning but can rise over time.
- Returning to SHI: Once fully private, returning to SHI can be restricted, especially after age 55. Treat the PHI decision as semi-permanent.
- Existing conditions: PHI is medically underwritten; disclose fully. SHI does not exclude pre-existing conditions.
Common Healthcare Questions from Americans Moving to Germany
Do I need insurance before my visa is approved?
Yes. For most long-stay visas and residence permits, proof of comprehensive, recognised health insurance is required.
Can I use US insurance in Germany?
Generally no. US plans rarely meet German residency requirements and are impractical for day-to-day care. You need German-recognised coverage.
What if I’m on a short assignment?
Your employer may arrange compliant cover. Verify it meets German legal standards and includes long-term care or equivalent arrangements.
Can I keep my US doctors?
Routine transatlantic care is impractical. Bring records, then transition to a German GP and specialists. Telehealth with US providers may be useful for context, but prescriptions and referrals must follow German rules.
What about dental and vision?
Basic dental is included in SHI with co-pays. Many residents add supplemental dental insurance for higher-end treatments. Vision aids have limited standard coverage; check your policy.
How do emergency services work?
Dial 112 for emergencies. Out-of-hours primary care is available via local medical on-call services; pharmacies operate a rota for night/weekend coverage.
Practical checklist
Pre-departure
- Confirm which path fits you: SHI vs PHI (and eligibility).
- Gather medical records, vaccination proof and medication lists.
- Arrange visa-compliant health insurance that covers your arrival period.
- Budget for long-term care insurance alongside health cover.
- Obtain preliminary quotes (Krankenkassen or private) and understand family implications.
Week 1–4 in Germany
- Complete Anmeldung (address registration).
- Finalise SHI enrolment with your chosen Krankenkasse or complete PHI underwriting.
- Provide insurance confirmation to employer/immigration office.
- Ensure long-term care insurance is active.
- Nominate a Hausarzt, learn local emergency and out-of-hours options.
- Set up direct debit and await your eGK.
Month 2–3
- Transfer prescriptions and update treatment plans with your GP.
- Add supplemental cover if needed (dental/hospital upgrades).
- Check family co-insurance status or private policies for dependants.
Get a German Health Insurance Quote
Sorting your German health insurance doesn’t need to be complicated. Our trusted partner, Feather Insurance, specialises in helping internationals secure the right cover in Germany, whether you need statutory, private, or supplemental insurance.
With Feather, you can:
- Get an instant, obligation-free quote online.
- Compare statutory and private options side by side.
- Ensure your insurance meets visa requirements and German legal standards.
