Health insurance: mandatory, statutory, or private
The German version of this page has been changed, this translation has not. Please rely on the German page.
In Germany you need health insurance. This applies to everyone who lives here. There are two systems: statutory health insurance (Krankenkasse) and private health insurance.
Employees are generally automatically covered by statutory insurance. You choose a Krankenkasse (statutory health insurer). Your employer registers you. Contributions are deducted from your salary.
Students at a university are generally covered by statutory insurance if they are not older than 30.
Self-employed people are not automatically covered by statutory insurance. You need to arrange this yourself: voluntary statutory insurance or private insurance.
Spouses and children can be co-insured free of charge under certain conditions (Familienversicherung, family insurance).
Without health insurance you often will not get a residence title. Healthcare costs can become very high. Clarify this early.
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- Clarify which case applies to youEmployed, studying, self-employed, without income, family member? This determines whether you are subject to statutory insurance, can voluntarily join statutory insurance, or take out private insurance.
- As an employee: choose a KrankenkasseYou choose a statutory Krankenkasse and inform your employer. If you don't do so within two weeks of the insurance obligation starting, your employer registers you with a Krankenkasse (§ 175 Abs. 3 SGB V). You then receive a membership certificate from the Krankenkasse.
- As a student: register with the KrankenkasseWhen enrolling, you present proof of a statutory Krankenkasse. If you are under 30, the discounted student rate generally applies (§ 5 Abs. 1 Nr. 9 SGB V).
- As a self-employed person: arrange your own coverFull-time self-employed people are not subject to the insurance obligation under § 5 Abs. 5 SGB V. Ask a Krankenkasse about voluntary insurance, or choose a private tariff. Seek advice that is as neutral as possible.
- Check your family: family insuranceSpouses, civil partners, and children of statutorily insured people can be co-insured free of charge (§ 10 SGB V) if residence in Germany and the income threshold both fit. Ask the Krankenkasse of the insured family member.
- Keep your proof of insuranceYou need this proof for residence titles and extensions. Sufficient health insurance coverage is part of securing your livelihood (§ 2 Abs. 3 AufenthG).
- Under § 5 Abs. 11 SGB V, third-country nationals fall under the mandatory fallback insurance (Auffangversicherung) only if they hold a Niederlassungserlaubnis or an Aufenthaltserlaubnis with a term of more than twelve months, and its grant did not require proof of livelihood security under § 5 Abs. 1 Nr. 1 AufenthG. Otherwise, often only private insurance is an option.
- Private insurance: per DAAD information, switching to statutory insurance during your studies is not possible. Have the consequences explained to you before deciding.
- Family insurance has an income threshold (one-seventh of the Bezugsgröße, the statutory reference value). It does not apply for spouses who are full-time self-employed.
- Krankenkassen and insurers have their own interest in their tariffs. Get neutral advice where possible. No reliable, vetted Berlin advice point with an address was found in the available sources for this.
- No confirmed information is available on fines or back-payment of contributions for lacking insurance.
In depth · Legal basis, figures and practice – for counsellors and professionals
Basic principle
Under § 193 Abs. 3 VVG, everyone residing in Germany must take out illness-cost insurance for outpatient and inpatient medical treatment with an authorized insurer; deductibles are capped at an annual effect of 5,000 euros per calendar year. Statutory insurance is governed by SGB V. These rules are federal law; a Berlin-specific rule on the insurance obligation is not documented in the available sources.
Insurance obligation in the GKV (statutory health insurance, § 5 SGB V)
- Employees working for pay and people employed for vocational training: § 5 Abs. 1 Nr. 1 SGB V. If regular annual earnings exceed the annual earnings threshold (2026: 77,400 euros, 6,450 euros monthly; Verordnung über maßgebende Rechengrößen der Sozialversicherung für 2026), exemption from the insurance obligation applies (§ 6 Abs. 1 Nr. 1 SGB V). People newly employed above this threshold must notify their intent to join voluntary GKV insurance within three months (§ 9 Abs. 1 Nr. 3 SGB V).
- Students at state or state-recognized universities: § 5 Abs. 1 Nr. 9 SGB V, up to the completion of age 30 at the latest, after which only for particular reasons. Per DAAD information, the contribution for under-30s is around 120 to 130 euros monthly (DAAD, retrieved 26.09.2026; not an official tariff). EU students with statutory coverage in their home country can, per the DAAD, generally use the European Health Insurance Card (EHIC) as proof; for a side job or internship, home-country coverage is no longer sufficient.
- Fallback insurance (Auffangversicherung) (§ 5 Abs. 1 Nr. 13 SGB V): people with no other entitlement to cover in case of illness, who were last statutorily insured or had previously neither statutory nor private insurance, unless they belong to the full-time self-employed (Abs. 5) or those exempted under § 6 Abs. 1 or 2. For third-country nationals, § 5 Abs. 11 SGB V applies (see "Caution"). Anyone subject to statutory insurance under § 5 Abs. 1 Nr. 1 to 12, a voluntary member, or family-insured under § 10 does not fall under Nr. 13 (§ 5 Abs. 8a SGB V).
- Full-time self-employed people are exempted under § 5 Abs. 5 SGB V from the obligation under Abs. 1 Nr. 1 and Nr. 5 to 12. They insure themselves voluntarily in the GKV or privately.
Choosing a Krankenkasse and registration (§ 175 SGB V)
Insured people choose their Krankenkasse by declaration to the chosen Krankenkasse; the Krankenkasse may not refuse membership (§ 175 Abs. 1 SGB V). People subject to the insurance obligation must inform the registration office, generally their employer, which Krankenkasse they have chosen; if this is not done within two weeks of the insurance obligation starting, the registration office registers them with the last-chosen Krankenkasse or another designated one (§ 175 Abs. 3 SGB V). Per information from a Krankenkasse (AOK, retrieved 26.09.2026), a binding period of generally twelve months applies after the choice is made; this was not confirmed against the statutory text.
Family insurance (§ 10 SGB V)
Spouses, civil partners, and children of members are co-insured free of charge if they have their residence or habitual residence domestically, are not full-time self-employed, have no priority insurance of their own, and their total income does not regularly exceed one-seventh of the Bezugsgröße (reference value) per month. Children: up to age 18, up to age 23 if not employed, up to age 25 during school or vocational training or voluntary service, with no age limit for disability under the statutory conditions. The Bezugsgröße for 2026 is 3,955 euros monthly (Verordnung über maßgebende Rechengrößen der Sozialversicherung für 2026); one-seventh of that is roughly 565 euros. A separate threshold applies for marginal employment (geringfügige Beschäftigung); only a secondary source is available for this (603 euros from 2026), not checked against the primary text.
Private health insurance
Anyone who cannot be insured under the GKV must take out private insurance (§ 193 Abs. 3 VVG). Under § 193 Abs. 5 VVG, insurers must offer the Basistarif (basic tariff) to certain groups of people (an obligation to accept; the application must be accepted within certain statutory deadlines). For newcomers, a secondary source (krankenkassen.de, retrieved 26.09.2026) names sufficient means, good health, and an age under 60 as typical requirements for private insurance; this is not an official requirement. Whether an obligation to accept the Basistarif applies for a particular group of immigrants depends on the individual case; no confirmed information is available for this.
Residence law
Under § 2 Abs. 3 AufenthG, livelihood is considered secured when a person can cover it, including sufficient health insurance coverage, without recourse to public funds. Health insurance coverage is therefore relevant for many residence titles (details: pages in the "Erwerbsmigration" section, particularly on social insurance).
Not checked
Average supplementary contribution rates, contribution rates and specific contributions of individual Krankenkassen, artists' social insurance (Künstlersozialversicherung), obligations to pay back contributions for lacking insurance: no confirmed information is available for this.
- What is “Health insurance” about?
- Anyone living in Germany must have health insurance: statutory or private, depending on your job, studies, and residence title.
- Which deadlines and figures matter?
- 2 Wochen nach Beginn der Versicherungspflicht: Choosing a Krankenkasse and informing your employer; after that, the registration office registers you itself (§ 175 Abs. 3 SGB V)
- 3 Monate (Beginn je nach Fall: Aufnahme der Beschäftigung bzw. des Aufenthalts): Notification of joining voluntary statutory insurance: people newly employed above the insurance-obligation threshold; foreign nationals with a residence permit under § 18d Abs. 1 AufenthG (§ 9 Abs. 1 Nr. 3 und Nr. 6 SGB V)
- Bis zur Vollendung des 30. Lebensjahres (danach nur bei besonderen Gründen): Insurance obligation as an enrolled student (§ 5 Abs. 1 Nr. 9 SGB V)
- What should I do first?
- Clarify which case applies to you: Employed, studying, self-employed, without income, family member? This determines whether you are subject to statutory insurance, can voluntarily join statutory insurance, or take out private insurance.
- As an employee: choose a Krankenkasse: You choose a statutory Krankenkasse and inform your employer. If you don't do so within two weeks of the insurance obligation starting, your employer registers you with a Krankenkasse (§ 175 Abs. 3 SGB V). You then receive a membership certificate from the Krankenkasse.
- As a student: register with the Krankenkasse: When enrolling, you present proof of a statutory Krankenkasse. If you are under 30, the discounted student rate generally applies (§ 5 Abs. 1 Nr. 9 SGB V).
- What should I watch out for?
- Under § 5 Abs. 11 SGB V, third-country nationals fall under the mandatory fallback insurance (Auffangversicherung) only if they hold a Niederlassungserlaubnis or an Aufenthaltserlaubnis with a term of more than twelve months, and its grant did not require proof of livelihood security under § 5 Abs. 1 Nr. 1 AufenthG. Otherwise, often only private insurance is an option.
- Private insurance: per DAAD information, switching to statutory insurance during your studies is not possible. Have the consequences explained to you before deciding.
- Family insurance has an income threshold (one-seventh of the Bezugsgröße, the statutory reference value). It does not apply for spouses who are full-time self-employed.
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