Social security and health insurance

Germany-US social security agreement (1979) and mandatory health insurance.

Social security agreement

• A Germany-US social security (totalization) agreement is in force since 1 December 1979 (German Foreign Office and DRV country lists; DRV; US side: SSA).
• Combining periods: insurance periods in both countries can be added up to meet minimum periods for a pension (the German Foreign Office states this for German pensions).
• Posting (Entsendung): posted workers stay in their home system for up to 5 years. The agreement covers pension insurance. Anyone exempted from it has also been exempt from German health and long-term-care insurance since 1 May 1996 (Final Protocol No. 5e; SSA). Certificate procedure not verified.
• Pension amounts: each country pays according to its rules. Details on benefits abroad not covered.

Health insurance is mandatory

• Everyone living in Germany needs health insurance. Employees below an income threshold are insured in statutory health insurance (§ 5 SGB V; text). Above the threshold, self-employed and some others may choose private insurance; the 2026 threshold was not verified.
• For the residence permit you must show cover. A US policy usually does not suffice: it often lacks the German minimum scope or is not valid long-term; the authority checks. Medicare in general does not pay for care abroad. Check with the LEA and the insurer.
• Students: statutory insurance or private; student rates not verified. Families: co-insurance of spouse and children in statutory insurance depends on income; see the fund.
• Freelancers and artists: Freelance (KSK).

Information: Make it in Germany: health insurance.