Germany runs a universal healthcare system where every resident is legally required to have health insurance. About 90% of the population is covered through statutory (public) health insurance, while the remaining 10% hold private policies. The system is built on a principle the Germans call “solidarity”: contributions are based on income, but everyone receives the same standard of care regardless of how much they pay in.
Statutory vs. Private Insurance
The two pillars of German healthcare are Statutory Health Insurance (known as GKV or SHI) and Private Health Insurance (PKV or PHI). Most people don’t get to choose between them. If you’re employed and earn below a specific income threshold, you’re automatically enrolled in statutory insurance. In 2025, that threshold is €73,800 per year. Earn above that amount and you can either stay in the statutory system voluntarily or switch to private insurance.
Civil servants, the self-employed, and freelancers can also opt for private coverage regardless of income. Non-EU citizens who aren’t employed in Germany, such as those on a jobseeker visa, are required to take out private insurance, often at special expat rates.
The practical difference between the two systems goes beyond price. Statutory insurance pools risk across all members. A 25-year-old marathon runner pays the same percentage of income as a 60-year-old with chronic illness. Family members, including non-working spouses and children, are covered at no additional cost. Roughly 16 million people in Germany are co-insured this way as dependents. Private insurance, by contrast, prices policies based on individual health risk and age, and each family member needs a separate policy.
What Statutory Insurance Covers
The statutory benefit package is broad. It includes doctor visits, hospital care (inpatient and outpatient), mental health care, dental checkups and basic dental treatment, physical therapy, prescription drugs, medical aids, rehabilitation, preventive screenings, immunizations, hospice and palliative care, and sick leave compensation. Psychotherapy is fully covered, though wait times for an initial appointment can stretch to several months depending on the region.
Certain dental services fall outside the standard package. Basic checkups and fillings are covered, but cosmetic procedures and some prosthetic work typically require supplemental insurance or out-of-pocket payment. Many Germans buy small private add-on policies specifically for dental and vision care.
Decisions about what the statutory system covers are made by the Federal Joint Committee (Gemeinsamer Bundesausschuss, or G-BA), an independent body that sets binding rules on everything from which drugs are reimbursed to which diagnostic procedures qualify for coverage. Its directives shape the care available to roughly 70 million people.
How Much You Pay
Statutory health insurance is funded through payroll contributions, split evenly between employee and employer. The general contribution rate is set nationally and applies to all statutory funds. On top of that, each insurance fund charges its own supplementary rate. TK, one of Germany’s largest funds, set its supplementary rate at 2.69% for 2025. Combined, most employees see roughly 15 to 16% of their gross salary go toward health insurance, with their employer covering half.
If you’re self-employed and in the statutory system, you pay the full contribution yourself, which makes it significantly more expensive. This is one reason many freelancers in Germany opt for private insurance, at least while they’re young and healthy.
Out-of-Pocket Costs
Co-payments in the statutory system are modest. Prescription medications cost between €5 and €10 per item. A hospital stay carries a €10 per day charge for accommodation and meals. Children and teenagers under 18 pay no co-payments at all for prescriptions. There are annual caps on total out-of-pocket spending, set at 2% of gross household income (1% for people with chronic conditions), after which further co-payments are waived for the rest of the year.
How Doctors Get Paid
Germany uses two entirely separate fee systems depending on whether a patient is publicly or privately insured. For statutory patients, doctors bill under a points-based schedule called the EBM. Each service is assigned a point value, and each point is worth roughly €0.12. Many tests and consultations are bundled into flat-rate packages, which keeps reimbursement predictable but relatively modest. A routine blood glucose test, for example, reimburses about €0.25.
For privately insured patients, doctors use a different fee schedule called the GOÄ. This system also assigns point values, but doctors can apply a multiplier (usually between 1.0 and 2.3 times the base rate) depending on the complexity of the case. The result is that doctors earn substantially more per visit from private patients. This creates a well-known two-tier dynamic: privately insured patients often get faster appointments and more attentive service, not because their care is medically different, but because they’re more financially rewarding to treat.
Choosing a Doctor or Hospital
Germany gives patients considerable freedom in choosing their providers. You don’t need a referral to see a specialist under statutory insurance, though some insurance funds offer bonus programs if you route care through a general practitioner first. You can also choose your hospital for planned procedures. The country has a dense network of providers: Germany has more hospital beds per capita than most European countries, and the mix of public, nonprofit, and private hospitals creates real competition.
The 2025 Hospital Reform
A major restructuring of hospital care took effect on January 1, 2025, under the Hospital Care Improvement Act. The reform tackles a long-standing problem: Germany has many hospitals, but their quality and specialization vary widely. The new law introduces 65 defined service groups (such as stroke units or general internal medicine), and hospitals must meet specific staffing and equipment requirements to qualify for each one.
The financing model is also changing. The old system relied heavily on per-case payments (DRGs), which incentivized hospitals to maximize patient volume. The new model blends flat fees, nursing staff costs, and residual per-case payments, aiming to reward quality over quantity. A €50 billion transformation fund, available from 2026 through 2035, will help hospitals invest in meeting the new standards, merge with other facilities, or convert into a new type of hybrid care center.
These hybrid facilities, called intersectoral care centers, are designed especially for rural areas where a full hospital may not be sustainable. They’ll combine outpatient physician care, day surgery, short-term inpatient stays, and geriatric services under one roof, keeping essential medical access in smaller communities that might otherwise lose their local hospital entirely.
Insurance for Newcomers and Expats
If you’re moving to Germany, you’ll need proof of health insurance to complete your residence registration and, in many cases, to obtain a visa. For the first few days or weeks before your German coverage kicks in, international travel health insurance can bridge the gap. Once you start employment, your employer will enroll you in a statutory fund unless your salary exceeds the opt-out threshold. You can choose which of the roughly 100 statutory funds to join, and switching between them is straightforward.
Citizens of EU and EEA countries may have temporary coverage through their European Health Insurance Card, but this is not a substitute for enrolling in a German fund once you’re a resident. Non-EU nationals who arrive without employment, such as those on student or jobseeker visas, will need to arrange private coverage. Several insurers offer packages specifically designed for expats at lower rates than standard private policies, though these often come with more limited benefits.