How healthcare works in Germany for foreign residents

Health insurance in Germany is compulsory, and it sits at the centre of how residents get medical care. You do not pay a doctor and claim later in most cases; you show an insurance card and the practice bills the insurer. For an American used to networks, deductibles and surprise bills, the system feels different in structure even when the medicine is familiar.

I lived and worked in Germany, and the general experience matched what the law describes: once you have an insurance card, routine visits are straightforward, and the main effort is finding a practice that takes new patients. This guide explains the two parts of the system, who belongs where, and how you actually reach a doctor.

Two systems: statutory and private

Germany has statutory health insurance (gesetzliche Krankenversicherung, GKV), run by public health insurance funds (Krankenkassen), and private health insurance (private Krankenversicherung, PKV), offered by private insurers.

Statutory insurance covers most residents. Contributions depend on income, not on age or health. Section 241 of Social Code Book V (SGB V) sets the general contribution rate at 14.6 percent of contributory income, and each fund charges a supplementary contribution on top. For employees, the employer pays part.

Private insurance sets premiums based on the tariff and the insured person's risk at the time of joining. It is open only to certain groups, mainly higher earners, self-employed people and civil servants.

Since Section 193 of the Insurance Contract Act (VVG) requires everyone resident in Germany to hold health cover, the question is not whether you are insured but in which system.

Who must join statutory insurance

Section 5 SGB V lists who is compulsorily insured. The most important group for Americans is employees: workers and salaried employees employed for pay are compulsorily insured. Other listed groups include people receiving unemployment benefit, artists and writers under the artists' social insurance scheme, and students in certain cases.

There is also a catch-all: Section 5(1) No. 13 covers people who have no other entitlement to cover in case of illness and were last insured under statutory insurance, among other conditions.

Who can choose

Section 6 SGB V exempts some people. Most relevant: employees whose regular annual earnings exceed the annual earnings limit (Jahresarbeitsentgeltgrenze) are free of compulsory insurance. The government sets that limit each year by regulation, adjusted in line with wage growth, so check the current figure with your fund or employer.

People who are free of compulsory insurance can often join voluntarily. Section 9 SGB V allows voluntary membership, for example for people taking up employment in Germany for the first time who are exempt because their earnings exceed the limit. Others can choose private insurance instead.

Self-employed people are not compulsorily insured as employees and usually choose between voluntary statutory and private cover, subject to the conditions for voluntary membership.

Choosing a fund

If you are in the statutory system, you choose your fund. Under Section 175 SGB V you declare your choice to the fund you have picked, and the fund may not refuse membership. Funds differ in supplementary contribution and in some extra services, while the core benefits are set by law.

Your employer will ask which fund you have joined, and the fund issues your electronic health card (elektronische Gesundheitskarte), which you show at every visit.

Family cover

One of the clearest differences from US-style plans is family insurance. Section 10 SGB V covers the spouse, registered partner and children of a statutory member at no extra contribution, if they live in Germany, are not insured in their own right, are not mainly self-employed and their regular total income does not exceed a set fraction of the reference amount in social insurance.

Private insurance has no equivalent: each family member is insured and pays separately.

Seeing a doctor

Free choice. Section 76 SGB V lets statutory patients choose freely among doctors and facilities admitted to statutory care. Other doctors may only be used in emergencies. You do not need to register with one GP, although a family doctor (Hausarzt) is the usual first stop.

GP-centred care. Section 73b SGB V obliges funds to offer GP-centred care (hausarztzentrierte Versorgung) as an option. If you enrol, you agree to see your chosen family doctor first and go to specialists through referral. It is voluntary.

Practices and appointments. Many practices take appointments by phone or online booking. In larger cities, finding a practice that takes new statutory patients can take time, so start looking soon after arrival.

The 116117 service. The national on-call service of the statutory health insurance physicians is reachable at 116117, around the clock and free of charge. Its website lets you assess symptoms, find on-call practices for evenings, weekends and public holidays, find doctors near you, and, for statutory patients, book appointments through its appointment service.

Emergencies. For life-threatening emergencies, call 112, the European emergency number, for an ambulance or fire service.

What you pay at the point of care

Statutory insurance has co-payments rather than deductibles. Section 61 SGB V sets the standard co-payment at 10 percent of the price, at least 5 euros and at most 10 euros, but never more than the cost of the item. That applies, for example, to many prescription medicines. Hospital stays have a co-payment of 10 euros per calendar day under the same section. Some services such as certain dental treatment involve larger contributions.

Private patients often receive a bill from the doctor and claim from their insurer, depending on the tariff.

English-speaking doctors

The US Embassy and Consulates in Germany publish lists of doctors and medical services by region. The embassy states that inclusion on the list is not an endorsement and that it cannot vouch for the information. The lists are a practical starting point for finding practices where English is spoken.

Prescriptions and pharmacies

Prescription medicines are dispensed by pharmacies (Apotheken). Statutory prescriptions are increasingly electronic and are read from your health card. Pharmacies take turns providing night and Sunday service, and the pharmacy door usually shows which one is open.

Bring a supply of any regular medication and a letter from your US doctor listing it by active ingredient, since brand names differ. A German doctor then issues new prescriptions.

Before you need care

1. Confirm whether you are compulsorily insured as an employee or must choose.
2. Join a statutory fund or take out private cover before or on your start date.
3. Register family members for family insurance if eligible.
4. Find a family doctor near your home.
5. Save 116117 and 112 in your phone.
6. Keep the embassy's medical provider list for English-speaking practices.

Common questions

Is health insurance mandatory in Germany? Yes. Section 193 of the Insurance Contract Act requires everyone resident in Germany to hold health cover, unless they are in statutory insurance or have comparable entitlements.

Can my spouse and children be covered without extra cost? In statutory insurance, yes, through family insurance under Section 10 SGB V, if they live in Germany and meet the income and other conditions. Private insurance charges for each person.

Do I need a referral to see a specialist? Not generally. Section 76 SGB V gives free choice of admitted doctors. A referral is required if you have enrolled in optional GP-centred care.

Who do I call when my doctor's office is closed? Call 116117 for the on-call medical service, available around the clock. Call 112 in a life-threatening emergency.