How does the healthcare system in Germany work?

Germany - the land of rules and bureaucracy. Of course, this also applies to the German healthcare system - but for the complexity, you also enjoy the care of one of the best healthcare systems in the world. 

But how exactly is it structured? What health insurances are there and how does the financing work, who pays for it? Whether you're new to Germany or have lived here all your life but are still confused about how exactly it works, you'll find the answers here - simply explained!

How is the healthcare system in Germany structured?

To summarize briefly in advance: the German healthcare system is based on the principle of solidarity. This means that everyone pays according to their income to ensure that everyone has access to healthcare services. However, you don't have to worry about this personally, the state or your workplace and health insurance company automatically receive a portion of your gross salary as long as you are employed. 

The aim of the state is to ensure that every person in Germany has access to health services - which is why every person in Germany must have health insurance. You will not be penalized if you enter Germany without health insurance - but you do run the risk of high additional payments. It is best to take care of this as soon as possible! 

Now to the basic structure of the German healthcare system: The German healthcare system consists of statutory health insurance (GKV) and private health insurance (PKV).

We'll explain the exact difference between these two types of health insurance in more detail in a moment. In a nutshell, you can remember the following: Statutory health insurance (GKV) is financed by income-based contributions paid jointly by employers and employees, which is regulated by the German state. Meanwhile, private health insurance (PKV) is financed individually through fixed contributions that depend on your age, state of health and scope of benefits.

In principle, the German healthcare system is very similar to that of other EU countries. Thanks to various agreements, it is also possible for EU citizens with statutory health insurance to be treated in other EU countries - unfortunately usually at little extra cost! For more information about working in Germany as an EU citizen, take a look at the articles on our website! 

Differences between statutory and private German health insurance

It's important to know that you can choose freely between the two systems - but you have to be insured under one of them. Below we show you the most important differences between statutory (GKV) and private health insurance (PKV) so that you can make the right decision for you.

Statutory health insurance (GKV):

• It covers around 90% of the German population. 
• When you immigrate to Germany, you will (very probably) first join the statutory health insurance scheme, as membership is easier to obtain. 
• Contribution dependent on income (approx. 14.6% of gross income).
• Family insurance: If a family member is insured, you can usually insure your spouse and children at no extra cost.
• Access to standard medical services such as visits to the doctor, hospital stays and medication.
• You can switch freely between statutory health insurance providers. 
• Examples of statutory health insurance providers: Techniker Krankenkasse (TK), Allgemeine Ortskrankenkasse (AOK), Barmer Ersatzkasse (Barmer), DAK-Gesundheit, IKK classic, Betriebskrankenkassen (BKK)
• You can find more information on statutory health insurance on the website of the Federal Ministry of Health, for example.  

Private health insurance (PKV):

• An option for high earners, the self-employed and civil servants. 
• To switch to private health insurance (PKV), you must exceed the annual income threshold (JAEG). This means you have to earn more than 73,800 euros gross per year (6,150 euros per month) - as of 2025. This is the income threshold for employees, while self-employed people, freelancers and civil servants can switch to private health insurance regardless of this.
• Premiums depend on age, state of health and chosen tariff.
• Individual additional services: Often more comfort, such as single rooms in hospital or specialized treatments.
• No family insurance: Each family member needs a separate contract.
• Examples of providers: Allianz, AXA, Debeka, Signal Iduna, HUK-Coburg

Switching from statutory to private health insurance is a personal decision that should be carefully considered. There is no obligation to switch to private health insurance, even if you meet the criteria. Which option suits you better depends on your individual situation and needs.

Important: Switching to private health insurance (PKV) is usually only worthwhile if you have a high income or special needs, as the premiums are calculated differently than in statutory health insurance (GKV).

• If you have a high income, private health insurance can be cheaper because the premiums are independent of income and are instead based on age, state of health and the chosen tariff.
• Private health insurance also offers individual benefits that go beyond the standards of statutory health insurance, such as treatment by specialists, shorter waiting times or comfort benefits such as a single room in hospital.

However, it should be noted that there is no family insurance in private health insurance and each family member needs their own contract, which can result in additional costs. In addition, premiums often increase with age. It therefore makes particular sense to switch if you are financially stable and the extended benefits are important to you in the long term.

Principle of benefits in kind: No advance payment as a statutory insured person

Another principle that is often mentioned in connection with health insurance companies is the principle of benefits in kind. In short, the principle of benefits in kind means that people with statutory health insurance receive medical services without having to pay in advance. This means that service providers - doctors, pharmacies, midwives, etc. - This means that service providers - doctors, pharmacies, midwives, etc. - bill the health insurance companies directly after your treatment. For example: You have statutory health insurance, go to your family doctor (who has statutory health insurance) and receive health insurance benefits there (e.g. consultation, diagnosis of typical illnesses, referral to a specialist, etc.). At the doctor's surgery, only your health insurance card is scanned and you leave the building without paying anything!

In summary, the principle of benefits in kind actually only means that you don't have to dig into your own pocket in advance to pay for treatment. A major advantage of statutory health insurance!

How is the healthcare system in Germany financed?

The German healthcare system is financed by:

• Contributions to health insurance: Employer and employee share the costs, usually deducted from the gross salary.
• State funding (indirectly through taxes): The state finances subsidies for family insurance or medical care for low-income earners, for example.
• Private contributions: For privately insured persons, the amount depends on the tariff.

Well, why make it so complicated? To keep the healthcare system affordable for everyone. If you want to delve deeper into the subject, the Federal Ministry of Health offers extensive information: The German healthcare system.

Free choice of doctor in Germany

Another practical tip for you: As a patient in Germany, you have a free choice of doctor. Whether it's a family doctor, specialist or clinic - you can decide for yourself who you go to. The only important thing is that the doctor is affiliated to the statutory health insurance scheme if you have statutory health insurance so that you don't incur any additional costs. In principle, however, you can also go to a private doctor if you have statutory health insurance (free choice of doctor!), but the treatment costs incurred there will not be covered by your statutory health insurance.

However, in Germany you don't need to be afraid of going bankrupt or not receiving treatment due to medical debt, as is the case in the USA, for example. Even private doctors are obliged to provide an emergency medical service if such a situation arises. One number you can memorize right away is 116117 - this number is the medical on-call service, which can advise you by phone at any time on any medical and related issues. 

As an employee, pay attention again: In the case of accidents at work, the choice of doctor is not unrestricted! In the case of serious accidents, you go directly to the nearest hospital - or you have the option of going to a transit doctor - usually specialists in orthopaedics and trauma surgery. Only in the case of (really!) minor accidents at work can you also go to a general practitioner / family doctor without any problems. You can find more information on what you need to do during and after an accident at work in our article.

Find your job in Germany with WorkerHero

To summarize: If you are part of the healthcare system in Germany - whether private or statutory - you will be treated safely and can estimate the costs with confidence. If you are new to Germany, WorkerHero is the perfect place for you to start your new life in Germany successfully! On our website you will find numerous articles to help you get started in everyday life and work in Germany: From the school system to dealing with German colleagues at work!

Are you already looking for a job in Germany? At WorkerHero you will find suitable vacancies for skilled workers in the blue- and grey-collar sector - for example as an electrician, HVAC plant mechanic, warehouse worker, production assistant or automotive mechatronics technician. Even if your German is not yet perfect, we will support you in successfully shaping your professional future in Germany. Take a look at our website now and find out more!