Healthcare in Germany — public, private, and how to use them
German healthcare is mandatory: every resident must have insurance. The split between gesetzliche Krankenversicherung (public, GKV) and private Krankenversicherung (PKV) is one of the most important early decisions you make. Public is broad, simple, and almost always the right choice for newcomers — but the path is not symmetric.
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- Coverage
- Mandatory — public (GKV) or private (PKV)
- Public contribution
- ~14.6% of gross salary, split with employer
- Emergency
- 112 — fire/ambulance
- Non-urgent advice
- 116 117 — 24/7
GKV vs PKV — the key first decision
Public insurance (gesetzliche Krankenversicherung, GKV) is income-based: roughly 14.6% of gross salary plus a small additional contribution (Zusatzbeitrag, 0.9–2.0% depending on insurer), split between you and the employer. There is a contribution ceiling (€5,512.50/month in 2026) — earnings above it are not subject to GKV contributions. Family members (non-working spouse, children) are covered free.
Private insurance (PKV) is risk-based: rates depend on age, health history, and chosen coverage level. PKV can look cheaper for young, healthy, high-earning singles (€300–500/month), but rates rise sharply with age — the same plan can cost €700–1,200/month at 60+. Family members are insured separately and pay separately.
Above the threshold (€73,800/year gross in 2026) employees can opt out of GKV into PKV. The catch: re-entry into GKV is heavily restricted once you leave. For most newcomers, including high earners with families, GKV is the right default.
Picking a public Krankenkasse
Public Krankenkassen (insurers) compete for members but offer effectively the same legally-mandated catalogue of services. The differences are mostly in the Zusatzbeitrag (additional contribution), customer service, app quality, and a few optional extras (alternative-medicine reimbursements, health-app subsidies, childbirth bonuses).
Major public insurers: Techniker Krankenkasse (TK), Barmer, AOK (regional — different ones per state), DAK-Gesundheit, BKK and IKK insurers (originally for specific industries, now mostly open). TK is the most popular among urban professionals; AOK has strong regional presence; specialised BKKs (BKK Mobil Oil, hkk) sometimes have lower Zusatzbeiträge.
Find a Hausarzt and use the system
Your Hausarzt (general practitioner) is the gateway to most care: routine check-ups, prescriptions, sick notes (Krankschreibung / Arbeitsunfähigkeitsbescheinigung), referrals to specialists. Choose one near home; you can switch any time. Booking via Doctolib, Jameda, or directly is now standard; same-week appointments are typical at non-popular practices, multi-week waits at popular ones.
Specialists (Facharzt) for some specialties (gynaecology, paediatrics, ophthalmology) can be visited directly without a Hausarzt referral. Others (cardiology, dermatology, orthopaedics) usually need a Überweisung (referral) from your Hausarzt or a Facharzt. Wait times for popular specialists in big cities can stretch to 2–4 months for routine appointments.
Notdienst and 116 117
116 117 (the Kassenärztlicher Bereitschaftsdienst) is the right first call for medical situations that need attention but are not life-threatening, especially evenings, weekends, and holidays. The line is staffed 24/7 by physicians and call advisors, free from any phone.
116 117 dispatches an on-call doctor (Hausbesuch), directs you to the nearest open emergency surgery (Notdienstpraxis), or — when needed — sends an ambulance. The Krankenhaus-Notaufnahme (hospital ER) is for life-threatening emergencies; routine evening illness goes through 116 117 first to avoid 4–8 hour ER waits.
Prescriptions and the Apotheke
Prescription drugs are sold only at Apotheken (green plus sign). Most prescriptions are now electronic (E-Rezept) — the doctor sends it to your insurance app and you redeem at any Apotheke with your health-insurance card or a QR code. Paper prescriptions still work where the rollout is incomplete.
Co-payment for prescription drugs is 10% of the price, minimum €5 and maximum €10 per item, capped at 2% of annual gross income (1% for chronic illness). Children under 18 get free prescriptions; adults on low income can apply for an annual exemption.
Dental and vision — basic public, top-up private
Public health insurance covers basic dental: 1 routine check-up every 6 months free, basic fillings (amalgam or simple white), root canals (with restrictions), and a fixed-amount subsidy toward crowns and dentures. Aesthetic and premium options (white fillings on back teeth, ceramic crowns, implants) are paid out of pocket or via a Zahnzusatzversicherung (dental top-up insurance, €5–25/month).
Vision: a routine eye exam at an Augenarzt is covered if there is medical reason (changing prescription, headaches). Glasses and contact lenses are paid out of pocket — Fielmann, Apollo, and online retailers (Mister Spex, Brille24) compete on price. Adult prescription eyewear is rarely covered; specific medical conditions trigger partial coverage.
Mental health — coverage and waiting times
Public health insurance covers psychotherapy (Psychotherapie) with licensed therapists — typically up to 80 sessions for behavioural therapy, 100+ for analytical. The catch is access: waiting lists for new patients can stretch 3–6 months in big cities. The Psychotherapeutenkammer maintains a search tool for therapists with open slots.
For acute crisis, 112 dispatches mental-health crisis teams in many cities; the Telefonseelsorge (0800 111 0 111) provides 24/7 anonymous phone counselling free. Online platforms like Selfapy and the apps subsidised by your Krankenkasse (DiGA — digital health applications) bridge the gap while you wait for in-person therapy.
Maternity care and parental support
Maternity care in Germany is well-funded: free pre-natal check-ups, midwife visits before and after birth (Hebamme — book one early in pregnancy as the supply is tight), free birth in a hospital, and Mutterschutz (paid maternity leave) covering 6 weeks before and 8 weeks after birth at full salary. Elternzeit (parental leave) extends to 36 months with Elterngeld (parental benefit) covering 65–67% of net salary for 12–14 months.
After birth, the Krankenkasse covers paediatric checkups (U-Untersuchungen), vaccinations, postnatal physiotherapy, and lactation consulting. The Familienkasse pays Kindergeld (€255/month per child in 2026) — a universal child benefit, not means-tested.
Further reading
Other guides for this country
Frequently asked questions
I just arrived — when must I have insurance?
From day one of legal residence. Visa applications usually require proof of insurance for the period covered. Once employed, your employer registers you with their default Krankenkasse and contributions start the first day of the contract. If you arrive ahead of a job, take out a short-term private travel-insurance plan until you can register with a public Krankenkasse.
Can I see specialists without a referral?
For some — gynaecology, paediatrics, ophthalmology, dentists — yes. For most others (cardiology, dermatology, orthopaedics, neurology) you typically need an Überweisung from your Hausarzt or another Facharzt. The Krankenkasse refunds the visit either way, but a referral helps the specialist understand the context.
Is private insurance worth it for me?
Most newcomers should stay in public. Private looks attractive for young, healthy, single high-earners — but rates rise with age, family members are insured separately, and re-entry to public is restricted. Couples planning children, anyone with chronic conditions, and most professionals over 35 are usually better off in public.
How fast does a Hausarzt appointment take to book?
Highly variable. Same-week or even same-day urgent slots are typical at non-popular practices. Routine appointments at popular practices in big cities can run 2–6 weeks ahead. The 116 117 service can also book a guaranteed appointment within 4 weeks via the Terminservicestelle.