How does Health Insurance Work in Germany?



Modified on: Thu, 11 Sep, 2025 at 12:48 PM

TABLE OF CONTENTS



Germany has one of the most robust and reliable healthcare systems in the world. For most employees, public health insurance (gesetzliche Krankenversicherung) is the default and highly recommended option.

Public Health Insurance: The Standard Choice

  • The vast majority of residents in Germany are covered by statutory public health insurance.
  • Employees earning below the annual income threshold (approx. EUR 69,300 gross in 2025) are automatically enrolled in the public system.
  • Employees must register with one of the statutory providers, such as:
    • AOK
    • TK (Techniker Krankenkasse)
    • Barmer
    • DAK
    • And others

Public insurance offers comprehensive coverage, is widely accepted, and ensures equal access to care across the country. It is:

  • Trusted by the majority of German residents
  • Offers broad coverage and access to top-tier healthcare
  • Seamlessly integrated with payroll and tax systems
  • No need for upfront payments or reimbursement claims

Private Health Insurance: Limited Eligibility

Only employees who:

  • Earn above the income threshold
  • Are self-employed
  • Are civil servants

may opt out of the public system and choose private health insurance.

If eligible, employees may select their own private provider. However, Horizons cannot recommend or dictate the choice of insurer.

How Contributions Work

Germany’s system does not allow for simple reimbursement of private premiums via payroll.

Instead:

  • Employers pay their share of the statutory contribution directly to the insurer.
  • Employee contributions are withheld from salary at source.
  • This applies to both public and private insurance arrangements.

What Employees Need to Do

  • Register with a health insurance provider (public or private, depending on eligibility).
  • Horizons will then set up payroll contributions correctly, ensuring compliance with German regulations.

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