German healthcare is excellent and insurance is legally mandatory. But if you arrive after your 55th birthday, the public system is usually closed to you — which makes insurance the biggest number in your German budget. Plan around it, honestly.
Figures verified 8 July 2026About 90% of Germans are in statutory insurance (GKV) — income-based premiums, no health questions, family members often covered free. The rest hold private insurance (PKV) — risk-rated premiums, richer amenities. Newcomers slot into one or the other. The rule that decides your fate: if you're 55 or older and haven't been in the German (or another EU/EEA) statutory system recently, GKV is generally barred. US and Canadian coverage — Medicare, provincial health plans — does not count. Most expat retirees therefore land in PKV or specialist expat cover, at age-rated prices. The full guide →
Germany spends more on health than almost any country in Europe, and it shows: dense specialist networks, modern hospitals, short waits by Canadian standards, and free choice of doctor. You register with any GP (Hausarzt) — no catchment areas, no waiting list to get a doctor. Specialists can be seen directly, though a GP referral smooths it. English-speaking doctors are common in big cities; the KV (regional physicians' association) directories filter by language.
| Stage | What you need |
|---|---|
| Visa application | Proof of health cover for the stay; travel policies only bridge the trip — the consulate wants to see a plan for substantive German cover. |
| Residence permit | Insurance "at statutory level" — a full PKV or GKV policy, or approved expat cover accepted by your Ausländerbehörde. Cheap incoming policies are increasingly rejected. |
| Settled resident | GKV or PKV, permanently. Switching between systems is heavily restricted — especially past 55. |
The over-55 rule, the narrow exceptions, real PKV prices at 60+, and the decision tree before you move.
Read the guide →KV directories, big-city practices, and how appointments actually work.
What happens to your US Medicare when you leave, and why most people keep Part A.
Most visas require proof of cover before you apply. We'll match you with an expat health insurance specialist we've independently vetted for Germany. Free, no obligation.