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 American and Canadian 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.