Just Moved to Germany with Your Family?
Sorting schools and housing is only part of the relocation journey—getting the right health insurance for your family is just as critical. Whether you’re here for work, study, or long-term residence, understanding your insurance options will help you avoid costly mistakes and ensure proper medical care.
What Expats Need to Know
Health insurance is mandatory in Germany for all residents, including expatriates and their families. The country operates a dual system consisting of public (GKV) and private (PKV) insurance, and the rules for family coverage vary significantly depending on the system you choose.
Why It Matters
Your insurance choice impacts not only your healthcare access but also visa approvals, school enrollment for your children, and your overall financial stability. Making an informed decision is vital, especially when navigating a foreign healthcare system with your loved ones in mind.
Key Concepts and Definitions
Germany’s Health Insurance System
- GKV (Statutory Public Insurance): Contributions are based on income and typically cover non-working spouses and children at no additional cost.
- PKV (Private Insurance): Premiums are calculated individually based on age, health, and chosen coverage. Each family member must have their own policy.
Family Eligibility Criteria
- Covered Family Members: Spouses and dependent children, including adopted and stepchildren, are usually eligible.
- Residency Requirements: To be insured under GKV as dependents, family members must live in Germany.
Historical and Legal Background
The Path to Mandatory Coverage
Since 2009, all residents in Germany are legally required to have health insurance. EU and non-EU citizens alike must prove adequate health insurance coverage to obtain or renew a residence permit.
Reforms and International Agreements
Germany has agreements with several countries (e.g., USA, UK, Canada) to avoid double insurance and facilitate transitions. However, EHIC cards from the EU only cover short stays and are not valid for long-term coverage.
Your Options Today
Public Providers That Support Expats
Many GKV providers offer English-language services and digital tools for newcomers:
- Techniker Krankenkasse (TK)
- AOK
- Barmer
These often allow free family coverage for spouses and children.
Private Insurance Choices
Popular private insurers with expat-tailored offerings:
- Ottonova: Fully digital with English service
- Allianz: Strong reputation and family plans
- Debeka: Known for competitive family coverage
Private insurers require separate policies for each family member and may charge based on health status.
Pros and Cons
GKV Benefits
- Free dependent coverage
- Comprehensive maternity and pediatric care
- No health screening or exclusions
PKV Benefits
- Faster access to specialists
- Enhanced hospital services and private rooms
- Customizable plans for dental, vision, etc.
The Challenges
With GKV
- High contributions for low-income self-employed expats
- Family members abroad may not qualify for free inclusion
- Wait times for certain specialists
With PKV
- Premiums rise with age
- Costs add up quickly when insuring multiple family members
- Difficult to switch back to GKV later
Best Practices for Expat Families
How to Choose Wisely
- Evaluate your employment status, income, and long-term plans
- Consider language support and customer service availability
Enrollment Tips
- Prepare documents: residence permits, passports, birth/marriage certificates
- Consider using an expat broker like Feather or Getsafe for streamlined onboarding
Cost Optimization
- Use income-based GKV discounts where applicable
- Take advantage of tax deductions for private premiums
- Choose higher deductibles for lower monthly PKV payments
Case Studies
Public Insurance: Family of Four
- Enrolled with TK
- Working parent, spouse and two children covered at no extra cost
- Navigated system with English support
Private Insurance: Dual-Income Couple
- Both parents in PKV, children added as separate contracts
- High service quality but higher monthly expenses
Transition Phase: Temporary Plan
- Used Cigna for initial 6-month period
- Switched to GKV upon obtaining residence permits
Overlooked Issues
Parental Leave Considerations
- GKV continues full coverage during maternity or paternity leave
- PKV may require continued premium payments during time off
Insurance and Visas
- Proof of full family insurance is required for most residence permits
- Rejected or inadequate insurance can delay or block family reunification
Addressing Common Concerns
Can I Add My Family to My Insurance?
- Only possible under GKV, and only if income and residence criteria are met
- PKV requires separate contracts for each person
Isn’t Private Insurance Always Better?
- Not necessarily for families: cost increases with each member
- Public insurance may be more affordable long-term
We’re Only Here for a Year—Do We Need Full Insurance?
Yes. Short-term stays still require valid insurance. Consider approved expat plans that satisfy visa requirements.
Alternative Solutions
Expat-Focused Platforms
- Feather, Getsafe, and Ottonova offer expat-friendly onboarding, English support, and digital administration
Short-Term International Plans
- Options like Bupa or Cigna may be suitable during initial months
- Important: Not always accepted for long-term residence permits
KSK for Creatives
- Eligible freelance artists can get 50% premium subsidy from the Künstlersozialkasse
- Can extend coverage to family members if conditions are met
Crucial But Underestimated Details
Retroactive Charges
If you delay getting insured, GKV can bill you for missed months. Some insurers allow payment plans to help offset large balances.
Gaps in PKV Coverage
- Not all PKV plans include maternity or pediatric care by default
- Be sure to verify what’s included and what’s optional
Debunking Myths
Public Insurance Is Always Better
GKV isn’t automatically the best fit. High-earning families may benefit more from PKV—but it depends on your situation.
PKV Is Cheaper for Young Families
Only if you’re insuring one or two people. Add kids and the cost rises quickly.
Overlooked Yet Important Topics
Mental Health for Children
- GKV offers services but has long wait times
- PKV can offer quicker access, but options vary
Insurance Requirements for Schooling
- Proof of insurance often needed for school and daycare registration
- GKV simplifies pediatric checkups and vaccine tracking
Mistakes to Avoid
Assuming Family Coverage is Automatic
- GKV: check residence and income requirements
- PKV: must enroll each member separately
Delaying Enrollment
- Leads to visa issues and back payments
- Begin process before your move if possible
Choosing Based on Price Alone
- Incomplete or minimal plans may leave major gaps in care
- Evaluate full coverage needs, not just monthly fees
Conclusion
Key Points
Health insurance for expat families in Germany is mandatory, complex, and deeply personal. GKV and PKV each have pros and cons—what matters is finding the best fit for your situation.
What You Should Do
- Compare both systems based on your income, dependents, and residency plans
- Use English-language platforms for guidance
- Plan early to avoid bureaucratic delays and costly mistakes
Take the Next Step
- Use services like Feather or Ottonova to get personalized quotes
- Secure insurance coverage before applying for visas or enrolling children in school
- Reassess your plan yearly as your family grows and needs change
