Complete guide to Krankenkasse in Germany

You cannot live in Germany without health insurance. It is the law. This guide explains choice, cost, and registration step by step.

Why Krankenkasse matters

Under § 193 Versicherungsvertragsgesetz (VVG), every resident needs health insurance:

• Without it: Aufenthaltstitel often not extended
• Without it: no legal employment (employer must enroll you in GKV)
• Without it: you pay full hospital bills (one night often 500 to 1,000 euros)
• Without it: prescriptions at full price

One of the most important steps right after Anmeldung.

Two systems: GKV and PKV

GKV, statutory health insurance

About 90 percent of residents use GKV:

• Premium: percent of gross income, 14.6 percent + Zusatzbeitrag (about 0.9 to 2.5 percent)
• Employee: pays half, employer the other half
• Coverage: legally identical across all funds
• Family: spouse and children without income often free (Familienversicherung)
• Acceptance: no health questions, everyone admitted

PKV, private health insurance

For employees above 73,800 euros gross/year (2025), self-employed, civil servants, some students:

• Premium: fixed by age, gender, medical history (200 to 800+ euros/month)
• Coverage: often better (private room, chief physician, faster appointments)
• Family: each member separately, expensive
• Risk: return to GKV after about 55 is very difficult, premiums rise with age

Tip for newcomers: choose PKV only with very high income and no dependents. GKV is more flexible.

Popular Krankenkassen compared

Basic coverage is the same by law. Differences in Zusatzbeitrag and service:

TK (Techniker Krankenkasse)

• Largest fund (~11 million members)
• Low Zusatzbeitrag (~1.2 percent)
• Good app, English customer service
• Best for: most newcomers

Barmer

• Second largest (~8 million)
• Strong family and pregnancy services
• Many branches
• Best for: families

DAK-Gesundheit

• Broad psychotherapy access
• Best for: therapy needs

AOK

• Regional branches (Bayern, Nordost, ...)
• Best for: small towns and rural areas

Other options: HEK, KKH, IKK Classic, BKK.

Costs, examples

Employee, 4,000 euros gross/month

• 14.6 percent + 1.2 percent Zusatz (TK) = 15.8 percent
• Total: 632 euros/month
• Employee share: 316 euros
• Nursing insurance extra: employee share about 68 euros

Student under 30

• Flat about 120 euros/month (health + nursing insurance)

Student over 30

• Voluntary GKV from about 210 euros/month
• Or student PKV about 80 to 150 euros (time-limited)

Self-employed / freelancer

• Voluntary GKV: about 210 to 900 euros/month by income
• Or PKV by age and plan

Step by step: GKV registration

Documents

1. Meldebescheinigung (Anmeldung)
2. Passport
3. Aufenthaltstitel
4. Steuer-ID (can add later)
5. If employed: employment contract
6. If studying: enrollment certificate
7. IBAN

Process

1. Open your fund’s website (e.g. tk.de)
2. Click “Mitgliedschaft beantragen” or “Online beitreten”
3. Complete form (10 to 15 minutes)
4. Upload documents
5. Immediate email confirmation
6. Gesundheitskarte in 1 to 2 weeks by post
7. Give insurance number to employer or university

Essential tips for newcomers

1. Before Anmeldung: travel insurance

Without Anmeldung and job or university acceptance, GKV is often not yet possible. Use travel health insurance (e.g. Mawista, DR-WALTER), about 30 to 80 euros/month. Not enough for visa extension alone, switch to GKV quickly.

2. Family insurance

Spouse with no or low income (under about 520 euros/month) can join free. Children under 18 too.

3. Find a Hausarzt

Large cities have multilingual doctors. arzt-auskunft.de has language filters. A trusted GP reduces stress.

4. Medicines with Gesundheitskarte

With prescription you pay only co-pay (about 5 to 10 euros). OTC at full price.

5. Emergency

112 (ambulance), 110 (police). 116 117 for non-life-threatening medical help.

6. Psychotherapy

Waiting lists of 3 to 6 months are normal. If urgent, ask your fund for a Bedarfstermin, legally within 4 weeks.

Checklist

• Choose GKV or PKV (usually GKV)
• Pick a Krankenkasse (default: TK)
• Register online
• Wait for Gesundheitskarte (1 to 2 weeks)
• Give insurance number to employer/university
• Find a Hausarzt
• Save emergency numbers: 112, 116 117

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