Contents (9 sections)
- Health insurance when returning to Germany: the rule of the last insurance
- Step 1: a job or family insurance can take you back
- Last publicly insured: public insurance takes you back
- Last privately insured: private insurance is compulsory
- Insured abroad in between: which countries count?
- Never insured in Germany or the EU?
- Paperwork: what to bring back
- Your return timeline
- Returning and thinking ahead
- When you return to Germany, the system you were last in usually decides: last publicly insured means public insurance, last privately insured means you must take out private insurance again (§ 193 (3) VVG).
- Public insurance in another EU/EEA country, Switzerland or the UK counts like German public insurance; periods in countries such as the USA or Thailand are disregarded.
- A job below the income threshold of €77,400 (2026) before age 55, or family insurance, can bring you into public insurance even after private cover.
- If you were last privately insured, apply within one month of your return – otherwise a one-off premium surcharge applies (§ 193 (4) VVG): for 14 months without cover, 5.5 monthly premiums.
- A dormant policy (Anwartschaft) is usually reactivated within about two months of your return – without new health questions.
When you return to Germany, your health insurance usually depends on the system you were last in. If you were last publicly insured – in Germany or in another EU/EEA country, Switzerland or the UK – you return to public insurance. If you were last privately insured, you must take out private insurance again (§ 193 (3) VVG), within one month to avoid a premium surcharge. A job below the income threshold before 55 or family insurance can open public insurance in any case (as of October 2026).
Health insurance when returning to Germany: the rule of the last insurance
Everyone living in Germany must have health insurance. When you come back, nobody asks which system you prefer – the law asks which one you belonged to last. The German health insurance funds apply a fixed order of questions. In simplified form (the fund decides in each case):
| Step | Question | If yes |
|---|---|---|
| 1 | Does a job below the threshold, unemployment benefit or family insurance make you publicly insured? | Public insurance through that route – the “last insurance” doesn't matter (from 55: special rule) |
| 2 | Do you already have other cover, e.g. a running or reactivated private policy? | That policy continues |
| 3 | Are you exempt, e.g. as an employee above the threshold or a civil servant? | Voluntary public insurance if you qualify – otherwise private |
| 4 | Was your last insurance public (Germany, EU/EEA, Switzerland, UK)? | Public fall-back insurance from your first day without cover |
| 5 | Was your last insurance private? | Private insurance is compulsory – at least the basic tariff |
| 6 | Never insured in Germany or the EU/EEA? | Public, unless you are self-employed or above the threshold – then private |
The full legal background, with all special cases, is explained in German at Rückkehr: zuletzt privat versichert (in German).
Step 1: a job or family insurance can take you back
Before the “last insurance” question comes into play, the funds check whether an ordinary route into public insurance applies:
Job below the threshold
An employee earning up to €77,400 (2026) or €84,150 (2027, draft) is compulsorily insured – also after years of private cover. From 55 this route is usually closed if you were not publicly insured in the five years before (§ 6 (3a) SGB V).
Family insurance
If your spouse is a public member, you may be insured free of charge – if you live in Germany, are not self-employed or exempt, and earn at most €565 a month (2026). This works after private cover, too.
Returning employee
If your public membership ended because you worked abroad, you can rejoin voluntarily if you take up a job within two months of your return; declare it within three months (§ 9 (1) no. 5 SGB V).
Prior insurance periods
Voluntary public insurance is also open if you have enough prior public insurance periods – EU/EEA periods count with form E 104 or S041 (§ 9 SGB V, DVKA).
Last publicly insured: public insurance takes you back
If your last insurance was public, the fall-back insurance (Auffangversicherung, § 5 (1) no. 13 SGB V) applies from the first day you have no other cover in Germany. It doesn't matter how long ago that public insurance was. Unlike a job, it also applies to the self-employed and to people over 55.
- Contributions: they follow your total income, like for voluntary members, with a minimum assessment of €1,318.33 a month (2026).
- Report promptly: membership starts by law; if you report late, contributions are charged retroactively, although the fund should reduce them appropriately.
- Exempt employees: if you return to a job above the threshold, you are exempt and the fall-back insurance doesn't apply. Then voluntary public insurance (if you qualify) or private insurance remain.
- Citizens of non-EU countries: the fall-back insurance only applies with a settlement permit or a residence permit of more than twelve months that doesn't require proof of a secured livelihood (§ 5 (11) SGB V).
Last privately insured: private insurance is compulsory
If your last insurance was private, no public fund has to take you – but a private insurer must. Anyone living in Germany must take out a health insurance policy with an insurer authorised in Germany (§ 193 (3) VVG). Insurers must offer you at least the basic tariff (Basistarif), whose premium may not exceed the maximum public contribution – €1,017.18 a month in 2026 according to the PKV association. A normal tariff is often cheaper, but requires health questions.
The one-month deadline.If you apply later than one month after the obligation arises, you pay a one-off premium surcharge: one monthly premium for each further started month without insurance, and from the sixth month one sixth of a premium per month (§ 193 (4) VVG). The PKV association's example: 14 months without insurance cost 5.5 monthly premiums – with a premium of €600 that is €3,300.
Kept a dormant policy? Then you are in a much better position. A dormant policy (Anwartschaft) is reactivated on request – insurers often expect this within about two months of your return (Allianz). You get your old contract back without new health questions; with the large version also with your old entry age. A pure dormant policy does not count as “last privately insured”, so your status before it decides.
Insured abroad in between: which countries count?
For the “last insurance” question, many foreign periods count – but not all. The funds follow the principles of the GKV-Spitzenverband and EU coordination law:
| Insured abroad in … | Counts as |
|---|---|
| Public system of an EU/EEA country, Switzerland or the UK | Last publicly insured – even if you were private in Germany before |
| Full private policy with an insurer in the EU/EEA, Switzerland or the UK | Last privately insured |
| Turkey, North Macedonia, Tunisia (agreements with equal treatment) | Counts according to the agreement |
| USA, Thailand, United Arab Emirates and other countries | Disregarded – your last insurance in Germany or the EU/EEA decides |
| Travel, expat, incoming or employer group policies for stays abroad | Disregarded – they don't establish “last privately insured” |
The UK still counts after Brexit: the EU–UK Trade and Cooperation Agreement continues social security coordination that essentially corresponds to the EU regulations (DVKA). Details for British citizens: health insurance in Germany for UK citizens. Coming back from the USA? See health insurance in Germany for Americans.
Never insured in Germany or the EU?
If you have never been insured in Germany or in the EU/EEA, Switzerland or the UK, you are generally assigned to public insurance – unless you are self-employed as your main occupation, earn above the threshold as an employee or are exempt for another reason. For people moving to Germany, the activity they last carried out abroad counts (GKV-Spitzenverband). For citizens of non-EU countries, the restriction in § 5 (11) SGB V applies on top. Newcomers in this situation will find the bigger picture in public vs private health insurance in Germany.
Paperwork: what to bring back
- EU/EEA, Switzerland, UK: proof of your public insurance periods – form E 104 or the electronic document S041; your new German fund can also request it (DVKA).
- Private policy abroad: confirmation of the insurer, the type of cover and the end date.
- Dormant policy: the contract and the reactivation deadline.
- Posting by a German employer: your A1 or other posting certificate – during a posting German rules may have continued to apply.
- Registration: the confirmation of your registration in Germany (Anmeldung) shows the date the obligation started.
Your return timeline
Before you move
Work out your last insurance with the table above and collect the proofs. Decide whether you will work as an employee, self-employed or not at all.
Within one month
If you were last privately insured: apply for private insurance or reactivate your dormant policy – otherwise the surcharge clock starts.
Within two months
Typical reactivation deadline for dormant policies (check your contract); take up a job within two months if you want to rejoin public insurance as a returning employee.
Within three months
Declare voluntary public insurance if you qualify – after that the right usually lapses (§ 9 (2) SGB V).
Returning and thinking ahead
A return is also the moment to plan the next move. If you might leave again, consider how each system behaves when you go: public insurance simply ends, a private policy continues only within the EU/EEA. The guide to leaving Germany explains this, and the leaving-Germany planner shows whether to cancel, pause or keep a policy. If you are privately insured and would prefer public insurance, read honestly when switching back to public works. Unsure which case applies to you? The free 60-second decider sorts your situation without health questions, German terms are explained in the glossary, and short answers to other common questions are in the FAQ.
Frequently asked questions
Which health insurance do I get when I move back to Germany?
Usually the system you were last in. If your last insurance was public – in Germany or in another EU/EEA country, Switzerland or the UK – you return to public insurance. If it was private, you must take out private insurance again. A job below the threshold before 55 or family insurance can open public insurance in any case.
I was privately insured before I left Germany. Do I have to go private again?
Usually yes, unless you were publicly insured in an EU/EEA country, Switzerland or the UK in the meantime, or a job below the threshold before 55 or family insurance makes you publicly insured. Insurers must offer you at least the basic tariff (Basistarif). Apply within one month to avoid a premium surcharge.
Does my health insurance in the USA count when I return to Germany?
No. Insurance periods in countries without an equivalent agreement, such as the USA, Thailand or the United Arab Emirates, are disregarded. What counts is your last insurance in Germany or in the EU/EEA, Switzerland or the UK.
Is there a deadline for health insurance after returning to Germany?
Yes. If you must take out private insurance, apply within one month, otherwise a premium surcharge applies (§ 193 (4) VVG). Public fall-back insurance starts automatically on your first day without cover, but report it promptly – contributions are charged retroactively. Voluntary public insurance must be declared within three months.
Can I go back to public health insurance after 55 when returning from abroad?
Through a job, usually not if you were not publicly insured in the five years before and were mostly exempt, privately insured or self-employed (§ 6 (3a) SGB V). The public fall-back insurance for people who were last publicly insured, however, also applies from 55. The fund decides in each case.
Sources
- § 5 SGB V – fall-back insurance (no. 13) and foreigners (para. 11)
- § 6 SGB V – age 55 rule (para. 3a)
- § 9 SGB V – voluntary insurance incl. returning employees
- § 193 VVG – obligation to insure, premium surcharge
- GKV-Spitzenverband: principles on fall-back compulsory insurance (Auffang-Versicherungspflicht) – of 24 July 2023 (via vdek)
- PKV association: brochure “Alternativen in jeder Lebenslage” – as of April 2025
- DVKA: frequently asked questions (insurance abroad, E 104/S041) – as of 26 May 2026
- DVKA: Brexit – coordination with the United Kingdom – as of 7 February 2025
- Regulation (EC) No 883/2004 on the coordination of social security systems
- Allianz: dormant health insurance (Anwartschaftsversicherung) – insurer information, retrieved 10 October 2026
This article provides general information on health insurance in Germany (as of 10 October 2026). It does not replace individual advice. Which solution suits you depends on your personal situation, e.g. age, health, income, family and length of stay. Despite careful review we cannot guarantee completeness and accuracy; laws and tariffs change. It is not immigration advice: whether your insurance is sufficient for a visa or residence permit is decided by the German mission abroad or your immigration office. Publisher: German-PKV.de. German-PKV.de is not an insurance broker and does not provide insurance, legal or tax advice; individual advice is provided exclusively by specialised cooperation partners licensed under § 34d GewO.