Contents (8 sections)
- Health insurance in Germany for Americans: the same rules as for everyone
- Is US health insurance valid in Germany?
- The US–German social security agreement: pensions only
- Employees from the US: the threshold and the three-month window
- Freelancers and self-employed Americans
- Family: spouse and children
- Moving back to the US: plan your exit before you sign
- Checklist for Americans moving to Germany
- US citizens follow the same rules as everyone in Germany: employees are publicly insured below €77,400 (2026) or €84,150 (2027, draft); above it, and as freelancers, they may choose private insurance.
- Residents must be insured with an insurer authorised in Germany (§ 193 (3) VVG) – a US domestic health plan usually doesn't meet that obligation.
- The US–German social security agreement only covers pensions; US insurance periods don't count for German public insurance.
- Self-employed Americans without prior public insurance in Germany or the EU usually have no route into public insurance and need private cover.
- Moving back to the US usually ends a German private policy; a temporary move can be bridged with a dormant policy.
Health insurance in Germany for Americans follows the same rules as for everyone: employees earning up to €77,400 (2026) or €84,150 (2027, draft) are publicly insured by law; above that, and as freelancers, private insurance is an option. A US domestic plan usually doesn't meet the German obligation to be insured, and the US–German social security agreement only covers pensions – US insurance periods don't count. Moving back to the US usually ends a German private policy (as of October 2026).
Health insurance in Germany for Americans: the same rules as for everyone
Your passport plays no role in German health insurance. What counts is your status and, as an employee, your regular salary. Germany has two full systems: public insurance (gesetzliche Krankenversicherung, GKV), run by 91 health insurance funds (Krankenkassen), and private insurance (private Krankenversicherung, PKV). There is no marketplace and no employer plan in the US sense – but employers pay about half, in both systems.
| Your situation | Health insurance (usually) |
|---|---|
| Employee up to €77,400 (2026) / €84,150 (2027) | Public by law – employer pays about half |
| Employee above the threshold, first job in Germany | Choice: public within three months, or private |
| Freelancer or self-employed, new from the US | Usually private – no route into public insurance |
| Spouse without own income, children | Free family insurance if you are publicly insured and they live in Germany |
| Posted by a US employer | Special rules – clarify with your employer and a German fund |
Not immigration advice.This is not immigration or legal advice. Whether your health insurance is sufficient for a visa or residence permit is decided by the German mission abroad or your local immigration office (Ausländerbehörde). Official information: Federal Foreign Office, BAMF and Make it in Germany.
Is US health insurance valid in Germany?
This is one of the first questions Americans ask – and the answer depends on whether you visit or live here.
- Visiting: some US plans pay for emergencies abroad, many don't or only partly. Check your plan's terms before you travel.
- Living in Germany: everyone resident in Germany must take out and keep health insurance “with an insurer authorised to do business in Germany” that covers at least outpatient and inpatient treatment, with deductibles capped at €5,000 a year (§ 193 (3) VVG) – unless they are in public insurance. A US domestic plan usually doesn't meet this.
- International expat plans: some global policies are offered by insurers authorised in Germany, others aren't. For the visa and residence permit, the authority decides whether a policy is sufficient – ask before you rely on it.
The US–German social security agreement: pensions only
Germany and the US have a social security agreement, but it is narrow. The German pension insurance puts it plainly: the German–US agreement only contains rules on pension insurance; all other branches of social insurance are not covered (DRV, retrieved 10 October 2026). For health insurance this means:
- US periods don't count: years of US coverage – employer plan, Medicare or ACA – are not prior public insurance periods in Germany. For the question “last publicly or privately insured?” they are disregarded (GKV-Spitzenverband).
- No card to bring along: there is no US equivalent of the European Health Insurance Card that German doctors accept.
- Postings: if a US employer sends you to Germany for a limited time, health insurance follows German law, including its special posting rules. Clarify your status with your employer and a German fund before you arrive.
Employees from the US: the threshold and the three-month window
As an employee, you are publicly insured by law below the income threshold – €77,400 in 2026, €84,150 in 2027 (draft). Above it you may choose. If this is your first job in Germany, public insurance stays open for three months after you start, without prior insurance (§ 9 (1) no. 3 SGB V). After that window it usually closes for good, because your US years don't count.
Cost-wise, an employee above the contribution ceiling pays up to €729.94 a month for public health and long-term care insurance in 2027 (childless, scenario). Stiftung Warentest found full-cover private tariffs for 35-year-olds at €649 to €1,137 a month (Finanztest 3/2025); the employer pays half of a private premium, with separate caps for health (about €557.81) and long-term care (about €114.75) – €672.56 at most in total in 2027 (scenario). Private premiums depend on your age, the tariff and the health questions in the application. Your exact dates: income threshold checker.
Freelancers and self-employed Americans
Many Americans come to Germany as freelancers – designers, developers, artists, consultants. They may choose freely in theory, but in practice the choice is often made for them: voluntary public insurance requires prior public insurance periods in Germany or the EU, which newcomers from the US don't have. The fall-back public insurance doesn't cover the self-employed who were never insured in Germany, and for non-EU citizens it applies only with certain residence permits (§ 5 (11) SGB V). So a private policy is usually the only option – the health insurance fund decides in each case. Remember sick pay: as a freelancer you need your own sick pay insurance (Krankentagegeld). Details: health insurance for freelancers in Germany.
Family: spouse and children
If you are publicly insured, your spouse without own income (up to €565 a month in 2026) and your children can be insured free of charge – if they live in Germany. In private insurance each person pays a premium; children's tariffs typically cost €120 to €250 a month (broker analysis, September 2026). For families on one income, public insurance is often the better deal. More: private health insurance with a family.
Moving back to the US: plan your exit before you sign
Many Americans stay in Germany for a few years and then return. That changes the maths:
Public insurance
Membership usually ends when you move away. There is nothing to cancel in the long term and no savings left behind.
Private insurance
Under the model terms a German policy ends when you move your residence outside the EU/EEA, unless your insurer agrees to continue it. For a temporary move you can ask for a dormant policy (Anwartschaft). Your ageing reserves stay in Germany.
Read what happens to your health insurance when you leave Germany and use the leaving-Germany planner before you deregister. Coming back to Germany later? Your last insurance in Germany decides, because US periods are disregarded – see health insurance when returning to Germany.
Checklist for Americans moving to Germany
- Don't rely on your US plan once you live in Germany – check the German obligation first.
- Employee? Compare your salary with €77,400 (2026) and €84,150 (2027, draft).
- First job above the threshold: decide within three months whether to stay public.
- Freelancer: expect private insurance and budget for sick pay cover.
- Plan your exit: how long will you stay, and will family join you?
The free 60-second decider asks exactly these questions – no health questions – and tells you honestly whether public insurance fits you better. For the complete comparison, read public vs private health insurance in Germany; quick answers are in the FAQ.
Frequently asked questions
Is US health insurance valid in Germany?
For a visit, your US plan may cover emergencies abroad – check its terms. If you live in Germany, the law requires a health insurance policy with an insurer authorised in Germany (§ 193 (3) VVG), unless you are in public insurance. A US domestic plan usually doesn't meet that. Whether a policy is sufficient for your residence permit is decided by the immigration office.
Can Americans join public health insurance in Germany?
Yes, as employees: below the income threshold they are publicly insured by law, and in their first job in Germany above the threshold they can still join within three months (§ 9 (1) no. 3 SGB V). Self-employed newcomers from the US usually can't, because US insurance periods don't count as prior public insurance.
Does the US–Germany social security agreement cover health insurance?
No. According to the German pension insurance (DRV), the German–US agreement only contains rules on pension insurance; all other branches of social insurance are not covered. For health insurance, German law decides.
Do I need private health insurance in Germany as an American?
Not because you are American. Most employees are publicly insured by law. Private insurance is an option above the threshold and for freelancers – and often the only option for self-employed newcomers from outside the EU.
What happens to my German health insurance when I move back to the US?
Public insurance usually ends with your move. A German private policy usually ends if you move your residence outside the EU/EEA, unless your insurer agrees to continue it; for a temporary move you can ask for a dormant policy (§ 15 (3) MB/KK 2009). Your ageing reserves stay in Germany.
Sources
- Deutsche Rentenversicherung: working in Germany and the USA (scope of the agreement) – retrieved 10 October 2026
- § 193 VVG – obligation to insure with an insurer authorised in Germany
- § 5 SGB V – compulsory insurance; foreigners (para. 11)
- § 9 SGB V – voluntary insurance, first job in Germany
- GKV-Spitzenverband: principles on fall-back compulsory insurance (periods in countries without agreement) – 24 July 2023
- PKV association: model terms MB/KK 2009 (§ 15 (3): moving abroad) – as of June 2024
- Federal Government: contribution ceilings 2027 (Cabinet decision) – 7 October 2026, Bundesrat pending
- Stiftung Warentest: private health insurance compared (Finanztest 3/2025) – 19 February 2025
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.