Country guide — Europe
Expat insurance and health insurance in Germany
In short
In Germany, health insurance is mandatory for every resident, regardless of nationality or status (employee, self-employed, student, retiree) — the Krankenversicherungspflicht, in force since 1 January 2009. For a French national, this obligation is met either by joining the German statutory scheme (GKV), by keeping French entitlements under EU regulation 883/2004 (form S1), or by taking out private insurance (PKV) for high earners and certain self-employed people. There's no criminal fine for non-compliance, but contributions are recovered retroactively with late-payment surcharges, and proof of insurance is required for university enrolment or hiring.
Key figures
- 93,281 French nationals registered with the consular register in 2025 (94,860 in 2024, -1.66%), including 27,212 in the Berlin-Hamburg consular district alone.
- Life expectancy: 78.8 years (men) and 83.4 years (women), 2023/2025 table.
- Health spending: €538.2 billion in 2024, i.e. €6,444 per capita and 12.4% of GDP — the highest share in the EU.
Local healthcare system
Germany applies universal mandatory health insurance built on two pillars: statutory insurance (GKV), covering the large majority of the population through more than 90 funds, financed by income-proportional contributions shared with the employer; and private insurance (PKV), reserved for employees whose annual gross income exceeds a cap revised each year (€77,400 in 2026), for the self-employed and for civil servants. A foreign resident is subject to the same obligation as any German resident, based on employment status and income, not nationality. Dental and optical care remain only partially covered.
Legal and visa obligations
- EU citizen: no visa required. The obligation that applies is general (German Social Code, SGB V), not tied to a visa.
- Employee hired in Germany: GKV affiliation (or PKV above the income cap) is automatic and handled by the employer from day one.
- Seconded employee: for up to 24 months (extendable), stays covered by French social security via the A1 certificate obtained by the employer, exempt from German affiliation during the secondment.
- Student: proof of insurance required for enrolment; statutory fund at a reduced student rate (≈€50/month) or European coverage (EHIC/S1) depending on the situation.
- Retiree: form S1 from your French pension fund before departure, for coverage by a German fund on France’s behalf. Beyond age 55, someone who has never been insured under the German statutory scheme in the previous 5 years is in principle excluded from voluntary GKV affiliation (§ 6 para. 3a SGB V), which effectively points towards form S1 or PKV.
- No insurance: no criminal penalty, but contributions are settled retroactively with late-payment surcharges; in practice this blocks university enrolment and access to non-urgent care billed directly (Selbstzahler).
Cost of some medical procedures
Orders of magnitude from specialised sources, not official fee schedules.
| Procedure | Public sector | Private sector |
|---|---|---|
| GP consultation (GOÄ base rate) | — | ≈€10.72 at the regulated rate; in practice €35 to €76 depending on the multiplier |
| Hospital emergency visit | — | ≈€126 to €300 |
| Night of hospitalisation (flat rate, uninsured) | — | ≈€500 to €800, up to €1,500+/day in intensive care |
| Specialist consultation | — | €35 to €195 depending on specialty (standard GOÄ factor 2.3), e.g. €60-150 internist, €65-195 psychiatrist |
| Standard X-ray | — | ≈€24 for a single image (GOÄ factor 2.3) |
| MRI | — | €300 to €700 on average depending on the body area, up to €999 with contrast agent |
| Delivery with hospitalisation | — | ≈€1,500 to €2,000 for a vaginal delivery, about double for a caesarean, excluding comfort extras |
| Ambulance | — | €200 to €2,000 depending on the Land and service (e.g. ≈€300 in Berlin, ≈€850 flat rate in Bavaria), + €250 to €1,050 if an emergency doctor is involved |
Social security agreements with France
No classic bilateral agreement: coordination runs through EU regulation 883/2004 (and 987/2009), as with other EU/EEA member states and Switzerland.
- Short stay: the EHIC covers care under German rules, as for a local insured person.
- Secondment (up to 24 months): A1 certificate, stays on the French scheme, exempt from German affiliation.
- Long-term move: form S1 for a locally employed person or a retiree, coverage by a German fund on France’s behalf.
- This coordination does not remove the general affiliation obligation (GKV/PKV) and does not cover fee excesses (dépassements d’honoraires).
Which insurance for my profile
General matrix — does not recommend any specific product or insurer.
| Profile | Regulatory constraint | Points of attention |
|---|---|---|
| Working holiday visa / young mobility | No working holiday visa programme (EU free movement) | EHIC for a short stay, GKV/PKV affiliation for a long-term move |
| Student | Proof of insurance required for enrolment | Check how the EHIC interacts with the statutory fund's student rate |
| Seconded employee | Stays on the French scheme via the A1 certificate | Apply before departure; 24-month maximum duration |
| Locally hired employee | Automatic GKV affiliation (or PKV above the income cap) | Choosing PKV has long-term consequences (difficult to return to GKV) |
| Retiree | Form S1 for coverage by a German fund | Request the form before departure; late affiliation without S1 can be difficult |
Hospitals and care network
- Charité – Universitätsmedizin Berlin — one of the largest university hospitals in Europe, around a hundred clinics and departments.
- Universitätsklinikum Frankfurt — a reference within the Frankfurt consular district.
- Klinikum der Universität München — a reference in Bavaria.
Practical steps
- Seconded employee: request the A1 certificate from the French fund before departure.
- Retiree: request form S1 from your pension fund before departure.
- Short stay: request the EHIC from your French fund.
- On arrival: Anmeldung (residence registration) at the local Bürgeramt, a prerequisite for joining a statutory fund.
- Locally employed: GKV/PKV affiliation initiated by the employer as soon as the contract is signed.
- In the months following the move: register with the roll of French nationals living abroad (Berlin, Frankfurt or Munich).
Frequently asked questions
Is health insurance really mandatory for all residents in Germany?
Yes, since 1 January 2009, everyone residing in Germany must show proof of health coverage, regardless of nationality. Lack of insurance is not a criminal offence but leads to retroactive contribution recovery with surcharges.
Is the EHIC enough to settle in Germany long-term?
No. The EHIC covers temporary stays; a long-term move requires affiliation with a German fund (GKV or PKV) or, for certain profiles, form S1.
Does a seconded employee need to join a German fund?
Not during the secondment (up to 24 months, extendable), provided their employer has obtained the A1 certificate from the French fund.
What's the difference between GKV and PKV for a French expat?
GKV calculates contributions as a proportion of income, up to a cap; PKV applies to employees above that cap (€77,400 in 2026), the self-employed and civil servants, with contributions based on individual risk.
Does a French retiree have to pay double contributions in Germany?
No, in principle: form S1 allows coverage by a German fund on France's behalf, avoiding double affiliation.
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Written by Expavy
Sources
- Destatis — Gesundheitsausgaben (2024 health spending)
- France Diplomatie — Germany, Health
- CLEISS — Secondment within the European Union (regulation 883/2004)
- CLEISS — Form S1
- Verivox — Krankenversicherungspflicht in Deutschland
- France Diplomatie — Global register of French nationals abroad (2025)
- dejure.org — § 6 SGB V, Versicherungsfreiheit (55-year age limit)
- Privatarzt-Rechner — GOÄ rates by specialty (2026)
- Versicherungen mit Kopf — Cost of an ambulance callout (Rettungswagen) in Germany