German residence permits and health insurance in 2026

A German residence permit generally requires adequate health insurance; it is generally part of the requirements under section 2(3) of the Residence Act (AufenthG). Distinguish statutory health insurance (GKV), comprehensive private health insurance (PKV) and temporary incoming policies. In 2026, the general GKV rate is 14.6 per cent plus the fund’s additional contribution; the official average additional rate is 2.9 per cent. Long-term care insurance is extra. Eligible relatives can receive contribution-free family cover. The general compulsory-insurance threshold for employees is €77,400 a year. Whether an incoming policy is sufficient depends on the residence purpose, benefits and application stage.

We explain the requirements, compare the systems and examine common problems when moving between policies.

‘Authority’ refers to the body responsible for the particular step:

• for visa applications abroad: the German mission;
• for required labour-market approval: the Federal Employment Agency; it does not decide whether health insurance is adequate for the residence permit;
• in the admission procedure for Jewish immigration : the Federal Office for Migration and Refugees (BAMF);
• for issuing and renewing residence permits in Germany: the immigration authority.

Responsibility therefore depends on the stage of the procedure.

• Why health insurance matters for a residence permit
• Compulsory health insurance and immigration law
• What insurance evidence does the immigration authority require?
• Types of health insurance for people moving to Germany
• GKV: eligibility, contributions and family insurance
• PKV: the 2026 earnings threshold, benefits and long-term risks
• Incoming/expat insurance: uses and limitations
• Insurance by purpose of residence
• Avoiding gaps between a D visa and a residence permit
• Insurance mistakes that can jeopardise a residence application
• Insufficient cover for pre-existing conditions or pregnancy
• Missing evidence of required long-term care insurance
• Unpaid insurance contributions
• FIRMDER helps with insurance and residence applications
• Frequently asked questions about insurance for residence permits

Why health insurance matters for a residence permit

The applicable insurance obligation follows social-insurance and insurance law. For residence permits, adequate health cover generally forms part of a secure livelihood, with exceptions depending on immigration law. Merely holding an inexpensive policy does not establish compliance. Check in particular:

• existing or binding confirmation of cover for the required period;
• the type of insurance and actual benefits;
• the period covered and a secure basis for continued insurance;
• benefits, exclusions and excesses assessed against the requirements and financial circumstances;
• contribution status and any benefit restrictions resulting from arrears.

Missing evidence can lead to requests for documents or delays. The authority determines any deadline and whether another appointment is needed. Respond within the stated time and protect your residence status by applying in good time.

Compulsory health insurance and immigration law

For employees subject to compulsory insurance, the employer reports GKV membership from the start of employment. Others need a separate eligibility assessment: students may qualify for student cover, relatives for family cover, and self-employed people for voluntary statutory or private insurance. Long-term care is a separate branch with separate contributions; it is not included in the GKV health-insurance rate.

What insurance evidence does the immigration authority require?

Statutory health insurance is sufficient under section 2(3) AufenthG. For private cover, assess the applicable requirements and actual benefits. Important checks include:

• reimbursement limits sufficient for the particular residence purpose;
• adequate cover for pre-existing and chronic conditions;
• appropriate maternity and childbirth benefits;
• sufficient duration of benefits for necessary treatment;
• adequate duration and any required long-term care insurance.

For GKV, provide current membership evidence. Private cover may require an insurer’s certificate and details of benefits, duration and policy terms. Section 257(2a) SGB V concerns particular conditions for the insurance company. Neither a particular price nor a reference to that provision proves that every policy is suitable.

Types of health insurance for people moving to Germany

The systems differ in eligibility, contribution calculations, benefits and family cover. Comparing only the monthly premium is insufficient.

The three options at a glance:

• GKV: statutory funds such as TK, AOK, BARMER and DAK. Contributions generally depend on assessable income. Eligible family members may receive cover without a separate contribution. Regular employees are generally compulsorily insured if their pay does not exceed the applicable annual threshold; different rules apply to situations such as mini-jobs.
• PKV: private insurers such as Allianz, Hallesche and Ottonova. Premiums depend on factors including age at entry, medical underwriting and benefits; each person generally needs their own cover. Access depends on compulsory-insurance rules and individual status.
• Incoming/expat policies: temporary products, for example from Care Concept, Mawista or Dr. Walter. Benefits, terms and suitability must be checked for the particular stay.

The following comparison uses the rules and figures for 2026.

GKV: eligibility, contributions and family insurance

The general GKV contribution is 14.6 per cent, plus the chosen fund’s additional rate. The official average additional rate for 2026 is 2.9 per cent. Long-term care insurance is calculated separately: generally 3.6 per cent, or 4.2 per cent for childless members aged 23 or over who are liable for the surcharge. Reductions apply for multiple qualifying children.

Employer and employee generally share the health contribution, including the additional rate, equally. An example outside Saxony: at €5,000 gross monthly pay, a 2.9 per cent additional rate and one child, the employee’s health and care contribution is €527.50; for a childless employee liable for the surcharge it is €557.50. The 2026 assessment ceiling is €5,812.50 monthly. Student contributions follow their specific rates and the chosen fund.

Contribution-free family insurance can be a major advantage. Spouses and children must meet section 10 SGB V. In 2026, the general monthly income limit is €565, or €603 for a mini-job. Children are subject to age and education limits, with further exceptions and exclusions. Core statutory benefits are prescribed by law; extra benefits, service and additional contribution rates differ.

PKV: the 2026 earnings threshold, benefits and long-term risks

The general employee earnings threshold in 2026 is €77,400. Exceeding it requires checking when compulsory insurance ends and the other applicable rules. Different provisions apply to self-employed people and students. Private premiums depend on age at entry, underwriting and benefits. A private hospital room, consultant treatment and extensive dental benefits are tariff-dependent; neither those benefits nor a particular premium range is universally guaranteed.

Alongside the advantages, consider these points before deciding:

1. Costs: GKV contributions depend on assessable income up to the ceiling. PKV premiums depend on the policy and do not automatically fall when income decreases; premium adjustments are possible.
2. Family: contribution-free GKV cover is subject to statutory conditions. In PKV, each person generally needs their own cover; children’s premiums depend on the quotation and policy.
3. Medical underwriting: GKV contributions do not depend on individual health, but access still requires statutory eligibility. PKV can involve underwriting and risk surcharges depending on the tariff; special rules apply to the basic tariff.
4. Returning to GKV requires a legal route into it, such as becoming compulsorily insured. From age 55, section 6(3a) SGB V can significantly restrict re-entry; previous insurance and other statutory conditions matter.
5. Billing: GKV-covered services are usually billed through the health card. Privately insured patients often receive invoices and claim reimbursement; direct billing may be available depending on the service and agreement.

Compare the systems over the long term: benefits, excesses, care insurance, family plans and affordability if income falls. A low initial private premium does not automatically mean lower total costs. Returning to GKV later is subject to statutory conditions.

Incoming/expat insurance: uses and limitations

‘Incoming’ is not a uniform level of cover. Some policies mainly cover acute illness; others offer broader benefits for temporary stays. Duration, price, pre-existing conditions, pregnancy, dental treatment and long-term care arrangements vary substantially. The complete policy terms matter more than the product label or monthly premium.

Suitability for a national D visa also depends on the residence purpose. Check the mission’s current guidance and the insurance intended afterwards. A €30,000 Schengen coverage limit alone does not establish suitability for long-term residence.

FIRMDER recommends checking the actual policy, not just its brand. A blanket rejection of all Mawista or Care Concept products cannot be inferred. Local guidance can differ: Berlin expressly lists travel health insurance as an option for a stand-alone language course. This does not replace checking the mission’s visa requirements.

Before the appointment, establish which insurance you can access and whether it is sufficient. Obtain written confirmation of the start date and cover, such as a GKV membership certificate.

Acceptance of a temporary policy on one occasion does not guarantee acceptance at renewal. Check the terms against the residence purpose and the competent authority’s current requirements.

Unsure whether your health insurance is sufficient for your residence application? Request a free initial review of your insurance arrangements with FIRMDER.

Insurance by purpose of residence

Residence purpose, employment status and previous insurance together determine the available cover and required evidence.

Four common starting points:

• employees and EU Blue Card holders: generally GKV where compulsory insurance applies; above the relevant earnings threshold, assess the available choice individually;
• freelancers and business owners: assess access to voluntary GKV or PKV based on previous insurance and individual status;
• university students: statutory student cover if eligible, followed by an appropriate arrangement for their status. A language course alone does not establish student-insurance eligibility;
• relatives: contribution-free family insurance where eligible, or suitable cover in their own right.

The right solution depends on individual circumstances. Resolve uncertainties in writing before buying a policy or applying.

Residence as an employee or EU Blue Card holder

For compulsorily insured employment, membership generally starts when the employment relationship begins. Confirm the date and arrange cover between arrival and the first working day. Whether another statutory membership already exists or transitional insurance is needed depends on individual status.

A holder of a EU Blue Card may choose PKV if eligible to leave compulsory insurance. If family members are moving too, check eligibility, family cover and the total contributions for everyone in advance.

Residence for freelancers and business owners

Self-employed voluntary GKV members generally pay the contribution themselves. In 2026, the monthly assessment base ranges from at least €1,318.33 to a maximum of €5,812.50. The amount depends on sick-pay entitlement, the fund’s additional rate, assessable income and care contributions. Request an individual total calculation.

Eligible self-employed artists and publicists can be insured through the Künstlersozialkasse and generally bear roughly half of the relevant contributions. The KSK assesses eligibility and is not itself a health insurer. Other self-employed people should not assume that private insurance will start cheaply or that their cover will only be checked again after three years.

Insurance for university students and language-course participants

Eligible university students can use statutory student insurance. The general age limit is 30, with cover normally ending at the end of the relevant semester; justified extensions are possible. Afterwards, voluntary GKV, PKV or another status may be available depending on eligibility. Arrange the next stage with the fund in advance.

Attending a language course under section 16f AufenthG does not by itself create compulsory student GKV membership. Another statutory route may still exist. Otherwise, arrange suitable private cover for the particular stay, considering the type of course, visa requirements and local guidance separately.

Family reunification: insuring a spouse and children

For family reunification, evidence of the required cover is needed for the arriving relatives. Ask the statutory fund to assess family-insurance eligibility in advance, or obtain binding confirmation of private cover. Family insurance requires the statutory conditions and the necessary notification and information. Include every person’s private premium in the financial plan.

Avoiding gaps between a D visa and a residence permit

A change of insurance may be needed between the visa application and residence permit, though it is not necessary in every case. Plan continuous cover through each stage:

• entry cover matching the visa purpose and actual start date, with a contractually flexible date if appropriate;
• register your address generally within two weeks of moving into a home, rather than automatically within two weeks of crossing the border;
• confirm the start date under the applicable statutory rule or contract;
• submit current membership or insurance confirmation as required by the competent authority.

Two transitions need particular attention.

Visa health insurance: requirements by purpose of residence

Cover must start on time and match the visa purpose. If the entry date is uncertain, a contractually agreed flexible start can help. Confirm how arrival must be reported and when cover takes effect. An expired certificate or incorrect date must be corrected before use.

From transitional insurance to suitable GKV or PKV: step by step

Employees should notify their employer of the chosen fund in good time. Self-employed people must first establish a legal route into voluntary GKV. Deadlines may apply to particular qualifying events; there is no universal three-month admission window after every arrival.

The start date follows the applicable statutory rule or contract, not automatically address registration. If membership is established retrospectively, contributions can become due even where an incoming policy already existed.

An example described in FIRMDER’s practice: a family of three moved to Hamburg on an employment visa. GKV was arranged from the employee’s first working day, while family-cover eligibility for the spouse and child was checked and reported. Once certificates were available, the transition could be coordinated with the incoming provider. Processing times, acceptance and any refund depend on the case and policy terms.

Insurance mistakes that can jeopardise a residence application

Insufficient benefits, missing evidence or contribution arrears can complicate the assessment. Three common areas of concern are:

• insufficient cover, for example for chronic illness or pregnancy;
• missing proof of required care insurance;
• unresolved arrears and resulting restrictions on benefits.

An early review leaves time to correct problems. A solution within a few weeks cannot be promised in every case.

Insufficient cover for pre-existing conditions or pregnancy

At renewal, do not rely solely on a certificate accepted previously. Review the policy terms, current residence purpose and any required transition early. Confirmation relating to the insurer under section 257(2a) SGB V may be requested, but does not replace assessment of the actual benefits.

Missing evidence of required long-term care insurance

Check whether compulsory long-term care insurance applies and whether it is documented. Basic travel insurance does not automatically include private compulsory care cover. Cost and availability require individual assessment; adding care insurance does not resolve every gap in health cover.

Unpaid insurance contributions

Unpaid contributions do not disappear. Statutory conditions can lead to late-payment charges and suspension of some benefits, subject to exceptions and protections. Resolve arrears with the fund promptly and document any effective instalment agreement. The immigration consequences require individual assessment; arrears do not automatically mean refusal.

FIRMDER helps with insurance and residence applications

We start with the residence purpose and insurance status, then consider income, previous cover, family members and age. Comparisons include long-term costs, benefits and care insurance. We help coordinate entry cover, subsequent insurance and the required certificates. We flag identifiable gaps before the application; binding decisions are made by insurers and the competent authorities.

We support your residence application by clarifying insurance needs, organising documents and coordinating enquiries. The competent authority decides on the permit. Book a personal consultation.