Compulsory health insurance in Germany: A must for every resident?
25.05.25
8
Minutes
Katrin Straub
Managing Director at nextsure
In Germany, health insurance is more than just a good idea – it is required by law. But what does that mean specifically for you, and what consequences could you face if you fail to comply? This article examines the obligation to have health insurance from all important perspectives.
The topic in brief and concise terms
In Germany, there is a legal obligation to have health insurance for all persons resident in the country (§ 193(3) VVG).
Exemptions from the obligation apply, among others, to civil servants, self-employed persons whose main occupation is self-employment, and employees earning above the annual earnings threshold (EUR 73,800 in 2025).
Lack of health insurance coverage leads to premium arrears, late payment penalties and restricted access to medical care.
Compulsory health insurance: Understanding the legal basis
In Germany, there is a general obligation for every person resident in the country to have health insurance. This was introduced in stages, beginning with the requirement for certain groups of people to be insured under the statutory health insurance scheme (GKV) from 1 April 2007. Since 1 January 2009, comprehensive health insurance has been mandatory for everyone, as set out in Section 193(3) of the Insurance Contract Act (VVG). The purpose of this rule is to ensure that every citizen is covered in the event of illness and is not exposed to existential financial hardship. The obligation includes taking out and maintaining medical expense insurance that covers at least outpatient and inpatient treatment. Deductibles are limited to an annual amount of EUR 5,000 per person. This comprehensive regulation closes an important gap in the social security system. For a detailed look at the fundamentals of health insurance, please read our in-depth article. The introduction of the obligation led to a marked decline in the number of uninsured people; while there were still 137,000 in 2011, the number fell to 61,000 by 2019.
Who is affected? Target groups of compulsory insurance in detail
As a rule, every person resident in Germany is required to have health insurance. This applies to employees whose income is below the annual earnings threshold (JAEG); for 2025, this is EUR 73,800. Apprentices, students under certain conditions and pensioners are also generally mandatorily insured in statutory health insurance (GKV). Self-employed persons and freelancers who do not fall under the exemption rules must also obtain insurance. For people without income, for example those receiving Bürgergeld, the state usually covers the contributions to statutory health insurance. The solidarity-based system therefore ensures that even financially weaker members have access to medical care. The < a href="/blog/freiwillige-krankenversicherung">voluntary health insurance offers an option for people who are not mandatorily insured. This broad coverage ensures that almost the entire population – almost ninety per cent in statutory health insurance and just over ten per cent privately insured – is protected in the event of illness.
Exceptions confirm the rule: When the obligation does not apply
Although the health insurance requirement is comprehensive, there are defined exceptions. For example, self-employed people and freelancers who work on a full-time basis are not required to have statutory health insurance. Civil servants, judges and soldiers serving on fixed-term contracts also fall under this exemption, as they are usually entitled to subsidies or free medical care. Employees whose regular annual earnings exceed the annual earnings threshold (JAEG) of currently EUR 73,800 (as of 2025) become exempt from compulsory insurance and can choose between statutory and private health insurance. This flexibility enables higher earners to tailor their cover more individually. An exemption from the insurance requirement is possible on application in certain circumstances, for example if income falls below the threshold again due to an increase in the JAEG and you wish to remain in private health insurance. Find out more about the private health insurance for civil servants. It is important to check the relevant requirements carefully, as an exemption has far-reaching consequences. People entitled to benefits under the Asylum Seekers' Benefits Act are also exempt from the requirement under Section 193 VVG.
Without cover: The consequences of not having health insurance
If someone in Germany is not insured under health insurance, although there is a legal obligation to do so, they are not committing a criminal offence, but they do have to expect significant financial consequences. The most important consequence is contribution debt, which arises from the time the insurance obligation begins. For the period without insurance cover, contributions must be paid retrospectively, even if no medical services were used. When returning to statutory health insurance, these back payments can be claimed for up to four years retrospectively. The limitation period begins after the end of the year in which the debt arose. In addition, late payment surcharges may apply. In the worst case, customs may collect the outstanding contributions, for example through an account seizure. Medical care for uninsured persons is generally only guaranteed in emergencies and during pregnancy. The question what happens if you are not insured is therefore of great importance. Average medical costs per person were €5,190 in 2020, which underlines the need for insurance cover.
The following points illustrate the risks:
Accruing contribution debts from the start of the insurance obligation.
Possible late payment surcharges on overdue contributions.
Restricted access to medical care, mostly emergency treatment only.
Risk of high treatment costs that must be paid personally.
Possible enforcement action to collect the debts.
These consequences show how important compliance with the insurance obligation is.
The way back: how to get back into health insurance
If you find that you are not covered by health insurance, you should act immediately. The first step is to clarify which system – statutory (GKV) or private (PKV) – you belong to. If you were last insured under the statutory system, you must contact your last health insurance fund; it is obliged to reinstate your cover. If you were last privately insured, your former insurer is the point of contact and must at least accept you into the basic tariff. Anyone who has never been insured is assigned depending on their professional situation: employees are generally assigned to the statutory system, self-employed people to private insurance. If you are unsure, it is advisable to contact a statutory health insurance fund, which can help with the clarification. There are also specialist advice centres or clearing centres that offer support. The affordable health insurance for self-employed people is an important topic for this professional group. For the period without insurance, contributions accrue that must be paid retrospectively; under certain circumstances, instalment payments or reductions (e.g. a suspended contribution of approx. 72 euros per month in 2024 under certain conditions) can be agreed.
Expert depth: legal details and recent court rulings on compulsory insurance
Health insurance obligation is primarily regulated in § 193 Absatz 3 of the Insurance Contract Act (VVG) and, in the area of statutory health insurance (GKV), in § 5 of Book Five of the Social Code (SGB V). § 5 SGB V defines who is compulsorily insured by law, for example employees below the JAEG or recipients of unemployment benefit. § 6 SGB V lists reasons for exemption from compulsory insurance, for example for civil servants or self-employed persons. An exemption from compulsory insurance is possible under § 8 SGB V. It is important to note that an exemption once granted can often not be revoked and applies only to the current employment; if a person becomes unemployed, the insurance obligation may revive. Current rulings repeatedly confirm the scope of the obligation and the need for seamless cover. Our expert tip: When your employment situation changes, check your insurance status carefully to avoid unintended gaps in cover or premium arrears. The health insurance for pensioners also has specific rules. The complexity of the legal position often makes expert advice essential to avoid individual pitfalls. For example, deductibles in private health insurance (PKV) must be structured so that their annual monetary impact does not exceed EUR 5,000.
Important sections at a glance:
§ 193 Abs. 3 VVG: General health insurance obligation for persons resident in Germany.
§ 5 SGB V: Definition of persons subject to compulsory insurance in statutory health insurance.
§ 6 SGB V: Rules on exemption from compulsory insurance (e.g. exceeding the JAEG, civil servants).
§ 8 SGB V: Requirements for exemption from compulsory insurance.
§ 174 Abs. 5 SGB V: Obligation to return to the last statutory health insurance fund.
These statutory provisions form the foundation of the obligation to have health insurance in Germany.
For certain groups of people, special rules apply with regard to compulsory health insurance. Students are mandatorily insured under student health insurance until they complete their 14th semester of study, and at the latest until they reach the age of 30, provided they are not covered under family insurance. After that, they must continue to insure themselves on a voluntary basis. Pensioners are generally mandatorily insured in the health insurance scheme for pensioners (KVdR) if they meet certain prior insurance periods. Contributions are based on the amount of the pension. Protection in old age is a key element of the system. Children are usually covered free of charge via a parent's family insurance, as long as certain income limits are not exceeded. The question of whether private or statutory health insurance for the child is more suitable depends on the parents' insurance situation. There are also specific rules for people on parental leave or who are unemployed, which ensure that insurance cover continues. These differentiated approaches take account of the diversity of life situations and ensure that insurance cover remains as seamless as possible. The obligation to have long-term care insurance applies in parallel to the obligation to have health insurance.
Recommendations for action: How to best secure your insurance cover
To optimise your health insurance cover and avoid legal pitfalls, there are a few points to bear in mind. Regularly check whether your current insurance status still suits your personal circumstances, especially if your working situation or income changes. If your income as an employee is above the JAEG threshold of EUR 73,800 (as of 2025), you can choose between GKV and PKV. Carefully weigh up the advantages and disadvantages of both systems. A well-informed decision can save costs in the long term and secure the level of cover you want. If you are unsure or have complex questions, for example about exemption from compulsory insurance or returning from abroad, professional advice is recommended. Pay attention to deadlines, for example when applying for exemption (within three months of the start of compulsory insurance). Keep careful records of all relevant documents. Also find out about the other compulsory insurance schemes in Germany. If you do nevertheless find yourself uninsured, act quickly and contact the relevant health insurance fund to find a solution for paying contributions retrospectively – instalment payments are often possible.
Checklist for safeguarding your insurance cover:
Regular review of insurance status, especially when life circumstances change.
Where you have a choice (e.g. income above JAEG), carefully compare GKV and PKV.
Seek professional advice in the event of complex questions or uncertainty.
Strict compliance with deadlines for applications and notifications.
Careful storage of all relevant insurance documents.
If an insurance gap is identified, contact the responsible fund immediately.
These steps will help you always be optimally insured.
Your next step towards optimal protection
Health insurance obligation in Germany is a fundamental part of the social security system and affects almost every resident. An understanding of the legal foundations, possible exemptions and the consequences of being uninsured is essential. As this article has shown, there are specific regulations for different life situations, from the benefit provided by health insurance to the level of contributions. Given the complexity and the individual factors that influence your insurance situation, personal advice can bring clarity. nextsure supports you as a digital insurance portal in finding tailored and easy-to-understand insurance solutions. We help you analyse your individual situation and identify the protection that is right for you. Make use of our expertise for your peace of mind.
Request an individual risk analysis now: have your insurance situation reviewed free of charge and receive specific suggestions for optimisation.
More useful links
Federal Ministry of Health provides information on statutory health insurance (GKV).
GKV-Spitzenverband provides detailed information on contribution assessment in statutory health insurance.
PKV (Association of Private Health Insurance) publishes a press release on the insurance obligation threshold and the options for switching to private health insurance.
Federal Statistical Office (Destatis) provides statistics on health insurance coverage in Germany.
Consumer advice centre explains what to do if you are not insured for health insurance in Germany.
Federal Ministry of Health offers a comprehensive guide to health insurance as a PDF document.
FAQ
Is health insurance in Germany really compulsory for everyone?
Yes, since 1 January 2009, general health insurance coverage has been compulsory for every person residing in Germany, with only a few exceptions defined by law.
How much does it cost if I don’t take out health insurance?
You must pay all contributions retrospectively from the start of compulsory insurance, even if you were not ill. In addition, late payment surcharges may apply and you are only entitled to emergency treatment.
I’ve never had insurance before, where do I need to register?
If you are employed, you are usually with a statutory health insurance fund. If you are self-employed, with private health insurance. If in doubt, a statutory insurer can help with classification.
Does the social welfare office cover the contributions if I have no income?
Yes, if you receive citizens’ benefit, for example, the responsible authority usually covers the contributions to statutory health insurance.
Does compulsory health insurance also apply to international students?
Yes, foreign students who are enrolled in Germany are generally also required to have student health insurance or must provide equivalent cover.
Can I freely choose my health insurance provider if I am compulsorily insured?
Yes, within the statutory health insurance scheme, you generally have the right to freely choose your health insurance provider, even if you are compulsorily insured.
