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How Does the German Healthcare System Work?

The German healthcare system for expatriates is based on two pillars:

  • Gesetzliche Krankenversicherung (GKV): public insurance
  • Private Krankenversicherung (PKV): private insurance

The choice depends on your status (employee, self-employed, student) and your income.

Employees earning less than €77,400 gross per year (2026) must be publicly insured. Above this threshold, private insurance is an option.

The CFE can be an interesting alternative for French expatriates wishing to maintain a connection with the French healthcare system while living in Germany.

What is the Difference between Public and Private Insurance?

Public (GKV): income-proportional contribution (14.6%), standard coverage, family included at no extra cost.

Private (PKV): contribution based on age and health status, broader coverage (private room, specialists, significantly reduced waiting times).

👉 For high earners, PKV is generally more advantageous in the long term.

What Do Pflichtversichert, Freiwillig Versichert, and Privatversichert Mean?

  • Pflichtversichert: legal obligation to be publicly insured.
  • Freiwillig versichert: voluntary public insurance, often after exceeding the income threshold.
  • Privatversichert: insured with a private company, under an individual contract.

Can I Remain Affiliated with the French Social Security System (CFE)?

Yes, via the Caisse des Français de l’Étranger (CFE).

It allows you to maintain a “French-style” coverage during your expatriation.

However:

  • CFE alone is not recognized as legal insurance in Germany.
  • You must add international supplementary insurance and long-term care insurance (Pflegepflichtversicherung) to comply with regulations.

👉 Our firm specializes in this hybrid setup (CFE + German supplementary insurance), which is often used by high-income expatriates or the self-employed.

Is it Possible to Cancel My German PKV to Join the CFE?

Yes, under certain conditions. But be aware:

  • CFE is not legally sufficient in Germany.
  • By leaving PKV, you lose the accumulated seniority reserve.
  • Some employers reject this arrangement.

A personalized analysis is essential before making any decision.

Can I Switch Back to German Public Insurance after Being Privately Insured?

Yes, it is possible, but under certain conditions:

  • Return as an employee with an income below the mandatory threshold: if you become an employee again and your annual gross income is below the GKV ceiling, you can return to the public system.
  • Return after a long period abroad: expatriates returning to Germany can be reintegrated into the GKV.

⚠️ Please note: The choice between PKV and GKV has implications for your contributions, health benefits, and future pension.

👉 Faller Finance assists expatriates in optimizing their health coverage (GKV, PKV, or CFE).

How are Medical Expenses Covered in Case of an Accident (E.G., Skiing or Travel)?

In Germany, GKV and PKV cover basic medical expenses. However:

  • Repatriation, mountain rescue, or certain treatments abroad may remain at your expense.

👉 It is highly recommended to take out supplementary travel insurance, especially for winter sports.

Emergency Numbers:

  • 🇩🇪 Germany → 112
  • 🇦🇹 Austria → 140
  • 🇨🇭 Switzerland → 144
  • 🇫🇷 France → 15
  • 🇮🇹 Italy → 118

Who Pays My Health Contributions?

  • In public insurance: deducted directly from salary (14.6%), split 50/50 between you and the employer.
  • In private insurance: deducted from your personal account; the employer pays their share on your payslip.

Does My Employer Choose My Health Fund?

No. It is up to you to choose your public health fund or private company. Our firm can recommend a fund based on your supplementary insurance needs.

I Am Self-Employed: What Options are Available to Me?

The self-employed can freely choose between:

  • Public health fund (freiwillig versichert): premium based on income (including rental income).
  • Private insurance (PKV): premium based on age and health, with more flexibility and better benefits.

Can I Deduct My Health Contributions in Germany?

Yes. Contributions to GKV, PKV, or CFE are tax-deductible up to legal limits, under the Sonderausgaben (special expenses) category.

What Happens if I Have an Accident Abroad?

Publicly insured individuals are covered in the EU with the European Health Insurance Card, but not beyond.

Privately insured individuals must check their contract terms: most cover treatment abroad for up to 12 months.

Can My Contributions Increase if I Frequently Use My PKV?

No. Increases depend on overall healthcare costs and the structure of the insured portfolio, not on your individual treatments.

Can I Change Public Health Funds?

Yes. A 2-month notice period from the end of the current month applies.

The change is simple and does not create a period without coverage.

What are the Advantages of Professional Support?

The German healthcare system is complex, especially for expatriates who have previously contributed in France.

A specialized advisor can:

  • Objectively compare PKV, GKV, and CFE options,
  • Prepare a file compliant with German law,
  • Optimize the tax treatment of your contributions,
  • And anticipate the impacts on pension and taxes.

Key Takeaways: Expatriate Health Insurance in Germany

The German healthcare system is based on two schemes: public (GKV) and private (PKV).

French expatriates in Germany can choose between German insurance or CFE (with supplementary coverage).

Health contributions are shared between employee and employer, or are deductible for the self-employed.

Medical care is well reimbursed, but it is advisable to arrange for supplementary international travel insurance.

Your choice of health insurance in Germany has a direct impact on your pension, taxes, and net income.

👉 For a personalized assessment of your health coverage in Germany, contact Faller Finance: we compare PKV, GKV, and CFE solutions based on your profile and objectives.