Health insurance

Health insurance in Germany is not optional — it is required by law, and the Ausländerbehörde will not issue or extend most residence permits without it. The system has two parallel tracks: gesetzliche Krankenversicherung (statutory / public) and private Krankenversicherung (private). Most newcomers belong in the public system; a smaller, well-defined group can opt for private.

Public insurance (GKV)

Roughly nine out of ten people in Germany have public insurance. The contribution is a percentage of your gross income (around 14.6 % plus a small Zusatzbeitrag set by each fund, split with your employer if you are employed). Family members without their own income are usually co-insured for free.

Public insurers are interchangeable in their core benefits because those benefits are defined by law. They differ in their extra perks (osteopathy reimbursements, electric breast pumps, English-speaking hotlines) and in the small Zusatzbeitrag. Common names in Düsseldorf include TK, AOK Rheinland/Hamburg, Barmer and DAK.

You can switch between public insurers freely after a holding period. To do so, sign up with the new fund and they will handle the cancellation for you.

Private insurance (PKV)

You can choose private insurance if you are:

• An employee earning above the annual income threshold (set each year by the federal government);
• A freelancer or self-employed person;
• A civil servant; or
• A student, in some cases.

Premiums are based on age and health at the time you join, not on income. Young, healthy, well-paid freelancers can pay less than they would publicly; older people and families with several children almost always pay more. Switching back to the public system later is difficult, so this is a long-term decision — treat it like one.

How to actually sign up

1. Pick a fund. Look at the Zusatzbeitrag, any English-language service, and the extras you actually care about.
2. Apply online. Most public insurers offer an English form or a video-ident process for foreigners.
3. You will receive a Mitgliedsbescheinigung (proof of membership) within days — that is what the Ausländerbehörde and your employer want to see.
4. A few weeks later, your physical health card (Gesundheitskarte) arrives by post.

Finding a doctor in Düsseldorf

You do not have to register with a single GP; you can in principle visit any doctor who accepts your insurance. In practice, getting a first appointment with a popular Hausarzt in central Düsseldorf can take weeks. A few tips:

• For urgent but not emergency care, the statutory medical service hotline (116 117) can connect you to an on-call doctor or a nearby Notdienstpraxis.
• For actual emergencies, call 112 or go to a hospital's Notaufnahme — Universitätsklinikum and Florence-Nightingale-Krankenhaus are two of several large hospitals in the city.
• Apps such as Doctolib list slots in real time and skew toward practices that speak some English.

Dentists, mental health, specialists

Most basic dental care is covered, but anything cosmetic, and many higher-grade fillings or crowns, you co-pay. For mental-health care, public insurance covers therapy with approved therapists; waiting lists are long, so start the search earlier than you think you need to. Specialist referrals (cardiology, dermatology, etc.) usually do not require a formal letter from a GP, but some specialists prefer one.

Comparing the main public funds

The legally defined benefits are the same across all public insurers. Differences sit in the Zusatzbeitrag, the digital tools, the customer service, and a handful of voluntary extras. A quick view of names you will meet often in Düsseldorf:

For most working employees the cost difference between two well-rated funds over a year is a few tens of euros. The service quality difference can be larger; ask colleagues which fund actually answers the phone.

Switching insurer

Switching is genuinely easy by German standards:

1. Sign up online with the new insurer. You sign a single form authorising them to handle the transfer.
2. The new insurer notifies your current one and tells you the effective date.
3. You inform your employer of the new fund (a one-line email is usually enough).

You can switch after a holding period of 12 months with your current fund, or earlier if your fund raises its Zusatzbeitrag — that triggers a special right to switch within two months. Cancellations are with a notice period of two months to the end of the second month thereafter.

Pharmacies and prescriptions

German pharmacies (Apotheke) are licensed shops with a pharmacist on duty whenever they are open. They are not drugstores; supermarket-style health and beauty products live at dm, Rossmann or Müller instead.

• Prescription medicines are dispensed against an electronic prescription (E-Rezept) loaded onto your Gesundheitskarte; the pharmacist reads the card.
• You pay a small co-payment per prescription (commonly €5–€10), capped per year for chronic patients.
• Many over-the-counter products that are sold off-the-shelf in other countries (e.g. mild painkillers) are only available at an Apotheke in Germany.
• Every district has a rotating Notdienst: one pharmacy stays open at night and on Sundays. The schedule is posted on every Apotheke's window.

Travel coverage and EHIC

The back of your German Gesundheitskarte is the European Health Insurance Card (EHIC). It gives you access to publicly funded care anywhere in the EU/EEA, Switzerland and a few other countries, on the same terms as locals. It does not cover private clinics, repatriation, or many tourist islands' private medicine. For trips outside Europe and for any longer holidays, a separate Auslandskrankenversicherung (often under €20 a year) is well worth it.

Dental, glasses and other co-payments

The German public system covers basic dental care: examinations, simple fillings, extractions and a fixed-rate contribution to crowns and dentures based on a Bonusheft (a passport-sized booklet stamped at every yearly check-up; ten years of regular check-ups maximises the subsidy). For high-quality crowns, implants or orthodontics, you co-pay or take out a dental top-up policy.

Glasses are subsidised only in narrow circumstances (very high diopters, certain medical conditions). Most adults pay for them themselves.

Mental health care, in practice

Public insurance covers therapy with approved psychotherapists (Richtlinienverfahren: behavioural, psychodynamic, systemic). Three practical hurdles:

• Waiting lists for an initial appointment run from weeks to many months. Start the search before you think you need to.
• The Terminservicestelle (116 117) can place you in an initial assessment within four weeks if you have a referral, but the long-term therapy slot still has to be found by you.
• You are entitled to a preliminary consultation (Sprechstunde) without a referral. After that the psychotherapist requests approval for a course of treatment.

English-speaking therapists exist in Düsseldorf but are heavily booked. Online platforms (HelloBetter, Selfapy) offer cognitive-behavioural programmes covered by some funds.

When you do not have insurance yet

If you arrive without insurance, do not stay uninsured. Two practical paths:

• If you have a job offer, the new employer registers you with a public fund of your choice. You can choose the fund before your first day.
• If you are a freelancer, a student or a job-seeker, you must take out insurance privately or apply to join a public fund directly. Public funds are obliged to admit anyone with a recent connection to the system; if your last cover was outside Germany, they may ask for evidence.

Travel-style "incoming" insurance is fine for the first weeks but is generally not accepted by the Ausländerbehörde for long-term permits. Switch to proper cover within the first month.

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