Family health insurance – Helpful advice for expats

Key Takeaways

Whether or not family health insurance in Germany is free depends on requirements, which can be divided into three categories.
If both spouses work there is no choice for family health insurance. In this case, each has either public or private health insurance.
If only one spouse works, there is the possibility of free family insurance. However, this is not always the case.
Children are only insured free of charge in one of five scenarios in the family insurance of the public health insurance.

Is family health insurance in Germany for free?

Many people believe that health insurance in Germany is free, but this is not the reality. Both employers and employees contribute to the public health insurance system, usually around 14.6% of the employee’s salary. Furthermore, it is a common misconception that families and children are automatically covered for free in all circumstances, again, this is not the case, as it depends on certain conditions. Generally, the conditions fall into three main categories:

Health insurance for adults (Both working)
Health insurance for adults (One working)
Health insurance for children

Each of these categories can include different scenarios, such as whether or not children are involved. In the following article, we will go into more detail about these scenarios to help you understand under which conditions your family may be eligible for free health care in Germany.

Family health insurance in Germany for adults: Both working

Before we get into the topic of children, it is important to first understand the health insurance options for adults. When both adults are either employed or self-employed, they have their own individual health insurance plans that are not linked. This means that each adult must pay for his or her own coverage and therefore is not eligible for family coverage.

High income or self-employed

An important consideration is that there is no option for free coverage in this case. However, adults who earn more than 66.600€ per year in 2023 or are self-employed have the option of choosing between public and private health insurance. This flexibility allows you to make a decision that best suits your individual needs and circumstances. You can find out more about this option on our private health insurance page.

Income below threshold

Adults earning less than 66.600€ per year in 2023, on the other hand, will be automatically enrolled in public health insurance. This is a requirement set by the government, and it is important to know that there is no way to decline this coverage. You can read more about the general coverage of mandatory insurance on our page about public health insurance.

Do you want to switch to private health insurance to get better benefits? Then let’s take a look at possible plans together.

Family health insurance in Germany for adults: One working

Under certain conditions, a working spouse may qualify for free family health insurance. However, the constellation must be right, and this is what we will look at in more detail below:

Employed spouse has public health insurance: If the employed spouse is insured in the public health insurance system, then the spouse may be entitled to free family health insurance. This option is available if she is not self-employed and earns less than 500 – 600 euros. The exact amount may vary depending on the tax situation, and a mini-job earning 520€ would qualify.
Employed spouse has private health insurance: If the employed spouse has private health insurance, the non-employed spouse can also be covered. However, a separate health insurance contract is required and the spouse is not covered free of charge. The same applies if the non-working spouse is insured by public health insurance. In this case, the total income of the couple is halved and thus the premium due for the statutory health insurance of the non-working spouse is determined.

If the couple is not married, it may be difficult for the non-working spouse to obtain private health insurance, and public insurance may be the only option, with premiums calculated based on a notional income of 1.100€ per month. Overall, it may be difficult to obtain free family insurance, with only one of the above scenarios being eligible.

Family health insurance in Germany for children

The same as above applies to the co-insurance of children. Only under certain conditions can free family insurance be obtained in Germany. The different scenarios are explained in more detail below:

Both spouses are employed and have public health insurance: If both parents work and have public health insurance, the child can be covered by public health insurance free of charge. In this case, there is also the possibility that you insure the child privately. This gives your child access to the best possible coverage. This costs about 150€/month until the age of 18 or 21. There is also a chance that your employer will pay half. However, this depends on your income.
Both spouses are employed and one has private health insurance: If one of the spouses is in private health insurance, then the health insurance depends on the income. The child is always insured with the higher-earning spouse.
One spouse is employed with public health insurance: If only one spouse works and has public health insurance, there is the possibility of family health insurance in Germany. We have already explained the conditions for the wife above. For the child, the automatic co-insurance also applies.
One spouse is employed with private health insurance: In this case, there is the possibility that the spouse also comes into the private health insurance, or remains in the public health insurance (as already explained). However, it is irrelevant what the non-working spouse does, since the child is always insured with the higher earner. Thus, in this case, the child must have private health insurance.
Not married and one is working: If the working parent is in public, the non-working parent has to pay for public health insurance as well. We discussed it earlier, and the child can be insured for free in the public health insurance or go private while both parents stay in the public health insurance. we discussed it earlier as well. If you are not married and the working parent is in private health insurance the non-working parent has to be in public health insurance the same as earlier and the child is always insured with the highest earner.

Again, contrary to the commonly shared opinion of free family health insurance in Germany, only one scenario exists to which this applies. So pay close attention to which of the different situations applies to you and how that affects you. Therefore, you can find a graphic below with all the different scenarios for family health insurance in Germany.

If you need help in choosing blessed public health insurance, you can learn more about it here. If you are unsure about switching to private health insurance or need help choosing a plan for you and your family, you are welcome to schedule a free consultation here.

Family health insurance Germany