What Is Covered by Public Health Insurance in Germany

Public health insurance in Germany, or GKV, covers necessary medical treatment, emergency care, hospitalization, surgeries, most lab tests, many preventive screenings, prescription medications, pregnancy, and childbirth. However, this is not an unlimited policy: some services require a copayment, certain procedures are available only when medically necessary, and comfort- or cosmetic-related options are usually at the patient’s own expense.

The information below helps you understand what to expect from statutory health insurance (gesetzliche Krankenversicherung), what costs even insured patients may face, and when it’s worth asking your health insurance provider (Krankenkasse) about coverage in advance.

How the GKV Works

Residents of Germany are required to have health insurance. Without a policy, it is difficult to receive regular medical care, and emergency or inpatient care can be very expensive. For more details on the risks, see the article “” (Health Insurance: What You Need to Know) and the article “” (The Consequences of Not Having Health Insurance).

There are two main systems in Germany:

(State Health Insurance, GKV);
private health insurance (PKV).

Employees with an income below the annual income threshold (Jahresarbeitsentgeltgrenze) generally remain in the GKV. In 2026, this threshold is 77,400 euros gross per year. If income exceeds the threshold, a person may, subject to certain conditions, switch to private health insurance (PKV) or remain in the GKV voluntarily. Self-employed individuals, students, retirees, and family members of an insured person are covered under separate rules.

GKV operates on the principle of Sachleistungsprinzip: the patient presents their insurance card, and the doctor or clinic bills the health insurance provider directly. The patient pays only the copayments set by law or for services that are not covered.

What Is Included in Basic Coverage

Statutory health insurance covers treatment that is considered adequate, appropriate, and cost-effective. In practice, this means that if a service is medically necessary and provided for under GKV regulations, the patient receives it through a doctor, clinic, or other approved service provider.

Category	What GKV Typically Covers	What Is Often Paid for Separately
Doctors	Appointments with general practitioners (Hausarzt), pediatricians (Kinderarzt), specialists, and psychotherapists approved by the GKV	Appointments with private doctors not approved by the health insurance fund (Kassenzulassung), expedited private consultations
Emergency Care	Ambulance service, emergency room, urgent treatment	Unjustified calls or private additional services may result in out-of-pocket costs
Hospital	treatment in a standard ward, medically necessary surgeries	private room, choice of attending physician, additional services
Medications	prescription drugs (red prescription)	copayments, non-covered medications, over-the-counter medications in most cases
Dental Care	basic treatment, preventive care, partial coverage for prosthetics	expensive materials, implants, advanced cosmetic procedures
Preventive Care	Approved checkups, screenings, and vaccinations as recommended by STIKO	Additional tests without medical indications, many IGeL services

A detailed overview of the system is provided in the article “” on GKV and PKV:. If you need to switch health insurance providers, see for the procedure for transferring to another health insurance provider:.

Copayments: When Patients Pay Out of Pocket

Even with GKV, there are statutory copayments. The most common examples are:

Prescription medications: typically 10% of the price, with a minimum of 5 euros and a maximum of 10 euros, but no more than the actual cost of the medication;
Hospitalization: 10 euros per day of stay, up to a maximum of 28 days per calendar year;
Medical treatments, such as physical therapy: typically 10% of the cost plus 10 euros per prescription;
Medical aids, such as certain orthopedic devices: the copayment depends on the type of device and the health insurance fund’s agreements;
Certain transportation costs: only if certain conditions are met and often with a copay.

For adults, there is an annual out-of-pocket maximum (Belastungsgrenze): once the legally established limit is reached, you can apply for an exemption from further copayments. For people with severe chronic illnesses, the limit is lower. The specific calculation depends on family income, family composition, and the recognized status of the chronic illness.

If a service is not covered by GKV

When a doctor offers a service as an IGeL or a private Zusatzleistung, it’s important not to sign the consent form automatically. Check three things:

Are there medical indications, and is the service covered by GKV under these indications?
Can you get a written estimate and an explanation of why a service is subject to a copayment?
Does your health insurance provider cover it as a statutory benefit (Satzungsleistung) or through a bonus program?

If a service is important but not included in basic coverage, private supplemental insurance can sometimes help: dental supplemental insurance (Zahnzusatzversicherung), hospital supplemental insurance (Krankenhauszusatzversicherung), or separate policies for eyeglasses or alternative medicine. Before signing up, be sure to check the exclusions, waiting periods, and payment limits.

Doctors and Specialists

With GKV, you can see doctors who work with statutory health insurance providers. Usually, you start by seeing your family doctor (Hausarzt), and then, if necessary, receive a referral to a specialist. Technically, many specialists will see you without a referral, but a referral helps with the referral process and paperwork.

It’s helpful to clarify the following in advance:

Does the practice accept patients with statutory health insurance?
whether a referral (Überweisung) is required;
What documents to bring: your electronic health card, a list of medications, and test results;
Whether the proposed procedure will be covered by GKV or classified as a self-pay service (Selbstzahler-Leistung).

For more details on making appointments and seeing a doctor: how to see a doctor in Germany.

Emergency Care

In the event of a life-threatening emergency or a sudden serious medical condition, call 112. This applies, for example, to severe chest pain, a stroke, a serious injury, loss of consciousness, or acute shortness of breath. For urgent but non-life-threatening situations, the on-call medical service at 116117 is often appropriate.

GKV covers necessary emergency care. But the choice of where to go matters: the Notaufnahme is not a substitute for a regular doctor’s appointment for minor complaints, and an unjustified call to the Rettungsdienst may lead to questions about the necessity of the expenses. For more details, see and how the ambulance service works at.

Hospitals, Surgeries, and Rehabilitation

Inpatient treatment is covered if it is prescribed by a doctor or is an emergency. Coverage includes necessary surgery, treatment in a standard ward, medications, meals, and care. Adults pay a set daily copayment for their hospital stay unless they are exempt.

GKV is not required to cover comfort-of-stay options: a single or double room upon request, treatment by the chief physician, or enhanced services. For such options, you’ll need separate Krankenhauszusatzversicherung or pay out of pocket.

Rehabilitation may be covered by GKV, pension insurance, or another payer. Who is responsible depends on the purpose of the rehabilitation: restoring health, preventing disability, or returning to work.

Tests, Diagnostics, and Preventive Care

Laboratory tests, ultrasounds, X-rays, CT scans, or MRIs are covered when a doctor deems them medically necessary and prescribes them under the GKV. Tests performed “just in case” without a medical indication may be subject to a copay.

Preventive care under the GKV includes approved checkups for children and adults, age- and risk-based screenings, and vaccinations in accordance with STIKO recommendations. Different health insurance providers offer additional programs: bonuses for preventive care, partial reimbursement for sports classes, and expanded checkups. These benefits vary by provider, so you should check the specific terms of your health insurance provider.

More on vaccinations: vaccinations for children and adults.

Medications and Prescriptions

Prescription medications are usually dispensed with a red prescription or via eRezept and are covered by GKV with a copayment from the patient. The pharmacy may dispense a medication under a Rabattvertrag—that is, a generic equivalent with the same active ingredient—if the doctor has not ruled out a substitution.

Over-the-counter medications for adults are most often paid for out of pocket. Exceptions may apply for children, certain diagnoses, and specific medications, if provided for in the policy guidelines.

Useful resources:

How pharmacies work in Germany;
Types of prescriptions and payment for medications.

Dentistry and Orthodontics

GKV covers basic dental care: checkups, cavity treatment, tooth extractions, and medically necessary gum treatment. For dentures, a fixed subsidy (Festzuschuss) applies: the health insurance provider pays a fixed portion of the standard treatment, and the remainder depends on the chosen treatment plan and materials.

Regular preventive checkups help increase the subsidy for dental prosthetics through the Bonusheft. Implants, ceramic restorations, complex cosmetic procedures, and many comfort-oriented options usually require a significant out-of-pocket payment.

Orthodontic treatment for children is covered if there is sufficient medical necessity. For adults, orthodontic treatment is usually covered only in limited cases, such as severe jaw abnormalities and surgical treatment.

For more information: (dental care in Germany), and (supplementary dental insurance), and.

Vision, Eyeglasses, and Medical Aids

The GKV covers eyeglasses and contact lenses for adults only under certain medical conditions and in cases of severe vision impairment. Coverage for children and adolescents is more extensive, but it also depends on the rules and a doctor’s prescription.

Medical aids—such as hearing aids, orthoses, walkers, or compression garments—are covered when prescribed and medically necessary. Often, a fixed amount or a co-payment model applies, so you may have to pay a copayment for a more expensive model.

Sick Leave and Sick Pay (Krankengeld)

An employee who falls ill and obtains a certificate of incapacity for work (Arbeitsunfähigkeitsbescheinigung) usually first receives continued pay from their employer. After a specified period in the case of a long-term illness, sickness benefits (Krankengeld) from the GKV may kick in. The details depend on employment status, insurance coverage, and medical documentation.

The practical procedures are described here: sick leave in Germany.

Pregnancy, Childbirth, and Family

GKV covers prenatal care, standard examinations, childbirth in a hospital or with approved specialists, postpartum care, and some services provided by a midwife (Hebamme). Additional examinations without a medical indication may be offered on a fee-for-service basis.

Children, spouses, and registered partners can be included in beitragsfreie Familienversicherung (premium-free family insurance) if they meet the requirements regarding residence, income, and the absence of other mandatory insurance. For more details: family insurance in the GKV.

Disability, Care, and Support

In the event of a disability or long-term illness, GKV may cover treatment, medical aids, medically necessary home care, and part of rehabilitation. However, many benefits, long-term care services, and social assistance are provided through other systems: long-term care insurance, pension insurance, the social welfare office (Sozialamt), or the integration office (Integrationsamt).

Therefore, in complex situations, it’s best to gather your documents and clarify which party is responsible for covering the specific treatment. For general guidelines, see the article “” (Rights and Benefits for People with Disabilities) at.

How to Check Coverage Before Treatment

Before undergoing a costly procedure or using a service you’re unsure about, follow these steps:

Ask your doctor to specify the diagnosis, the medical necessity, and the service code.
Ask whether the treatment will be provided as a Kassenleistung or as a private service.
If you’re paying out of pocket, ask for a written cost breakdown.
Submit a request to your health insurance provider before starting treatment, especially if the cost is high.
Keep a written response from the health insurance provider and all your appointments.

This is especially important for dental care, rehabilitation, medical aids, elective surgeries, IVF, treatment abroad, and services that doctors classify as IGeL.

Brief Conclusion

In Germany, statutory health insurance (GKV) covers basic medical care: doctors, medically necessary diagnostics, emergency care, hospitalization, prescription medications, basic dental care, pregnancy, and some preventive care. The main limitations relate to copayments, the “adequate and cost-effective” standard of care, cosmetic services, hospital amenities, and additional programs offered by specific health insurance providers. If treatment is expensive or non-standard, it’s best to obtain written confirmation of coverage in advance.