For most English-speaking expats, TK (Techniker Krankenkasse) is the best choice: lowest rate among major insurers at 2.69% additional contribution (2026), best English support, and consistently high user satisfaction. Barmer is worth considering if mental health coverage matters to you. AOK makes sense in specific regions — particularly Bavaria. DAK is strong on bonus programs. All four cover the same core services by law.
Table of Contents
- How German Public Health Insurance Works
- TK (Techniker Krankenkasse): Why It Is the Expat Favourite
- AOK: Regional Differences and When It Makes Sense
- Barmer: Best for Families and Mental Health Coverage
- DAK-Gesundheit: Strong on Bonus Programs
- Head-to-Head Comparison
- How to Switch Insurers
- Which Insurer Should You Choose?
- FAQ
Germany has over 90 public health insurers. For most expats, the decision comes down to four: TK, AOK, Barmer, and DAK. Together they cover around 70% of all publicly insured people in Germany and are the ones with meaningful English-language support. This guide compares 2026 rates, English coverage, and the extras that actually differ — so you can make the decision quickly.
Not sure whether you need public or private insurance? Read our complete guide to German health insurance for expats first.
How German Public Health Insurance Works
German public health insurance (gesetzliche Krankenversicherung — GKV) is mandatory for most employees earning under €77,400 per year (2026 threshold). Above that, you can choose between public and private insurance.
What you pay
Your contribution has two parts. The base rate of 14.6% of gross salary is the same for every public insurer — set by law. The additional contribution (Zusatzbeitrag) varies by insurer — this is where they compete. Your employer pays half the total. So if the combined rate is 17.29% (TK's 2026 rate), you pay 8.645% from your salary. There is also a monthly earnings cap: in 2026, contributions are only calculated on income up to €5,812.50 per month. Earn above that and your health insurance cost stays the same regardless.
What is covered
Around 95% of coverage is identical across all public insurers — it is mandated by law. Every public insurer covers doctor visits (general practitioner and specialists), hospital stays, prescription medications with small co-payments, mental health treatment, pregnancy and childbirth, preventive care and screenings, and rehabilitation.
The 5% that differs is in extras: alternative medicine subsidies, dental cleaning contributions, bonus programs, and — critically for expats — English-language support.
Family coverage
One of the strongest features of public insurance: your spouse and children can be covered for free if they earn under €565 per month. This applies equally across all public insurers — no advantage to choosing one over another specifically for family coverage.
Verified English-friendly health insurers and advisors — searchable by provider type and city.
Browse health insurance →
TK (Techniker Krankenkasse): Why It Is the Expat Favourite
TK is Germany's largest public health insurer with around 12 million members. It is consistently the top recommendation in expat communities — and the reasons are clear.
2026 costs
TK's additional contribution for 2026 is 2.69%, giving a total rate of 17.29%. That is the lowest among the four major insurers covered here. For someone earning €4,000 per month, your share after employer contribution is around €346 per month. Compare that to Barmer's €358 per month — a difference of roughly €144 per year.
English support
TK offers the strongest English support of any German public insurer:
- 24/7 English hotline: +49 40 46 06 62 53 00
- Fully English app — available in English throughout, with iOS and Android ratings above 4.0/5
- English online application — you can sign up entirely in English
- Seven languages total: English, Spanish, Polish, Turkish, Mandarin, Arabic, and German
- English chat support in the app
The app lets you submit sick notes, find doctors, request certificates, and contact support — all in English. For an expat navigating German bureaucracy, this matters significantly.
Coverage extras
- €120 per year for osteopathy (three sessions at €40 each)
- €100 per year for homeopathy treatments
- €40 per year toward professional teeth cleaning
- Extensive digital health apps (DiGAs) covered
- Travel vaccination subsidies
TK holds a 4.3/5 Trustpilot rating from over 7,000 reviews — the highest among major insurers. Common praise focuses on responsive English support and straightforward claims processing. Common complaints: letters still arrive in German, and self-employed applications can take longer to process.
Best for: Most expats. Especially those who want reliable English support and competitive rates without compromise.
AOK: Regional Differences and When It Makes Sense
AOK is not a single insurer — it is 11 independent regional insurers sharing a brand. Your experience (and your costs) depend entirely on where you live.
2026 costs (varies by region)
AOK rates vary significantly across regions:
- AOK Rheinland-Pfalz/Saarland: 2.47% — among the cheapest options nationally
- AOK Bayern: 2.69% — same as TK
- AOK Baden-Württemberg: 2.99%
- AOK Nordost (Berlin): 3.50% — most expensive
That 1% spread means around €400–500 per year difference depending on your income and location.
English support
English support is AOK's main weakness for expats and varies sharply by region. AOK Nordost (Berlin) has an International Service Centre with support in 14+ languages. AOK Bayern offers an 11-language helpline. Most other AOK regions operate primarily in German, and the Meine AOK app has no English option.
Coverage extras
Also regional. AOK Bayern offers €100 per year for teeth cleaning and €300 per year for osteopathy during pregnancy. AOK Baden-Württemberg provides a €300 "Gesundheitskonto" for various extras. Some regions offer bonus programs worth up to €400 per year.
AOK holds a 3.3/5 Trustpilot rating. Expat feedback is mixed, with better experiences reported in Bavaria and Baden-Württemberg than in Berlin.
Best for: Expats in Bavaria (AOK Bayern matches TK's rate with reasonable multilingual support) or Rheinland-Pfalz/Saarland (cheapest major option). Not recommended if you rely on English digital services.
Barmer: Best for Families and Mental Health Coverage
Barmer is Germany's second-largest public insurer. It is more expensive than TK but offers genuinely differentiated benefits that matter to specific groups.
2026 costs
Barmer's additional contribution remains at 3.29% for 2026 (unchanged from 2025), giving a total rate of 17.89%. For someone earning €4,000 per month, your share is around €358 per month — approximately €12 more per month than TK.
English support
- 24/7 English hotline: 0800 333 10 10 (free from Germany)
- International number: +49 202 568 333 0060
- English online application available
- 350+ service centres for in-person help
The significant downside: Barmer's app is German-only. If you rely on digital services in English, this is a real limitation.
Coverage extras (mental health focus)
- HelloBetter partnership: free 12-month digital programmes for depression, stress, and sleep — unique among major insurers
- Familie Plus programmes: additional support for families with children
- Up to €200 via bonus programme for teeth cleaning and alternative medicine
- Digital health apps (DiGAs) fully covered
The mental health extras are genuinely valuable. Finding a therapist in Germany typically takes months — having digital support bridges that gap. Barmer holds a 2.7/5 Trustpilot rating with mixed feedback: strong praise for phone support, frustration with German-only digital services.
Best for: Families, people prioritising mental health support, and those who prefer phone over app-based services.
DAK-Gesundheit: Strong on Bonus Programs
DAK is Germany's third-largest insurer and often overlooked by expats. It is worth considering if you will actively engage with preventive health programmes.
2026 costs
DAK's additional contribution is 3.20% for 2026 (up from 2.80% in 2025), giving a total rate of 17.80%. That places it between TK and Barmer on price.
English support
- English phone line: 040 325 325 536 (Monday–Thursday 8:00–16:00, Friday 8:00–13:00)
- Basic English information on the website
- Partial English in the app when device language is set to English
- 500 service centres nationwide
English support exists but is less comprehensive than TK. The limited phone hours are a practical drawback if you work standard hours.
Coverage extras
- AktivBonus programme: up to €500 per year for preventive activities — one of the most generous bonus programmes among major insurers
- €60 per year for teeth cleaning — highest direct subsidy among the four
- €120 per year for osteopathy
- MamaPLUS: strong pregnancy programme with extra ultrasounds and support
- 7Mind meditation app: free access for stress management
- Fast-access mental health programme
DAK holds a 2.5/5 Trustpilot rating. Main complaints relate to sudden premium increases for self-employed members and slow bureaucratic processes. However, members who actively use the AktivBonus programme report strong value.
Best for: Health-conscious expats who will actively use the bonus programme, people expecting children (MamaPLUS), and those interested in alternative medicine.
Verified English-friendly general practitioners, specialists and clinics — searchable by city.
Browse health services →
Head-to-Head Comparison
2026 additional contribution (Zusatzbeitrag):
- TK: 2.69% — total rate 17.29%
- AOK: 2.47%–3.50% depending on region
- Barmer: 3.29% — total rate 17.89%
- DAK: 3.20% — total rate 17.80%
English support:
- TK: 24/7 phone, full English app, English application — best overall
- AOK: depends on region — excellent in Berlin and Bavaria, limited elsewhere
- Barmer: 24/7 phone in English, English application, app German-only
- DAK: English phone with limited hours, partial English app
Best coverage extras:
- TK: digital services, osteopathy, travel vaccinations
- AOK: varies by region — Bavaria strongest for extras
- Barmer: HelloBetter mental health programmes, family support
- DAK: AktivBonus up to €500/year, MamaPLUS pregnancy programme
Trustpilot rating: TK 4.3/5 — Barmer 2.7/5 — AOK 3.3/5 — DAK 2.5/5
How to Switch Insurers
Switching is simpler than most expats expect. A 2021 reform streamlined the process significantly.
Basic rules: minimum 12-month membership with your current insurer, then two months' notice before the end of any month. You do not need to contact your old insurer yourself — apply to your new one and they notify the old insurer on your behalf.
Special cancellation rights (Sonderkündigungsrecht): You can switch immediately — without the 12-month wait — if your insurer raises rates, you change jobs (within 14 days), you just moved to Germany, or your insurance status changes (for example, your income crosses the private insurance threshold). When TK and DAK announced their 2026 increases, affected members had immediate switching rights.
Step-by-step process:
- Check you have been with your current insurer for 12+ months (or have a special switching right)
- Apply to your new insurer online
- Your new insurer sends the cancellation notice to your old one
- You receive confirmation from both
- New coverage starts after the notice period
The whole process typically takes two to three months from application to new coverage starting. If you want English-language help choosing and switching, Feather Insurance offers free consultations in English.
Which Insurer Should You Choose?
Choose TK if you want reliable English support across phone, app, and online; competitive rates; and a straightforward, low-friction experience. TK is the safe default for most expats. View TK →
Choose AOK if you live in Bavaria (AOK Bayern matches TK's rate with good multilingual support), you are in Rheinland-Pfalz/Saarland and want the cheapest option, or you prefer local in-person service and do not need English digital tools. View AOK →
Choose Barmer if mental health coverage is a priority (HelloBetter digital programmes are genuinely useful), you have or are planning a family, or you prefer phone support over apps and are willing to pay slightly more. View Barmer →
Choose DAK if you will actively use the AktivBonus programme (up to €500 per year), you are pregnant or planning a pregnancy (MamaPLUS), or alternative medicine coverage matters to you and you do not need 24/7 English phone support.
If you want personalised help, Feather Insurance offers free English-language consultations and handles the application process for you. View Feather on FindEnglish →
Step-by-step guide covering Anmeldung, banking, health insurance and tax ID — in the right order.
Read the First 30 Days guide →
FAQ
Can I switch health insurers if I do not speak German?
Yes. TK and Barmer both offer complete English-language applications. Your new insurer handles the cancellation with your old one — you do not need to navigate German bureaucracy yourself. Feather offers free English-speaking support throughout the process if needed.
Is TK really better than AOK for expats?
For most expats, yes. TK offers consistently stronger English support (24/7 hotline, full English app), competitive rates, and a 4.3/5 Trustpilot rating versus AOK's 3.3/5. However, AOK Bayern matches TK's rate and has good multilingual support — if you are in Munich, both are solid choices.
What is the cheapest public health insurance in Germany?
Among nationwide insurers, TK (2.69%) offers the best value for expats. AOK Rheinland-Pfalz/Saarland (2.47%) is technically cheaper but lacks English support. Some smaller regional insurers offer even lower rates but provide no English-language services.
How long does it take to get a health insurance card?
Typically two to four weeks after your application is approved and documents are complete. In the meantime, your insurer provides a provisional membership certificate (Mitgliedsbescheinigung) that doctors accept. TK generally delivers within the standard timeframe.
Do all public health insurers cover the same things?
About 95% of coverage is identical — mandated by German law. All public insurers cover doctor visits, hospital stays, prescriptions, mental health treatment, and preventive care. Differences are in extras: alternative medicine, dental cleaning subsidies, bonus programmes, and English-language services. See our complete health insurance guide for more detail.
What is the income threshold for public health insurance in 2026?
€77,400 gross per year (€6,450 per month). Below this threshold, public insurance is mandatory for employees. Above it, you can choose between public and private insurance.
Last updated: March 2026
This guide is for informational purposes only. Contribution rates, coverage extras, and insurer policies change annually. Always verify current rates directly with the insurer before enrolling. This is not medical or financial advice.
