The German Healthcare System

Almost every guide to the German healthcare system tells you how it is funded. Very few tell you what to do at nine o’clock on a Sunday evening when your child has a fever of 39.5 and every practice in the city is shut. This chapter is about the second thing. It assumes you have sorted out your insurance, or are about to, and it deals with the part nobody explains: how you actually get a doctor to look at you, how fast, at what cost, and which of the four different numbers you could dial is the right one.

This matters more here than in many countries, because the German healthcare system is excellent at treating you and poor at telling you how to reach it. There is no single national health service with one front door. There are roughly ninety-odd independent insurers, tens of thousands of self-employed doctors in private practices, a separate on-call service, a separate hospital emergency system, and a separate appointment brokerage that exists specifically to solve the waiting-time problem and that most newcomers have never heard of. Learn the map once and the system works well. Do not learn it, and you will spend six hours in a hospital emergency room for a urinary tract infection while a doctor two streets away could have seen you in twenty minutes.

What follows is the map. It is written for someone who is insured in Germany and is trying to use that insurance for the first time. It is not medical advice, and nothing here should be used to decide whether a symptom is serious. Where a decision could be a safety question, the rule in this chapter is always the same: if you think it might be life-threatening, treat it as life-threatening.

The Shape of the German Healthcare System

Germany does not have a health service. It has a compulsory insurance system with a legal duty on the state to make sure care exists, and then leaves the actual delivery of that care to self-employed doctors, charitable and municipal and private hospitals, and independent pharmacies. Everyone living here must be insured, either in the gesetzliche Krankenversicherung, the statutory health insurance usually shortened to GKV, or in the private Krankenversicherung, the private health insurance shortened to PKV. Around nine in ten people are in the GKV. The GKV is not one organisation: it is a set of independent non-profit insurers called Krankenkassen, and there were 93 of them as at 1 January 2026, not the “over 100” that older guides still repeat.

The single most useful thing to understand about the GKV is the Sachleistungsprinzip, the benefits-in-kind principle. You do not pay the doctor and claim it back. You hand over a card, the doctor treats you, and the doctor bills a body called the Kassenärztliche Vereinigung, the regional association of panel doctors, which settles with your Krankenkasse. From your side, an ordinary appointment costs nothing at the point of care. There is no fee to see a doctor, no fee to see a specialist, and no annual deductible. The costs you do meet are narrow and capped, and they are covered further down. Private insurance works the opposite way: you get an invoice, you pay it, and you claim it back from your insurer.

The other body worth knowing by name is that same Kassenärztliche Vereinigung, usually abbreviated KV. Each federal state has one, and by law it carries the Sicherstellungsauftrag, the duty to ensure that outpatient care is actually available to insured people, including at night and at weekends. This is not an abstraction. It is why the on-call service exists, why the appointment service exists, and why a legal maximum waiting time exists. When this chapter says the system owes you something, the KV is usually the body that owes it.

Which system you are in changes your experience at the margins rather than the core. Private patients often get an appointment faster and are more likely to be seen by a senior doctor in hospital, because private billing pays practices more. Statutory patients get a comprehensive, standardised catalogue of benefits, free co-insurance for a non-earning spouse and children, and contributions that follow their income rather than their health. The choice between the two is one of the most consequential and least reversible financial decisions you will make in Germany, and it is dealt with properly in the chapter on insurance essentials in Germany, which also carries the current income thresholds and explains the age-55 lock-out under §6 Abs. 3a SGB V that makes leaving the GKV close to permanent. Read that before you sign anything. This chapter assumes the decision is made.

Your Health Card and What to Do Before It Arrives

Your key to the whole system is a plastic card with a photo on it called the elektronische Gesundheitskarte, the electronic health card, universally abbreviated to eGK. Your Krankenkasse issues it after you enrol, and it is not merely identification. It is the token that proves entitlement, that unlocks your electronic prescriptions at the pharmacy, and that a practice reads once per calendar quarter to confirm you are still insured. Carry it. Every practice will ask for it before anything else happens, and in some the receptionist will ask for nothing else at all.

Two details on the card catch newcomers out. First, the current cards are NFC-capable, meaning they can talk to a smartphone wirelessly, but that only becomes useful once you also have your Versicherten-PIN, a personal identification number you have to request separately from your Krankenkasse. Without the PIN you cannot use the E-Rezept app or several other digital services. Request it early, because it arrives by post and takes time. Second, the card is read once per quarter. If your first visit to a practice falls at the end of March and your next is in April, you will be asked for the card again, and this is normal rather than an error.

Now the situation that actually bites: you have registered, you have a job, you are covered, and the card has not arrived. This happens constantly and there is a clean answer. Ask your Krankenkasse for an Ersatzbescheinigung, a substitute certificate of entitlement. Under §19 Abs. 2 of the Bundesmantelvertrag-Ärzte, the framework contract between the panel doctors and the Krankenkassen, the Kasse must issue one where the card cannot be presented, and it is a valid proof of entitlement. Most Kassen will email or post it within a day or two, and many will send it while you are still on the phone. Take it to the practice and you are treated as a normal statutory patient.

If you turn up without card and without certificate, the practice will usually still treat you, but the clock starts. Under the same framework contract you have ten days to produce the eGK or another valid proof. If you do not, the practice is entitled to bill you privately for that treatment. That is not the end of the story: if a valid card or proof covering the treatment date reaches the practice by the end of the calendar quarter, the practice must refund what you paid. Keep the receipt, get the certificate, take it back, and ask for the money. People lose real sums here purely by not knowing the refund exists.

Finding a Hausarzt Before You Need One

The Hausarzt, literally house doctor and best translated as family doctor or general practitioner, is the person who should know your history, manage your chronic conditions, write your referrals, and sign your sick notes. §76 Abs. 3 Satz 2 of the Fifth Book of the Social Code, SGB V, puts it in four words: “Der Versicherte wählt einen Hausarzt.” The insured person chooses a family doctor. The law expects you to have one. Nothing forces you to, and nothing stops you seeing someone else, but the expectation is written into the statute and the whole system is built around the assumption that it is true.

Register with one while you are healthy. This is the single most valuable practical instruction in this chapter, and it is the one newcomers ignore, because registering with a doctor when nothing is wrong feels absurd. It is not. Good practices in German cities frequently have an Aufnahmestopp, a stop on taking new patients, and finding one that will take you can take weeks of phone calls. Doing that with a fever is miserable. Doing it in your first month here, calmly, is twenty minutes of work. It also matters for a reason that will make sense later in this chapter: the telephone sick note is only available to patients the practice already knows.

To find one, use arztsuche.116117.de, the official doctor search run by the Kassenärztliche Bundesvereinigung, the national association of panel doctors. It lists every doctor licensed to treat statutory patients, and you can filter by specialty, by location, and by the languages the practice speaks, which is discussed in its own section below. If you cannot find anyone, you have a legal backstop that almost nobody uses: under §75 Abs. 1a SGB V the Terminservicestelle, the appointment service, is explicitly required to help insured people find a Hausarzt. Call 116117 and ask them to do it. That is not a favour. It is one of their four statutory duties.

When you call a practice, the German phrase you want is “Ich möchte mich als neue Patientin anmelden” or “als neuer Patient anmelden”, meaning you would like to register as a new patient. Ask whether they are taking new patients, “Nehmen Sie neue Patienten auf?” If the answer is no, ask for a recommendation, because receptionists usually know which practices nearby are still open. Once you are registered, a practice will generally see you for something acute even without a booked slot, which is worth more than any convenience the system otherwise offers.

Referrals, Specialists and the Überweisung

Here is where most English-language guides to the German healthcare system get it wrong, including the earlier version of this one. They tell you that you need a referral from your Hausarzt to see a specialist. In general you do not. §76 Abs. 1 SGB V grants freie Arztwahl, free choice of doctor: you may choose freely among all doctors licensed for statutory care. You can call a dermatologist directly. You can call a gynaecologist, an orthopaedist, an ear-nose-and-throat doctor, an ophthalmologist, a paediatrician or a psychotherapist directly. No referral is required and none should be demanded.

There are exactly seven exceptions, set by §13 Abs. 4 of the Bundesmantelvertrag-Ärzte, and they are the specialties that do not really have patients of their own: laboratory medicine, microbiology and infection epidemiology, nuclear medicine, pathology, radiological diagnostics and radiology, radiation therapy, and transfusion medicine. These may be used only on an Überweisung, a referral, because they perform work another doctor has ordered. That is why you need a referral for an MRI scan and not for a dermatologist. There is also one specialty you can never be referred to: referrals to dentists are not permitted at all, so you simply call a dentist yourself.

So why does everyone believe referrals are compulsory? Three reasons, all real. First, a specialist’s practice may still ask for one, because a referral tells them what has already been done and sometimes affects how they bill. It costs you nothing to get one and it usually smooths the appointment, so if a practice asks, ask your Hausarzt. Second, if you have voluntarily joined a hausarztzentrierte Versorgung, the family-doctor-centred care programme under §73b SGB V, you have contractually agreed to see specialists only on your Hausarzt’s referral. Krankenkassen must offer this programme and often reward joining it with a bonus. Participation is voluntary by law, you can revoke your enrolment within two weeks without giving reasons, and Augenärzte and Frauenärzte, eye doctors and gynaecologists, are carved out even inside it. Read what you sign.

Third, and this is the reason the belief may soon become true, the current coalition wants to make it compulsory. The CDU/CSU and SPD coalition agreement provides for a Primärarztsystem, a primary-care system in which your Hausarzt or your child’s paediatrician becomes the binding first point of contact and the route to specialists, with eye doctors and gynaecologists exempted. The Federal Ministry of Health has announced a draft law. It is not law. Nothing about how you access specialists has changed, and you should not behave as though it has. But it is the direction of travel, which is one more argument for getting registered with a family doctor now rather than later.

One last piece of mechanics: a referral is generally valid for the calendar quarter it was issued in, and it is not tied to a federal state. A referral written in Berlin can be used at a practice in Munich. It names a specialty rather than a person, so you choose who to take it to.

The 116117 Number That Almost No Newcomer Knows

If you remember one thing from this chapter, remember this number. 116117 is the Patientenservice, the patient service run by the panel doctors’ associations. It works from any German landline or mobile without an area code, anywhere in the country, and it is free. It is staffed 24 hours a day, seven days a week, which §75 Abs. 1a SGB V has required since 1 January 2020. It serves both statutory and private patients. And it does two entirely different jobs that people constantly confuse, so take them one at a time.

The first job is the Terminservicestelle, the appointment service, and it exists precisely because of the waiting times that make expats despair. If you cannot get a specialist appointment, the Terminservicestelle must find you one. The law is specific. It has one week to broker an appointment for you. The appointment it brokers must be no more than four weeks away, or three weeks for a radiological appointment. The distance to the doctor must be reasonable. If it cannot place you within those limits, it must offer you an outpatient appointment at an approved hospital instead, and where it does, §76 Abs. 1a SGB V lets you use hospitals that do not otherwise take statutory outpatients, including the follow-up treatment needed to secure the result. This is an entitlement, not a courtesy, and hardly any foreign resident uses it.

The limits are worth knowing so you do not call for the wrong thing. For a specialist appointment you generally need a referral first, with three exceptions written into the statute: eye doctors and gynaecologists need none, acute cases need none, and you need none if a hospital emergency department has already assessed you and found that you need a doctor but not immediately. The service does not apply to routine check-ups that can be postponed, nor to minor ailments, and it does not cover dentists or orthodontists at all. For those, ask the dentist directly or use the emergency dental service described below.

The second job is the ärztlicher Bereitschaftsdienst, the on-call medical service, and it is what you want when practices are shut. Call the same number and you reach a medically trained person at your regional control centre who will tell you where to go, direct you to a Bereitschaftspraxis, an on-call practice that is open when everything else is closed, pass you to a doctor, or in some cases send a doctor to your home. You can also find the nearest on-call practice yourself at 116117.de without phoning, and the site has a self-assessment tool called the Patienten-Navi that walks you through your symptoms and recommends the right level of care. The website is offered in German, English, Turkish, Russian, Ukrainian, Arabic, Polish, French, Spanish and Italian, and there are versions in plain German and in sign language.

Emergencies: Which Number, and When

This is the part of the German healthcare system where getting it wrong has consequences in both directions, so read it carefully. There are three destinations and one governing rule. The rule first: if you believe the situation may be life-threatening, dial 112 and do not think about anything else in this section. 112 is the European emergency number, it reaches the Rettungsdienst, the rescue service, it works from any phone including one with no SIM card, and it is free. No part of this chapter is a reason to hesitate.

The official examples of what 112 is for are worth committing to memory, because they are the ones the panel doctors themselves publish. Unconsciousness or a serious clouding of consciousness. Severe shortness of breath. Severe chest pain or heart symptoms. Heavy bleeding you cannot stop. Accidents where serious injury is suspected. Poisoning. Severe burns. Drowning. Electrical accidents. Suicide attempts of any kind. Acute and persistent seizures. Sudden birth, or complications in pregnancy. Acute and persistent extreme pain. If what is in front of you looks like any of those, you are done reading. Call 112.

The Bereitschaftsdienst, reached on 116117, is for the very large middle ground, and it is defined by three conditions that must all be true at once. The practices are closed, for example it is evening, a weekend or a public holiday. The problem is one you would normally take to a doctor’s practice. And it cannot medically wait until the next day. The published examples are a cold with a fever above 39 degrees, persistent vomiting and diarrhoea when you cannot keep fluids down, severe throat or ear pain, an acute urinary tract infection, acute back pain, and acute abdominal pain. Those are exactly the complaints that fill German emergency departments at midnight, and they should not be there.

The Notaufnahme, the hospital emergency department also called the Rettungsstelle, is above all for life-threatening emergencies. You can walk into one, nobody will turn you away, and if you are genuinely in danger that is where you should be. But if you walk in with a problem the on-call service could have handled, you will be triaged behind everyone sicker than you and you may wait many hours, while the staff you are waiting for are the same staff someone with chest pain needs. The Bereitschaftspraxis is frequently located at the hospital itself, sometimes in the next corridor, and it is the same medicine without the wait. If you have gone to the emergency department and the assessment finds you need a doctor but not immediately, that assessment doubles as your ticket into the appointment service without a referral.

Two practical points before you dial. If you are on the phone and unsure, the operator at 116117 is medically trained and will escalate you to 112 if you need it, so calling the “wrong” one of those two is not a disaster in the direction of 116117. And if your German is not up to an emergency phone call, prepare before you need to: the Notfall-Phrasen tool discussed later gives you the German sentences for exactly this situation, and Germans who answer emergency lines will work with broken German far more readily than you expect. Give the address first, always. Everything else can follow.

Pharmacies, the E-Rezept and What You Pay

A German Apotheke, pharmacy, is not the shop you are used to if you come from Britain or North America. §43 of the Arzneimittelgesetz, the medicines act, reserves the sale of medicines to pharmacies unless a specific rule releases them for sale elsewhere. This is the Apothekenpflicht, the pharmacy-only requirement, and it means the supermarket has no painkiller aisle. Even ibuprofen and paracetamol come from an Apotheke, over a counter, from a pharmacist. Prescription medicines are behind the counter and there is no self-service. Ask, and be prepared for the pharmacist to ask you questions back, because in Germany the pharmacist is a clinical professional rather than a shop assistant, and the consultation is part of the job.

Prescriptions themselves have gone digital. Since 1 January 2024 the E-Rezept, the electronic prescription, has been mandatory for prescription-only medicines, and the pink paper Rezept is gone. There are four ways to redeem one. You can put your eGK into the card terminal at any pharmacy, which is the simplest and needs nothing else. You can use the gematik E-Rezept app, which needs an NFC-capable card and that Versicherten-PIN mentioned earlier. You can use a pharmacy’s own app via a procedure called CardLink, which turns your phone into the card reader. Or you can ask the practice for a paper printout of the access codes, which is not a prescription but works like one at the counter. You may redeem at any pharmacy you like, including online ones, and repeat prescriptions can now be issued without you going back to the practice at all.

Now what it costs. For adults, the Zuzahlung, the co-payment, on a prescribed medicine is set by §61 SGB V at 10 percent of the price, with a minimum of 5 euros and a maximum of 10 euros, and never more than the medicine actually costs. So a 4-euro medicine costs 4 euros and a 400-euro medicine costs 10. Insured people who have not yet completed their eighteenth year pay nothing under §31 Abs. 3 SGB V. Inpatient hospital treatment costs 10 euros per calendar day, but only for a maximum of 28 days in a calendar year and only from age 18, so a long admission does not compound. Physiotherapy and similar Heilmittel cost 10 percent of the price plus 10 euros per prescription. Whoever takes your co-payment must give you a receipt and may not charge you for it.

Those receipts are the point. §62 SGB V caps your total co-payments for the whole calendar year at 2 percent of your gross household income, and at 1 percent if you are chronically ill and in continuous treatment for the same serious condition. Once you hit the limit, your Krankenkasse must certify that you owe nothing more that year. The calculation aggregates your household, with allowances deducted for a spouse or partner and for each child, so a family reaches the limit sooner than the arithmetic first suggests. Keep every receipt in an envelope and send them to your Kasse when they add up. One caveat worth knowing: for people born after 1 April 1972, the 1 percent limit for chronic illness depends on having taken the statutory screening examinations before falling ill, or on taking part in a structured treatment programme.

Two more things about pharmacies. There is always one open. Pharmacies rotate an Apotheken-Notdienst, an emergency pharmacy service, and you can find the nearest one at aponet.de, which is built on the official data of the Bundesapothekerkammer, the federal chamber of pharmacists. Every pharmacy also posts the current rota on its door. Between 8pm and 6am, and on Sundays and public holidays, §6 of the Arzneimittelpreisverordnung lets the pharmacy charge an extra 2,50 euros including VAT for the night service, on top of any co-payment. That is the whole surcharge. Nobody is overcharging you.

Sick Notes, the eAU and What the 2026 Reform Would Change

If you fall ill and cannot work, two separate obligations start, and confusing them is the classic newcomer mistake. The first is to tell your employer. §5 Abs. 1 of the Entgeltfortzahlungsgesetz, the continued remuneration act, requires you to notify your employer of your incapacity and its likely duration unverzüglich, meaning without culpable delay, which in practice means before your shift starts on the first day. This obligation is yours, it is personal, and no doctor and no insurer does it for you. The second is to obtain the medical certificate, and that has its own deadline.

The certificate is the Arbeitsunfähigkeitsbescheinigung, the certificate of incapacity to work, universally shortened to AU and colloquially called an Attest. By law it is due when the incapacity lasts longer than three calendar days, at the latest on the following working day. Note calendar days: fall ill on Friday and the count includes the weekend. But read the next sentence of the statute, because it is the one people miss. Your employer is expressly entitled to demand the certificate earlier, from day one if they wish, and many German employment contracts already say exactly that. Check your contract now rather than on a morning when you are ill.

The paperwork itself has largely vanished. The “gelber Zettel”, the yellow slip, is gone for statutory patients. Your practice transmits the elektronische Arbeitsunfähigkeitsbescheinigung, the electronic sick note or eAU, straight to your Krankenkasse, and your employer retrieves it from there. This is convenient and it is also the source of a dangerous misunderstanding: because the certificate travels electronically, people assume the employer has been informed. It has not. You must still tell your employer yourself. Ask the practice for a printout for your own records anyway, because employers sometimes cannot retrieve the record and you will want the evidence.

The telephone sick note, the telefonische Krankschreibung, still exists as this is written, and its rules are precise. It is available for light illnesses such as an ordinary respiratory infection. The condition is that you must already be known to the practice, which is the second time in this chapter that registering with a Hausarzt in advance turns out to be worth real money. The doctor asks about your symptoms on the phone and decides whether a call is enough or whether you must come in. It runs for at most five calendar days. It cannot be extended by phone unless the first certificate was issued during an actual visit. If your card has not been read at the practice in that quarter, you have to catch up on that afterwards. Parents can get a certificate for a sick child on the same conditions, for up to five working days, which is what unlocks Kinderkrankengeld, the sickness benefit paid at about 90 percent of lost net pay while you look after your child.

Now the reform, and the framing matters. On 2 July 2026 the coalition committee of the CDU/CSU and SPD agreed a package that would abolish the telephone sick note entirely and require a doctor’s certificate from the first day of any illness. It has been widely reported as though it had happened. It has not. It requires a law that the Bundestag has not passed, parliamentary debate is expected in autumn 2026, and entry into force is not expected before 2027. The Bundesregierung’s own page on the telephone sick note, updated on 13 July 2026 and therefore after the announcement, says it plainly: the coalition parties have agreed to abolish it and to introduce a day-one certificate, and “bis zur Umsetzung dieser Maßnahmen bleiben die bisherigen Regelungen bestehen” – until those measures are implemented, the existing rules remain. So the rules above are the rules today. Watch the autumn.

The Dentist and What the Bonusheft Is Actually Worth

Dental care sits inside the GKV but on visibly different terms, and this is where statutory patients meet a bill for the first time. Routine things are covered: the annual check-up, most fillings, treatment of disease. Cosmetic and premium things are not. If you want a filling that goes beyond the standard provision, §28 Abs. 2 SGB V says you pay the difference yourself, the Kasse settles the cheapest comparable plastic filling as a benefit in kind, and a written agreement must be signed with the dentist before treatment starts. If a dentist starts describing options and has not put anything in writing, stop and ask for the agreement. Orthodontics for adults is not covered at all unless there is a severe jaw anomaly.

Zahnersatz, dental prosthetics, meaning crowns, bridges and dentures, is the real exposure, and it works through befundbezogene Festzuschüsse, fixed subsidies tied to the diagnosis rather than to the treatment you choose. The Kasse pays a fixed amount for your finding, and you pay the rest, whatever you and your dentist decide to do. §55 Abs. 1 SGB V sets that subsidy at 60 percent of the standard provision, the Regelversorgung. So a crown that would cost 700 euros in the standard version brings a subsidy of 420 euros, and if you choose something more expensive, the subsidy stays where it is and the extra is entirely yours.

This is where the Bonusheft earns its reputation. It is a small paper booklet your dentist stamps at each annual check-up, and it is one of the highest-return pieces of paper in German life. The statute never uses the word: what §55 rewards is “eigene Bemühungen zur Gesunderhaltung der Zähne”, your own efforts to keep your teeth healthy, and the booklet is simply how you prove it. Attend once a year for five consecutive years and the subsidy rises from 60 to 70 percent. Do it for ten unbroken calendar years and it rises to 75 percent. On a 700-euro standard crown that is the difference between 420 and 525 euros of subsidy, for the cost of one appointment a year that was free anyway. Ask for the booklet at your first appointment, ask for the stamp every single time, and do not lose it. There is a hardship rule too: under §55 Abs. 2 the Kasse covers the standard provision in full if your income is at or below 40 percent of the monthly reference figure, or if you receive Grundsicherung, SGB II benefits, Hilfe zum Lebensunterhalt or BAföG.

Two practical notes. Because the gap between the subsidy and the bill is potentially large and entirely predictable, a Zahnzusatzversicherung, supplementary dental insurance, is one of the few optional policies in Germany that reliably pays for itself, and the time to buy it is while your teeth are fine, because insurers exclude what is already diagnosed and usually impose waiting periods. The insurance essentials chapter sets out how to judge one. And if a tooth breaks on a Sunday, dentists run their own emergency rota, entirely separate from 116117’s medical service, organised per federal state and listed on 116117.de under zahnärztliche Notdienste. The appointment service cannot help you with a dentist, so use that.

Getting Psychotherapy Without Waiting a Year

Psychotherapy is a full statutory benefit, and the access route is unusually well defined once you know it. You do not need a referral, ever. You call a practice directly. Practices with a full licence are required to be reachable by phone for at least 200 minutes a week, and every route into treatment begins in the same place: the psychotherapeutische Sprechstunde, the psychotherapeutic consultation, which must happen before any treatment starts. It is a short assessment that establishes whether there is a diagnosis, whether therapy would help, which method suits you, and whether something else would serve you better.

What comes out of that consultation is a form called PTV 11, and it is the key to the whole system. It records the result and the recommendation, and it carries a Vermittlungscode, a brokerage code. If it is marked that ambulant psychotherapy is “zeitnah erforderlich”, required promptly, you take that code to 116117 and the appointment service must find you a place. The deadlines are in law. The service has one week to broker a slot, and the slot must be within four weeks, so five weeks in total. For a psychotherapeutische Akutbehandlung, acute psychotherapeutic treatment, the slot must be within two weeks, so three weeks in total. If it cannot place you with a panel therapist, it has one further week to find you a hospital or hospital outpatient appointment.

The Akutbehandlung deserves its own paragraph, because it is the fastest route to real help and almost nobody knows it exists. It is up to twelve sessions of fifty minutes for acute crises and severe strain, and its defining feature is that it requires no application to your Krankenkasse and no approval. It can begin straight after the consultation. Its purpose is to stabilise you, either as treatment in itself or so that you are able to start longer therapy. If you are in a bad state, this is the sentence to say to a practice: ask whether an Akutbehandlung is appropriate for you.

Beyond that, four methods are approved for statutory outpatient treatment: Verhaltenstherapie, behavioural therapy, which works directly on symptoms with targeted exercises; tiefenpsychologisch fundierte Psychotherapie, depth-psychology-based therapy; analytische Psychotherapie, psychoanalysis; and systemische Therapie, systemic therapy, which puts your family or social system at the centre. Each can be individual, group or both, and group therapy is at least as effective as individual therapy, considerably easier to get into, and available as a low-threshold Gruppenpsychotherapeutische Grundversorgung with no application to the Kasse at all. Search for practices at psychotherapiesuche.116117.de, or call 116117 if you cannot find one yourself.

Two things worth saying plainly. You are allowed to shop around: hold first conversations with several therapists, and if the fit is wrong, say so and ask 116117 for a different practice. Nobody will hold it against you, and the fit genuinely determines whether therapy works. And if you have just been discharged from hospital or rehabilitation with a psychiatric diagnosis, you need neither the PTV 11 form nor a code, and appointments for the preparatory sessions can be arranged while you are still an inpatient.

Finding a Doctor Who Speaks Your Language

There is no legal right to be treated in English, and this is the point at which the German healthcare system is least forgiving of foreigners. Worse, there is a specific gap you need to know about: your Krankenkasse does not have to pay for an interpreter. The Bundessozialgericht held in 2006 that an interpreter for outpatient treatment is not part of the adequate, appropriate and economical care the GKV owes, and the Landessozialgericht Niedersachsen-Bremen confirmed on 23 January 2018 that Krankenkassen need not bear interpreter costs, reasoning that an interpreter sits outside the doctor’s professional control and so is not a billable auxiliary service. If you bring someone to translate, you are paying for them. The one clear exception is §17 Abs. 2 SGB I: deaf and hearing-impaired people have the right to use Gebärdensprache, sign language, during medical examinations and treatment, and the responsible social insurance body bears the necessary costs.

So you find doctors who speak your language, and there are more than you think. The official search at arztsuche.116117.de lets you filter by Fremdsprachen, foreign languages, which is by far the most reliable route because it lists every doctor licensed for statutory patients rather than only those who paid to be listed. In large cities, English-speaking practices are common, and Turkish, Russian, Arabic, Polish and Spanish are widely spoken in practices too. Many embassies and consulates in Germany publish lists of local doctors who speak their country’s language, and these are usually free and easy to find on the embassy website.

Prepare for the visits you cannot conduct in English. Write down your diagnoses, your allergies and your current medicines with their generic ingredient names rather than the brand names, because brands differ between countries while the Wirkstoff, the active ingredient, does not. Take that list to every appointment. If you have a chronic condition, ask a German-speaking friend to help you write a paragraph describing it once, and reuse it forever. And for the situation where none of this is possible, prepare the emergency vocabulary in advance rather than at the moment you need it.

Visitors, the EHIC and Why It Is Not Your Cover

If you are visiting Germany from another EU or EEA country and you have a European Health Insurance Card, the EHIC, you are entitled to treatment that cannot wait until you go home, on the same terms as a German insured person. Show the card at the practice and you should be treated as a statutory patient. That entitlement has hard edges. It does not cover planned treatment, so you cannot come to Germany for a procedure. It does not cover private healthcare at all, only providers inside the public system, which matters because a German doctor may offer to treat you privately and the EHIC will not touch that bill. And it does not cover rescue or repatriation home, which is what travel insurance is for. The EHIC is not travel insurance and does not replace it.

The far more important point is for residents. The moment you live and work in Germany, an EHIC issued by your home country is not your health cover. You are subject to German insurance law, you need German cover, and holding an EHIC or an expat or travel policy instead does not satisfy it. This is not merely a health question. Sufficient health cover is part of the statutory definition of a secured livelihood under §2 Abs. 3 of the Aufenthaltsgesetz, the residence act, which means it is bound up with your residence permit. The insurance essentials chapter sets out the criteria the Ausländerbehörde applies and why most expat policies fail them. If you have moved here and are still relying on a card from home, deal with it this week.

A note for the in-between cases, because they are common. Non-EU nationals cannot use an EHIC for treatment in Denmark, Iceland, Liechtenstein, Norway or Switzerland unless they are refugees or covered as family members of an EU citizen. If a parent visits you from outside the EU, they need travel health insurance and you should check that it covers pre-existing conditions, which many policies quietly do not. And if you are a German resident travelling within the EU, your own Krankenkasse issues you an EHIC, usually printed on the back of your eGK, so turn your card over before you buy anything.

Hospitals, Long-Term Care and the Rest of the German Healthcare System

Planned hospital treatment normally comes through a doctor. Your Hausarzt or specialist issues an Einweisung, a hospital admission referral, and you take it to the hospital of your choice. You are not assigned a hospital. As a statutory patient you get the standard package: medical care by the ward team and a shared room. What private patients and people with a Krankenhauszusatzversicherung, supplementary hospital insurance, buy on top is Wahlleistungen, optional extras: a single or twin room and treatment by the senior consultant. These are comfort rather than medicine, and the actual treatment is the same.

Discharge is better organised than most newcomers expect. Hospitals carry a statutory duty of Entlassmanagement, discharge management, which means the hospital can bridge you with prescriptions, sick notes and follow-up care rather than turning you out to find a doctor yourself. Ask about it before you leave, because it saves you a scramble the next morning. On the way out, take copies of everything, especially the Arztbrief, the doctor’s letter, and the medication list, and give both to your Hausarzt.

Two neighbouring systems are worth naming so you do not look for them in the wrong place. The first is Pflegeversicherung, long-term care insurance, which is a separate pillar of German social insurance with its own rules, its own assessment and its own benefits, and it is not part of your health insurance even though the same Kasse administers it. If someone in your family needs ongoing care rather than medical treatment, that is dealt with in the chapter on care services for the elderly, which also covers the two-year qualifying period that catches people who have only recently arrived. The second is the wider architecture of contributions and entitlements sitting behind all of this, which the chapter on the social security system overview sets out, including the 2026 contribution rates.

Finally, use the preventive care you are already paying for. The GKV funds a series of screening examinations at defined ages, plus dental check-ups, child development checks and vaccinations, and most people here never claim them. They are free, and as §62 SGB V shows, taking the screenings can even change what you pay later. The chapter on preventive healthcare and wellness in Germany goes through what is on offer and at what age.

Tools That Help With the Paperwork

Some of this is arithmetic and form-filling rather than medicine, and a few browser tools take the tedium out of it. Werkzeu.ge is built by Cryon UG, the company behind WeLiveIn.de, so treat this as the disclosed recommendation it is. It is a set of browser tools for German bureaucracy that calculate with documented formulas rather than AI. It is in beta until 30 November 2026 and its own terms note that tools may be incomplete or buggy. Two limits matter more than usual in a health chapter: it is explicitly not legal, tax or financial advice, and it is emphatically not medical advice – nothing on it can tell you whether a symptom is serious, and nothing in this chapter should be read as a substitute for a doctor. It prepares and generates; it never submits anything to an authority, a Krankenkasse or a practice on your behalf.

Two of the tools map directly onto this chapter, and both are in the Gast tier, meaning free with no account at all. The Arztbesuch-Navigator walks through how a German doctor’s visit works, covering insurance, referrals and the pharmacy, and it is written for immigrants rather than for Germans. The Notfall-Phrasen tool gives you the German sentences you need in an emergency, for the police, the fire service and a doctor, with pronunciation, in German, English and Ukrainian. Read the second one before you need it, not during. Both sit in the Einwanderung category at werkzeu.ge/de/tools/einwanderung.

Three others are adjacent. The Formularamt, also free in the Gast tier, is a searchable archive of thousands of official federal, state and municipal forms, each with its source, retrieval date and status, filled in the browser with your entries staying on your device, and it says so openly when a form only exists digitally or no longer exists at all. It is useful for the Krankenkasse paperwork around applications, exemptions and refunds. The Krankenkassen-Beitragsrechner works out GKV contributions including the Zusatzbeitrag and the employer and employee shares, and the Krankenkassen-Wert-Check compares Kassen on their supplementary contributions and benefit catalogues. Both of those last two are in the Plus tier, which is paid; the free tier carries ads. The pricing is changing this year, so rather than quote a number that will be wrong by the time you read this, see the current pricing at werkzeu.ge/en/pricing.

What to Do Next

Do these five things in your first month, in this order, and the German healthcare system will work for you rather than against you. Register with a Hausarzt while you are healthy, because a practice that already knows you will see you at short notice, will write you a telephone sick note while that still exists, and will be your route into everything else. Request your Versicherten-PIN from your Krankenkasse, because the eGK you are holding cannot do half of what it is capable of until the PIN arrives by post. If your card has not come yet, ask for an Ersatzbescheinigung today rather than at a practice reception with a fever.

Then put two numbers where you will find them under pressure: 112 for anything you think might be life-threatening, and 116117 for everything urgent that is not. Save both in your phone now, and tell whoever you live with. Bookmark 116117.de and use the Patienten-Navi when you are unsure. And at your first dental appointment, ask for a Bonusheft and get it stamped, then keep doing that every year, because it is the highest hourly rate you will earn in Germany for turning up.

Two things to watch this year. The coalition’s plan to require a doctor’s note from day one and to abolish the telephone sick note is a proposal, not law, and the existing rules stand until a law passes; the Bundestag is expected to debate it in autumn 2026, so check before you rely on the current position. And the Primärarztsystem that would make your Hausarzt a compulsory gateway to specialists is likewise a plan with a draft law announced and nothing enacted. Both point the same way, and both make registering with a family doctor now the correct move regardless of how they turn out.

Finally, read the two chapters this one deliberately does not duplicate. If you are still deciding between statutory and private cover, or you have been approached by someone who is paid when you sign, read insurance essentials in Germany in full first, because the age-55 rule makes that decision close to irreversible and it is the one thing in German healthcare you may not be able to undo. And keep the receipts. Every co-payment you make counts towards a legal annual cap, your Krankenkasse will not calculate it for you, and the envelope on your shelf is worth exactly as much as you bother to send in.