Most people living in Germany feel pretty well covered. And they are - as long as they stay in Germany. The moment you board a flight to Thailand, visit family in Brazil, or take a business trip to New York, the picture changes quite a bit. And it is one of those things that nobody really explains until you need it.
This guide is for expats already living in Germany who travel regularly, are thinking about relocating again, or simply want to understand what their current insurance actually does outside German borders.
What happens to your German insurance when you travel?
The short answer: it depends on where you are going and which insurance you have.
Germany has two main systems: the statutory public insurance (gesetzliche Krankenversicherung, GKV) and private insurance (private Krankenversicherung, PKV). Both behave differently when you leave the country.
If you have GKV, you have access to a card called the EHIC (European Health Insurance Card), which covers medically necessary, state-provided healthcare within the EU/EEA and Switzerland. The EHIC is genuinely useful for trips within Europe - if you break your leg in Spain, you will be treated under the same conditions as a Spanish resident. That part works well.
The problem is everything it does not cover. Outside the EU and EEA, GKV coverage drops to essentially nothing. There are a handful of bilateral agreements Germany has with certain countries (Turkey, Tunisia, Morocco, for example), but these are limited and do not cover private clinics or anything beyond basic emergency care.
If you have PKV, coverage abroad depends almost entirely on which tariff you chose. A well-structured PKV policy typically includes emergency treatment anywhere in the world. Some tariffs go further and cover routine care abroad too. But many do not, and the details are buried in the fine print of your individual policy. If you are not sure what yours covers, now is a good time to check.
What does the EHIC card actually not cover?
Since GKV clients often assume the EHIC handles everything in Europe, it is worth being specific about the gaps.
The EHIC gives you access to state-provided, medically necessary healthcare. What it does not cover includes:
- Return transportation home or to Germany. If you are hospitalised in Greece and medically stable but want to recover at home, the flight and medical escort are on you. The German DVKA (Deutsche Verbindungsstelle Krankenversicherung Ausland) confirms this explicitly: return transport is not included under statutory insurance benefits and is therefore not covered by the EHIC.
- Private hospitals. In some countries, the best or nearest hospital is private. The EHIC only applies to state-contracted facilities.
- Non-emergency care. Routine check-ups, specialist consultations, prescriptions - these may or may not be reimbursed depending on local rules.
- Coverage outside the EU/EEA. The US, Canada, most of Asia, Africa, Latin America - none of these are covered at all under GKV via EHIC.
The European Commission itself is clear on this: "The EHIC is not an alternative to travel insurance."
Do I need international health insurance as an expat in Germany?
For most expats, the honest answer is: probably not a full standalone plan, but very likely a top-up of some kind.
If you live in Germany with GKV or PKV and travel a few times a year, a cheap travel add-on covers the gaps and you are done. If you spend months at a time outside Germany - working remotely, splitting your year across borders, or moving between countries - that is when a proper international health plan starts to make sense.
The three products below cover these different situations. They are easy to mix up, so it is worth knowing what each one actually does before you buy anything.
What types of international insurance are there?
There are three products that come up most often, and they are quite different from each other.
The Auslandskrankenversicherung (short-term travel health insurance)
This is the most common add-on for German residents who travel. It is a supplemental policy that sits on top of your existing GKV or PKV and kicks in when your main insurance does not.
A good Auslandskrankenversicherung covers emergency medical treatment worldwide, medical transport to the nearest suitable hospital, and repatriation back to Germany if medically necessary. It is specifically designed to fill the gaps that GKV leaves outside the EU, and to provide repatriation even within Europe where the EHIC falls short.
The standard version is usually valid for trips up to 56 days (some go to 90 days), and many policies are designed as annual plans you can buy once and forget. The cost is remarkably low for what it covers - we will get to the actual numbers further down.
One important limitation: the Auslandskrankenversicherung is a travel add-on, not a standalone health insurance. It does not satisfy German residency health insurance requirements, and it is not designed for people who spend extended time abroad.
International expat health insurance (internationale Krankenversicherung)
This is the more comprehensive product, designed for people who spend significant time in multiple countries - digital nomads, people on international assignments, frequent long-haul travelers, or expats who are between residency situations. In German you will sometimes see it called an internationale Krankenversicherung.
It is a standalone product that can cover you in multiple countries simultaneously. Unlike the Auslandskrankenversicherung, it is not tied to a German base policy. It typically covers both emergency and routine care, hospitalisation, specialist visits, mental health, and sometimes dental and maternity depending on the plan tier.
This is a crowded market, and the plans differ enormously in what they include. Some are built specifically for digital nomads and even cover a few months per year back in your home country - which matters a lot if you are based in Germany but spend large chunks of the year elsewhere. Because the important differences are in the detail (coverage zones, home-country rules, medical underwriting, exclusions), this is exactly the kind of product worth talking through with a broker rather than picking blind from a comparison page.
This type of policy does not replace German health insurance for residency purposes - you would still need GKV or PKV to satisfy German legal requirements if you are resident here. It tends to be used alongside existing coverage, or as a bridge when transitioning between countries.
International travel insurance (full trip coverage)
This is broader than health coverage alone. A full travel insurance policy bundles emergency medical, medical evacuation, trip cancellation, trip interruption, lost or delayed baggage, and sometimes personal liability into one plan.
It is particularly relevant if you are taking an expensive international trip where the money is already at stake before you even land. If your flight is cancelled, your luggage disappears, or you are hospitalised and your hotel is non-refundable, a good travel insurance policy has all of that covered.
For medical evacuation specifically, the numbers can be startling. Emergency medical evacuation - being airlifted or transported with medical staff from a remote area to a hospital, or back to Germany - can cost anywhere from €20,000 to over €100,000 depending on location, and the US CDC notes that air-ambulance transport can climb higher still. The top international travel insurance policies now offer the equivalent of €1 million or more in evacuation coverage as standard.
What should you look for in a plan?
Whether you are buying a simple Auslandskrankenversicherung or a more comprehensive international plan, a few things are worth checking carefully.
Geographic coverage zones. Most plans divide the world into zones. A common split is: Europe only, worldwide excluding USA/Canada, or worldwide including USA/Canada. The USA zone is priced separately because US healthcare is dramatically more expensive. If you never go to the US, you can save money by excluding it. If you do travel there for work, make sure you are in the right zone.
Emergency evacuation and repatriation. This is the one coverage people most often underestimate. Emergency evacuations are rare but expensive. Always check whether your plan covers medical evacuation to the nearest appropriate facility and separate repatriation back to Germany, and what the limits are. For anything beyond a simple domestic medical trip, you want at least €100,000 in evacuation coverage, and ideally more.
Repatriation of remains. A grim topic, but international policies typically also include coverage for the repatriation of remains in the event of death abroad. It is worth confirming this is in any international plan you take out.
Routine care vs. emergency only. Many basic Auslandskrankenversicherung policies cover emergencies only. If you have a condition that requires regular medication or specialist follow-up, check whether routine visits are included. This is also relevant for people with chronic conditions who travel frequently.
Direct billing vs. reimbursement. Some international insurers pay hospitals directly. Others require you to pay out of pocket and then claim reimbursement. In a medical emergency in a country where you do not speak the language, direct billing can make a huge difference in practice.
Coverage duration limits. Standard Auslandskrankenversicherung policies cap individual trips at 56 or 90 days. If you plan to stay abroad for longer - working remotely from another country for three months, for example - you need a policy that accommodates that. Some German insurers offer extended policies for this, and international health insurance products are designed for exactly this kind of flexibility.
What about pre-existing conditions?
This is where international insurance gets more complicated. Unlike German GKV, which covers you regardless of your health history, international insurers typically use medical underwriting. That means they review your health history before accepting you, and they may:
- Accept you with full coverage
- Accept you but exclude a specific pre-existing condition
- Charge a higher premium (loading) for a known condition
- Decline coverage altogether in some cases
The key thing is to declare everything accurately. If you do not disclose a condition and later claim for something related to it, the claim can be denied. Declare it, understand what the insurer will and will not cover, and make a decision with full information.
Short-term travel insurance policies are generally stricter on this point. Many cover an "acute onset" of a pre-existing condition (meaning a sudden flare-up that requires emergency treatment), but they will not cover ongoing treatment for that condition while you are abroad. If you have a chronic illness and travel regularly, international health insurance - rather than a basic travel add-on - is the product to look at.
Who actually needs what?
This does not need to be complicated. Here is a rough guide based on your situation.
You travel a few times a year within Europe and have GKV. An annual Auslandskrankenversicherung is exactly what you need. It is cheap, it covers the gaps your EHIC leaves, and it includes repatriation. Buy it once, renew annually.
You travel regularly outside the EU - business trips to Asia, the US, or elsewhere. The Auslandskrankenversicherung still makes sense, but make sure your plan covers worldwide including wherever you actually go. If you travel to the US frequently, specifically confirm US coverage.
You work remotely and spend several months per year outside Germany. A standard travel policy will hit duration limits quickly. Look at international health insurance (internationale Krankenversicherung) built for digital nomads or long-stay travelers, and pay close attention to whether the plan covers time back in Germany. This is one of the trickier categories to get right, so it is worth talking through with a broker before committing.
You are on PKV. Check your tariff first. Many good PKV policies already include worldwide emergency coverage. If yours does, you may only need a policy for repatriation and trip-related risks (cancellation, luggage). If your PKV tariff is limited, add an international supplement.
You are thinking about leaving Germany. If you are planning to move to another country, international health insurance becomes a bridge product for the transition period. It can cover you while you establish residency and local insurance in the new country. Plan this in advance - do not wait until your German insurance lapses.
You have family abroad and visit regularly. Same as the frequent traveler category. An annual plan is the most cost-effective approach. Buying a new policy for each trip adds up quickly.
Not sure which of these buckets you fall into? That is exactly the kind of thing we sort out in a short conversation - and yes, we help expats place both German and international cover, not just the German basics.
How much does it cost?
The range is wide because the products are very different.
A basic annual Auslandskrankenversicherung for a single adult, covering worldwide trips up to 56 days each, runs roughly €10 to €40 per year for most German insurers. Adding a partner or family raises the cost, but the per-person price often drops. For what it covers - including emergency evacuation and repatriation - this is genuinely one of the better deals in the insurance world.
International health insurance is a different price bracket. For a healthy adult in their 30s, annual costs typically land between €600 and €2,000, depending on coverage zone, coverage limits, and deductible choices. Entry-level plans with lower medical limits sit at the bottom of that range, while comprehensive plans with high limits sit at the top, and the USA zone adds noticeably to the premium.
Annual multi-trip travel insurance with full trip cancellation protection sits in between. For a single adult taking several international trips per year, expect €100 to €300 for a solid plan.
Age has a significant impact across all categories. The older you are, the higher the premium, and some international plans have upper age limits or require a medical exam above a certain age.
A few things that catch people off guard
The EHIC does not work at private hospitals. Even within Europe, if the emergency room that treats you turns out to be private, your GKV may not reimburse it. Always confirm before assuming.
Your PKV tariff may not cover as much abroad as you think. Worldwide emergency coverage sounds comprehensive, but some tariffs limit reimbursements to what treatment would have cost in Germany. If you are treated somewhere more expensive - say, a private clinic in Switzerland or the US - you may get a partial reimbursement and be on the hook for the rest.
The Schengen visa insurance rule probably does not apply to you anymore. If you first came to Germany on a short-stay Schengen visa (the tourist or visitor type), you had to show travel-medical insurance with a minimum of €30,000 in coverage. But once you became a resident on a national visa or residence permit, that requirement was replaced by proper German health insurance (GKV or PKV) - and the short-term policy you bought for the visa has long since expired. It is worth checking whether you ever replaced it with something ongoing for your trips.
Travel insurance and health insurance are not the same product. People sometimes assume their health insurance covers trip cancellations or lost luggage. It does not. And some travel insurers assume your health insurance covers routine care. The two products cover different risks, and for regular international travelers, both have a role to play.
Is this worth the effort?
Honestly, for most people, this does not need to be a big decision. A good annual Auslandskrankenversicherung from a German insurer costs less than a dinner out and covers the essential risks for normal travel. If you travel within Europe regularly, get one. If you travel worldwide, make sure it covers your actual destinations.
The more interesting question comes up when you start spending significant time outside Germany - whether for work, family, or lifestyle reasons. That is where a short conversation with an independent broker pays off, because the right product depends heavily on your specific situation: your health history, your travel patterns, whether you have a family, and what your plans look like for the next few years.
If that sounds like you, we are happy to help you think it through. We work with expats navigating exactly this kind of question every day, and we can place both your German cover and the international side of things. The starting point is always the same: understanding what you actually have before figuring out what you need.
Contact our international insurance expert!
Daniel Weiss
Email: daniel.weiss@versicherungsbuero-weiss.com
Telefon: +49 30-40 36 31 95 1
Mobil / WhatsApp: +49 178-140 584 0