How to have German healthinsurance when living abroad?

This question has been sitting on top of my head for quite a while since we’re playing with the idea of moving from Germany to Romania. This can get quite complicated especially when you have kids.

For me one of the main problems I would have in Romania is the lack of a proper healthcare system. I know, i know, many of you would say that the German system is not that good and there are so many problems. Oh boy…You. Have. No. Fucking. Idea….about how fantastic the German system is compared to…let’s say…hmmm. ROMANIA! The country which should be renamed to “Corrupt and Shit-Healtcare Country of Romania”.

It’s not that there are no good doctors. There are. There are many who opened private clinics and they’re making a lot more money than they would earn in (probably) any other western country. Many doctors are doing a great job and are not very financially driven. Respect for them.

But many doctors are sitting in the state healthcare system and would not give you the right attention/care if you won’t give them an envelope with money. These fuckers are just the tip of the romanian sick healthcare iceberg. A system that is based on “bribe” and no polititian has come up with a plan to reform it.

Maybe the most tragic problem in this system is that if you have a serious problem, like cancer, you have to probably travel hundreds of kilometers and have many envelopes in your pocket to have a proper treatment since only a handful of major cities treat thes sort of things. If you’re lucky. If you’re not, then you might face a situation (like a friend of mine with a brain tumor) where you have to leave the country and pay 30.000€ for an operation. From your pocket of course. Eventhough she paid health insurance for years.

Ok. I’ll stop here. This post is not supposed to be about the romanian healthcare system but about how you can have a german heathinsurance if you move abroad.

Disclaimer: First of all I want to make one thing cleare: everything I write in this article is how I understood the system. I am not an expert in this field in any way. I might misunderstood things (in this case, please let me know), things can change and I am surely not describing all aspects of this complicated issue. So please do your research if you are interested in detail.

Understood? Good. Let’s move on.

I thought that if I decided to move away from Germany I can just continue to pay in my german health insurance and I’m done. Well, no. If you move away from Germany, you can’t have a german health insurance. In our case, if we decided to move to Romania, we will have to pay into the romanian state healthcare system, and only there.

Well, I think by now you should know me well enough to know that this is a situation I don’t like to accept. Instead, I’ll pick up the phone and call around to see how this problen can be solved somehow: I want the option of a german health insurance while living in Romania. Is it possible? What’s the price?

So, I called my german private health insurance. They told me something I didn’t know: if I move abroad, I cannot be insured, but, I could choose to pay a special insurance called “Anwartschaftsversicherung” (sounds very german, isn’t it?).

Anwartschaftsversicherung (AWV)

It means:

  • it’s not a health insurance.
  • it makes sure that the insurance company will be obliged to insure you (even if your are really ill) when you return to Germany and want to be insured.
  • the insurance premium won’t be higher just because you have a disease.

That means, if I get really ill, and I don’t want to (or can’t) be treated in Romania, I can just move back to Germany, get insured in a couple of weeks and I can use the german healthcare system.

Well, this is quite cool. If I break my leg, or have a minor health issue in Romania, the system there is OK. I’m fine with it. I can just go to a private clinic, treat it, pay cash and I’m fine. But if I have cancer, I probably want to be in Germany. And this insurance will give me exactly this option. Its like a health-joker for shit situations.

Case 1: If you have a state health insurance

In this case, when you move abroad and after a few years you want to move back to Germany you might not be able to be insured in the state system. That’s where the AWV kicks in and makes youre they’ll take you in.

Also, the AWV is some sort of guarantee for law changes. You never know. I would do it.

The AWV in the state system costs about 50€/month.

Case 2: If you have a private healthinsurance

Here things get a bit more interesting. You can chose between tha Small AWV or the Big AWV. Let’s see the difference:

2.1 Small AWV (Kleine Anwartschaftsversicherung): 

will simply make sure that you will be taken back into the private insurance at your return to Germany. No matter what happens to you and how ill you are.

This cost about 5% of your current premium. In my case it would cost about 7-8€ a month.

2.2 Big AWV (Große Anwartschaftsversichrung): 

it does 2 things:
– it includes what the Small AWV does: will guarantee that you’ll be insured without checking your health at your return in Germany plus
– it freezes your age. Meaning: at your return to the country, your premium will be lower. Basically if you leave the country when your 30 years old, and move back 20 years later, you will pay as much as a 30 years old would pay at that point. This is a cool thing because private insurance costs a lot more when you’re old compared to when you’re young.

The cost of this will be something like 30-40% of your current premium.

Other alternatives

When researching this article, I stumbled upon a global healthinsurance called IntegraGlobal. I didn’t dig in deeper and I don’t know exactly what the cover but it does sound very interesting. A family plan for us would cost about 7000 dollars a year.

The other one I’ve found was where the price was similar for the package I think would suit us.

Does anyone have experience with them? Do you know anything similar?


First of all, you cannot be insure by a german insurer if you move away (Abmeldung). If you plan to leave Germany, but you might come back at some point, or you don’t know for sure if you’ll come back, it might be a very good idea to pay the AWV to be sure you will be insured in Germany at your return. If we were to move to Romania we’re surely going to go with it. In fact I (since I am privately insured) will probably go for the Big AWV to make sure I’ll have a smaller premium if/when I move back to Germany. For me it’s worth it.

If, sometime in the future, we’ll end up in a country where we’re happy with life in gerneral and the healthinsurance we can always cancel the german AWV.

Further Reading

Here are some pages I’ve found that go in deeper detail if you’re interested:

If you plan on leaving Germany for a short or long time, what are your plans for health insurance?

  • Karl

    How to Pay 0% Income Tax – Part 1/ Part 2 …
    How to have German health insurance when living abroad…

    Are there more of such ‘social’ contributions to expect?

    Please reflect ‘how to beat the system attitude’ is quite selfish and unsociable. Any contributions from you for the society? You are benefiting from the society … just some samples: you will send your kids to school and I am sure you don’t plan for a private that you will pay for. Your life and your investments rely on a certain infrastructure, legal system, public security, … you are enjoying yourself being clever enough not to do any contributions. The health insurance at the cheapest – you buy only an option for your personal worst case – again on the cost of all. You are smart enough and obviously you have time enough to be a bit more reflective and selective what and how to communicate. Sad to say – but lucky for you that there not as many as clever as you

    • Thank you for the challenging questions Karl.
      I appreciate a lot many aspects in Germany and I’m also happy to pay for that. At the same time, some things are in my view not OK or simply not fair.

      Taxes: First of all, you can relax: We have paid and are going to pay more tax than probably the average person in this country even though we’re trying to use the legal possibilities to pay less.

      Health insurance: Let’s begin with the health insurance. This is one of the things I’m happy with and it works a lot better then in many other countries. It’s not perfect though. It’s fine that the health insurance has a social aspect: healthy and young people should pay more so that the least healthy & old people are properly covered. I’m happy to pay it. I’m not interested in paying more than I am legally obliged to though.
      Having said that, I don’t see why my objective to pay in the German healthcare system (as well) while living abroad (and at the same time not using it) means “contributing less” for the society. Can you explain that please? Maybe I didn’t get your question…

      You wrote: “The health insurance at the cheapest – you buy only an option for your personal worst case – again on the cost of all.” Can you explain please why our “insuring the worst case” plan (and paying everything else from our pockets) is on the cost of all?

      The pension system: I think it’s unfair, intransparent and inefficient. In many cases it encourages people not to pay in it and benefit from it. Also, the state pension system motivates people not to think about their long term finances. I don’t see why should I feel guilty not paying in it. Really don’t. But feel free to explain your points! I do want to have these sort of conversations.

      What you are saying is basically that we’re trying to find all sorts of ways to avoid paying tax while profiting from the system and using all the benefits. You are saying that this is selfish. Well…exactly. Of course! Why? Because we have to! Why? Because when you’re self employed in Germany you don’t have the same options as an employed person: no state pension, no unemployment benefit. If we want to make sure we’re covered when we’re older, we have to do something. If you call that selfishness, it’s fine with me but I don’t think that’s bad for the society in any way.
      Taking care of ourselves first and becoming financially independent early is a pretty good thing for the society as well since we’ll have the time and money to give back and focus our energy on social projects we believe in. We’re already doing that and if you’ll read our other posts you’ll understand how. I truly believe that making others happy is the best way to make yourself happy.

      Some points you made are worth (and important) to have discussions about in our society. So let’s start here.
      Can you please write a bit about yourself.
      Which country are you living?
      Do you have a fulltime job or are you self employed?
      Do you pay more tax than you’re legally obliged to?
      What do you think about my points about the German state pension? And what do you think about it?
      The same for the healthcare system.
      Can you explain in more detail why achieving financial independence early is bad for the society?
      What are your plans?
      How do you give back to the society?

      Really looking forward to your answers and to a proper civilised discussion!

    • Karl, i gave you a reply. Will you give me one?

  • Mustard Seed Money

    Isn’t it really interesting how we appreciate the little things like basic health care when exposed to just deplorable conditions. Thanks for sharing your perspective!!!


    We are contemplating moving back to the US. One thing on my con-list is health insurance. I remember when I had health insurance for the first time in the US. I was a poor student and they send me a catalog what was covered and at which percentage. I freaked out! I wanted to go the dentist and I thought Ill have to take the catalogue with me and check every little task he wants to perform if I can afford it. It was horrible and it hasn’t gotten better with Obamacare. So many people in the US go bankrupt because of medical bills. Yes, the German system is far from perfect, but I know I won’t go broke going to the doctor.

    • yeah…I only hear horror stories from the US. Just the other week, a family friend was asking for donations for cancer treatment. They have a big family and they worked for at least 30 years in the US. Now their “begging” for money. Is this the greatest country in the world? Unbelievable…

  • Ha! When we left Germany we were more interested in how to get completely out of the German healthcare system. Cancer is not something to be afraid of, UNLESS you go the conventional treatment route – then it’s extremely harsh and scary. After realizing that, we have no reason anymore to want to stay in any systems, and are fine paying out of pocket for any emergencies like broken bones, stitches, etc…

    • “Cancer is not something to be afraid of” – that is a hell of a statement” !!! 🙂
      …what do you mean? What is the alternative to conventional treatment? Are there any proper studies about that?