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?