Moving Abroad from Germany: How to Keep Your Health Insurance allive?

Leaving Germany is exciting, but deregistering (Abmeldung) comes with a massive administrative question: What happens to your health insurance?

If you plan to return to Germany eventually, canceling your policy outright might seem like the easiest way to save money. However, completely cutting ties can create serious legal, medical, and financial headaches when you come back.

Fortunately, the German healthcare system has a built-in safety net designed for this exact situation: the Anwartschaftsversicherung (dormant or prospective entitlement insurance).

Here is a straightforward breakdown of how it works, how much it costs, and whether you actually need it.

What is an Anwartschaft?

An Anwartschaft is essentially a "pause button" for your German health insurance.

Instead of terminating your contract, you pay a reduced monthly maintenance fee while residing abroad. In exchange:

• Your active coverage is suspended: You do not use your German health card for regular treatments while overseas (you will need local or international travel/expat insurance abroad).
• Your membership stays legally alive: When you return to Germany, you can reactivate full coverage immediately without legal barriers, penalties, or extensive health checks.

The rules differ significantly depending on whether you are in the Statutory (GKV) or Private (PKV) system.

1. Statutory Health Insurance (GKV — TK, Barmer, AOK, etc.)

Many expats assume that public health insurance will simply take them back whenever they return. While that is often true for standard employees, leaving without an Anwartschaft can backfire under specific circumstances.

Cost

• Roughly €65 to €85 per month (covers dormant health and long-term care insurance under § 240 Abs. 4b SGB V).

Why pay for it if you aren't using it?

1. The Retiree Trap (The "9/10 Rule"):To access the highly subsidized public health insurance for pensioners (Krankenversicherung der Rentner or KVdR) in your retirement, you must have been insured in the GKV for at least 90% of the second half of your working life.Years spent living outside the EU/EEA without coverage count as gaps. If you fail this test, you will be classified as a voluntarily insured pensioner. Instead of paying contributions only on your state pension, the GKV will assess contributions on all your worldwide income, including capital gains, dividends, rental income, and private pensions. An Anwartschaft bridges this gap and protects your future retirement income.
2. Returning as Self-Employed or a High Earner:If you return to Germany as a freelancer, business owner, or take a high-paying job above the compulsory threshold (Jahresarbeitsentgeltgrenze), you are not automatically forced into the GKV. To join as a voluntary member (freiwillig versichert), you must prove continuous prior coverage. If you cannot prove this, the GKV can reject your application, forcing you into private insurance. An Anwartschaft guarantees your unconditional right to re-enter.
3. Moving to Non-EU/Non-EEA Countries:Within the EU, member states recognize each other's insurance periods. But if you move to countries like the US, Canada, Australia, or anywhere in Asia/Latin America, bilateral social security agreements often do not cover healthcare gaps. An Anwartschaft keeps your German record unbroken.

2. Private Health Insurance (PKV — Allianz, ARAG, OTTONOVA, Debeka, AXA, etc.)

In private insurance, canceling your plan without an Anwartschaft is very risky. If you cancel completely, rejoining later requires a brand-new medical evaluation based on your older age and any conditions you developed while abroad.

Private insurers offer two distinct tiers:

Quick Comparison: Do You Need It?

You probably DO NOT need an Anwartschaft if:

• You are in the GKV, leaving only for 1–2 years, and are still early in your career.
• You are 100% certain you will return to Germany as a standard salaried employee earning an average wage (under the statutory threshold). By German law, your employer must automatically enroll you into the statutory system anyway.
• You are relocating inside the EU/EEA and will be covered by local state health systems that have reciprocal agreements with Germany.

You SHOULD seriously consider an Anwartschaft if:

• You have Private Health Insurance (PKV) and want to keep your plan or protect against developing pre-existing conditions.
• You are in the GKV and moving to a non-EU country.
• You might return to Germany as a freelancer, entrepreneur, or high-income executive.
• You have worked in Germany for a long time and want to safeguard your subsidized healthcare in retirement (KVdR).

3 Golden Rules Before You Depart

1. Apply Before You De-register: You must set up the Anwartschaft with your insurer before your official departure date and deregistration (Abmeldung). Retroactive applications are rarely granted.
2. It Does Not Replace Expat Insurance: A dormant German policy provides zero coverage for doctor visits, hospital stays, or medications while you are abroad. Always secure local or international expat health insurance.
3. Ask for the Right Form: Reach out to your provider's customer service and ask directly for an "Antrag auf Anwartschaftsversicherung wegen Auslandsaufenthalt".
   
   

   Frequently Asked Questions (FAQ)

   1. Does the Anwartschaft cover medical emergencies while I am abroad or visiting Germany?

   No. While living abroad, your German coverage is legally paused (ruhend), meaning the insurer will not pay for routine visits, hospital stays, or medications outside Germany. You must secure a local or international expat health insurance policy. If you briefly visit Germany on holiday, you must either rely on your foreign travel insurance or contact your German insurer in advance to ask about temporary emergency activation.

   2. Can I apply for an Anwartschaft retroactively after I have already moved?

   In almost all cases, no. German health insurers require you to apply before your official deregistration (Abmeldebestätigung) and departure date. If you deregister and leave without notifying them, your policy will simply be terminated, and setting up a dormant membership after the fact is rarely permitted.

   3. What documents do I need to submit to apply?

   Typically, your insurer requires:

   • An informal written request or their dedicated application form (Antrag auf Anwartschaftsversicherung).
   • A copy of your official deregistration certificate from the citizens' office (Abmeldebestätigung der Meldebehörde).
   • Proof of your relocation abroad (such as an overseas employment contract, visa, rental agreement, or proof of foreign health insurance).

   4. How do I reactivate my full German coverage when I return?

   Notify your insurer as soon as you re-register your address in Germany (Anmeldung). Send them your registration certificate, along with proof of your new status—such as an employment contract, proof of self-employment, or notification of job seeking. Your active policy will be reinstated immediately without waiting periods.

   5. What happens if I decide never to return to Germany?

   You are not locked into the Anwartschaft indefinitely. If your plans change and your stay abroad becomes permanent, you can cancel your dormant membership with standard notice (usually by the end of the month following the next month) by providing proof of continued residence and health coverage abroad.

   6. Are my non-working spouse and children covered under my Anwartschaft?

   In the public system (GKV), family insurance (Familienversicherung) is paused alongside your main membership. Depending on your fund, family members who reside abroad with you can either be included in your dormant status or need separate documentation. In private health insurance (PKV), each family member has their own contract and must hold their own individual Anwartschaft.

   7. Does an Anwartschaft count as "Vorversicherungszeit" for the statutory pension health scheme (KVdR)?

   Yes. One of the main reasons to maintain a public Anwartschaft is satisfying the "9/10 rule" for the Krankenversicherung der Rentner (KVdR). The months you pay the dormant contribution count toward your required insurance history in the second half of your working life, shielding your retirement investments and private pensions from high GKV assessments.

   8. What is the main difference between a "Kleine" and "Große" Anwartschaft in private insurance?

   • Kleine Anwartschaft: Freezes only your medical history. When you return, the insurer cannot charge surcharges or refuse entry for any illness or injury you sustained while abroad, but your premium will be recalculated based on your older age.
   • Große Anwartschaft: Freezes both your health status and your original entry age while continuing your aging reserves (Alterungsrückstellungen). Your monthly premium upon return will be calculated as if you had never aged, preventing significant premium hikes later in life.

   9. If I return to an ordinary salaried job, isn't my employer forced to enroll me anyway?

   Yes. If you return under a regular employment contract with a gross salary below the compulsory threshold (Versicherungspflichtgrenze), you are legally obligated (versicherungspflichtig) to join the GKV, regardless of whether you had an Anwartschaft. The dormant policy is primarily vital if you return as a freelancer, business owner, high-income employee above the threshold, or if you want to protect your long-term retirement status (KVdR).

   10. Can I switch from private insurance (PKV) back to public (GKV) using an Anwartschaft?

   No. An Anwartschaft only preserves your status in the specific system you left. You cannot take out a public Anwartschaft if you were privately insured, or vice versa. Returning to the GKV from the private system depends entirely on meeting the statutory conditions for compulsory insurance (such as taking up a salaried position below the threshold before reaching age 55).