Guide
German Anwartschaft Guide
for Expats
How to protect your right to return to German public health insurance
When you leave Germany and deregister, you generally end your obligation to be insured in the German health insurance system. An Anwartschaft (dormant membership) is a tool to keep your return options open – and is particularly important for your health insurance as a retiree. Along with choosing the right international health insurance, the Anwartschaft is one of the most important topics for expats.
What Happens When You Deregister from Germany?
The statutory insurance obligation applies to everyone who is officially registered in Germany. After officially deregistering from Germany, leaving the GKV (statutory health insurance) is straightforward.
Important: To terminate GKV membership, you need the deregistration certificate from the registration office or proof that your habitual residence is abroad.
The Age 55 Threshold: Critical Barrier for Return
The German legislature has introduced an age limit of 55 for returning to the GKV. Anyone older who has been privately insured for an extended period is barred from returning – even if all other requirements are met.
Specifically, this means: Persons aged 55 and over who would otherwise become subject to mandatory insurance (e.g., through employment with a salary below the insurance threshold) remain exempt from insurance if:
- They were not statutorily insured in the last five years
- They were insurance-exempt, released from mandatory insurance, or self-employed for at least half of that time
Important for returnees: To be admitted to the GKV, employees aged 55+ must prove they were statutorily insured for at least one day in the previous 5 years in their former country of residence.
Recent Changes (November 2025)
The German Bundestag has passed legislation making it even harder for those over 55 to return to statutory health insurance. After returning from abroad, they now face "insurance exemption": they can only obtain private insurance.
Remaining Options After Age 55
- Family insurance: Return possible if spouse is statutorily insured (income limit: 637.50 EUR/month)
- EU insurance periods: Time spent with statutory insurance in NL, AT, ES, CH, or SE counts toward German requirements
Health Insurance for Retirees (KVdR)
The KVdR is the most attractive status for retirees in the GKV: Health insurance is subsidized by the pension insurance. This means retirees don't have to pay full contributions.
The 9/10 Rule
Only those who were statutorily insured for 90% of the second half of their working life are admitted to the KVdR. It doesn't matter whether you were mandatorily insured, voluntarily insured, or family-insured.
The working life period runs from the start of your first employment (including vocational training and self-employment) until your application for the statutory pension.
Anwartschaft Counts as Pre-Insurance Time
If you cannot be a GKV member for work-related reasons, you can pay for an Anwartschaft with dormant benefits. These periods then count as pre-insurance time for the KVdR.
No Anwartschaft, no KVdR: Only if you maintained an uninterrupted Anwartschaft during your time abroad can you be admitted to the KVdR.
The Difference: KVdR vs. Voluntary Insurance
| Status | Contribution Basis | Consequence |
|---|---|---|
| KVdR (Mandatory insurance) | Only pension, company pensions, private pension contracts | Lower contributions |
| Voluntarily insured | Total economic capacity | Including rental income, capital gains, etc. |
This can mean several hundred euros difference per month.
Recognition of Foreign Insurance Periods
Foreign insurance periods can be recognized if they are equivalent under supranational law or bilateral social security agreements.
- EU/EEA/Switzerland: No Anwartschaft needed – statutory insurance periods there are recognized
- USA, Thailand, Singapore, etc.: Without Anwartschaft, nothing counts – no social security agreement
Child-Raising Periods as a Lifeline
Since August 2017: Every insured person receives a flat three years per child as pre-insurance time. This applies to both parents and includes adopted, foster, and stepchildren.
GKV Anwartschaft: Costs and Requirements
The GKV Anwartschaft for expats abroad provides recognition of pre-insurance periods during your time abroad for the KVdR and long-term care insurance.
Cost: Approximately 70 EUR per month (varies by health insurance fund) for health and long-term care insurance.
When is a GKV Anwartschaft possible?
- For private stays abroad lasting more than three calendar months
- Excluded: When residing in the EU/EEA or countries with a social security agreement
During the Anwartschaft, you have no entitlement to benefits from German health insurance – private international health insurance is mandatory.
PKV Anwartschaft: Small vs. Large (Private Insurance)
Small Anwartschaft (Kleine Anwartschaft)
The small Anwartschaft ensures no new risk assessment upon return. Illnesses occurring during your time abroad are included in coverage.
| Aspect | Details |
|---|---|
| Risk assessment | Waived upon return |
| Entry age | Recalculated |
| Cost | 5–10% of previous PKV premium |
Large Anwartschaft (Große Anwartschaft)
With the large Anwartschaft, both your health status and entry age are preserved – the insurer essentially "freezes" your age.
| Aspect | Details |
|---|---|
| Risk assessment | Waived upon return |
| Entry age | Preserved |
| Cost | 30–45% of previous premium |
| Benefit | Lower premium after return |
PKV Basic Tariff as a Fallback
Private health insurers are required to offer a "basic tariff" with benefits comparable to the GKV. The premium may not exceed the GKV maximum contribution.
Don't Forget Long-Term Care Insurance
For benefits from statutory long-term care insurance, a waiting period applies: You must prove 2 years of pre-insurance time in the last 10 years before application.
Important deadline: Long-term care Anwartschaft can only be applied for within 1 month of your previous insurance ending. Later applications are not possible.
Decision Matrix
| Situation | Recommendation |
|---|---|
| Under 55, return certain, non-European abroad | GKV Anwartschaft (approx. 70 EUR/month) |
| Under 55, EU stay with statutory insurance | No Anwartschaft needed |
| Over 55, non-European abroad | Check if Anwartschaft exists/makes sense |
| PKV-insured, abroad 1–3 years | Small Anwartschaft (5–10% of premium) |
| PKV-insured, abroad 5+ years | Consider large Anwartschaft (30–45%) |
| Return uncertain, KVdR times already met | Only check long-term care Anwartschaft |
Practical Steps Before Departure
- Calculate your 9/10 status: Check how many years of pre-insurance time you still need for the KVdR
- Check your destination: EU/EEA/Switzerland or country with social security agreement? Then those periods count
- Contact your insurer early: Discuss the best solution and get everything confirmed in writing
- Mind the deadlines: The Anwartschaft must typically be applied for within one month of your previous insurance ending
- Get international health insurance: During the Anwartschaft, you have no benefit entitlements
Conclusion
The Anwartschaft is more than just a return option – for many expats, it's the key to affordable health insurance in retirement. Those who don't meet the 9/10 rule pay significantly higher contributions on all income as a voluntarily insured person in old age.
The monthly 70 EUR for a GKV Anwartschaft can pay off many times over during your retirement years.
Especially critical after 55: Without an Anwartschaft, the return to GKV may be permanently blocked. Recent legislative changes have further tightened these restrictions.
Frequently Asked Questions About Anwartschaft
How much does a GKV Anwartschaft cost?
The GKV Anwartschaft costs approximately 70 EUR per month (varies by health insurance fund) for health and long-term care insurance. During the Anwartschaft, you have no benefit entitlements – you need additional international health insurance coverage.
When is an Anwartschaft worth it?
An Anwartschaft is especially worthwhile if you want to meet the 9/10 rule for the KVdR (retiree health insurance) and are moving to a country without a social security agreement (e.g., USA, Thailand, Singapore). In EU/EEA countries, insurance periods are recognized anyway.
What's the difference between small and large PKV Anwartschaft?
With the small Anwartschaft (5–10% of premium), the risk assessment is waived upon return, but your entry age is recalculated. With the large Anwartschaft (30–45% of premium), your original entry age is also preserved – resulting in lower premiums after your return.
Can I return to the GKV after age 55?
Returning after age 55 is severely restricted. You must prove you were statutorily insured for at least one day in the last 5 years. Alternatives include family insurance (if your partner has GKV coverage) or insurance periods in EU countries like the Netherlands, Austria, or Spain.
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