Before you start

Proof of health insurance is required to activate your residence permit
An employment contract (for payroll-based public enrolment) or proof of income (self-employed)
Anmeldung / address — needed to register, though insurers usually accept your lease to start cover
Passport and, once issued, your German tax ID and social-security number

Step-by-step

1
Confirm you are insured before the permit appointment
No valid health insurance means no residence permit — the immigration office treats a confirmation of cover (gesetzliche or private) as a hard requirement. Sort insurance before, or alongside, your Anmeldung so the certificate is ready when you need it.
OnlineWho: YouBefore the permit is issuedDepends on system chosen
2
Default route: pick a public insurer (TK, AOK, Barmer)
Most employees join a statutory fund (Krankenkasse) such as Techniker Krankenkasse (TK), AOK or Barmer. Apply online — TK and others have English flows — and you receive a membership confirmation you can hand to both your employer and the immigration office.
OnlineWho: YouConfirmation in daysIncome-based (see totals)
3
Let payroll enrol you and split the contribution
Once you give your employer the Krankenkasse details, contributions are deducted automatically from gross salary, with employer and employee each paying roughly half. You do not pay the insurer directly; it all flows through payroll.
Via employerWho: Employer + youFrom your first payslip~7.3% + half the supplement (employee share)
4
Only if eligible: consider private insurance carefully
High earners above the compulsory threshold (about €77,400 gross/year for 2026), the self-employed and civil servants may choose private cover (private Krankenversicherung). Weigh it slowly: premiums are age- and health-based, and returning to public cover later is very hard.
OnlineWho: YouDecide before committingRisk-rated premium (varies widely)

Documents you’ll need

Passport / ID
Employment contract or proof of self-employed income
Anmeldung or lease (to register cover)
German tax ID and social-security number (issued after you start work)
Membership / cover confirmation (Mitgliedsbescheinigung) for the immigration office

Things most newcomers don’t know

No health insurance = no residence permit.

Cover is a hard prerequisite: the immigration office will not issue or activate your permit without proof of valid health insurance. Treat securing insurance as part of the residence-permit task, not an afterthought.

Source: make-it-in-germany / allaboutberlin (insurance for a visa)

Employees are auto-enrolled in public cover through payroll — you barely lift a finger.

Once you choose a Krankenkasse and pass the details to your employer, the contribution is deducted from gross pay and split with the employer; the employee share is roughly 7.3% plus half the fund supplement. There is no separate bill to pay yourself.

Source: how-to-germany.com / German social-security 2026

Going private is a near one-way door — switching back is very hard.

Private cover can look cheaper when you are young, healthy and high-earning, but returning to the public system is only allowed under strict conditions (and is effectively closed after 55). Premiums also climb with age. Do not pick private just for a short-term saving.

Source: how-to-germany.com (switching back to GKV)

Insurers accept your lease to start cover, breaking the Anmeldung chicken-and-egg.

You need an address to register and insurance to finalise the permit, which feels circular. In practice most Krankenkassen will open cover against your rental contract, and you then use their certificate to complete the Anmeldung and permit.

Source: allaboutberlin / make-it-in-germany

Common mistakes to avoid

Leaving the permit appointment to chance with no proof of cover in hand
Choosing private insurance for the short-term saving and being unable to return to public later
Assuming the headline 14.6% is all yours — the employer pays about half
Forgetting the fund's variable supplement (around 2.5–2.9% in 2026), which differs between Krankenkassen
Delaying registration because you lack an Anmeldung, when a lease usually suffices to start