International Health Insurance for Expats Leaving Germany

From EUR 80 per month you can be insured worldwide — without a German address, without a country lock-in, without a coverage gap. Because after your deregistration from Germany, GKV (statutory health insurance) and PKV (private health insurance) end. A hospital stay in the USA quickly costs EUR 50,000. Even in Thailand, complex treatments run into the thousands.

Since 2014 we have supported 40,000+ deregistrations. The health-insurance question comes up in almost every case — and this is where the most expensive mistakes happen. This guide walks through your options, what they cost, which providers do best in practice, and what to watch for in the selection.

Book a free insurance consultation (advertising)

At a glance

• Mandatory for emigrants: GKV and PKV end with deregistration — you need international health insurance or local cover in the destination country.
• Cost: from ~EUR 80/month for a 30-year-old, more for seniors and US residents.
• Top providers 2025: through grenzenlos-sicher as the independent broker — the most relevant carriers are APRIL International, Passportcard, Cigna Global, Allianz Care.
• Family tariffs are often cheaper than individual policies — children under 18 are usually insured free of charge.
• USA specifics: the ACA mandate at federal level has lapsed, but Green Card holders should check local plans.
• Pre-existing conditions: surcharges (5–30 %) or exclusions are possible — best strategy: insure before deregistering.
• Recommendation: free independent consultation at grenzenlos-sicher.de (advertising) — compares every provider without lock-in.

Why you need new cover after deregistration

After your residence deregistration from Germany, your entitlement to statutory or private health insurance generally ends. Many emigrants are not aware of this — and this is where the most expensive mistakes happen.

Statutory health insurance (GKV): ends with deregistration

GKV is tied to your residence in Germany. As soon as you have your deregistration certificate and can no longer prove a German residence, the insurance obligation ends. The European Health Insurance Card (EHIC) only provides limited cover inside the EU, and only as long as you are still a member of a German fund. Outside Europe or after deregistration, it no longer applies.

Private health insurance (PKV): residence as prerequisite

Private insurers also tie their policies to a German address. Without a registered address you risk losing your entire cover. Some providers offer time-limited continuation, but that is not a permanent solution for life abroad.

The result: a dangerous coverage gap

Without active cover, you pay every treatment abroad out of pocket. A US hospital stay can quickly cost EUR 50,000 and up. Even in cheaper countries like Thailand or Mexico, complex treatments run into the thousands. Many countries require proof of valid health insurance for visas or residence permits — without it you may not even get a residence permit.

"The biggest mistake I have seen across 40,000+ cases: emigrating permanently with a normal travel insurance. These policies are built for holidays, not for a new life abroad." — Oliver Frankfurth

Exactly how to cancel a German health fund and which proofs the fund asks for — Oliver walks through it in the detailed video:

What is international health insurance?

International health insurance is a worldwide long-term policy for medical treatment. It works like private health insurance — without the geographic restrictions and without the requirement of a fixed address.

Unlike temporary travel insurance, it is designed for people who live permanently or long-term abroad. The key features:

• No address required: no German registered address needed
• Worldwide validity: including or excluding USA/Canada, depending on tariff
• Free doctor choice: you go to the doctor of your choice, anywhere
• Unlimited runtime: no expiry date like with travel insurance
• Online conclusion: contract and management fully digital

The critical difference: travel insurance vs. international health insurance

Many emigrants reach for classic travel insurance and assume they are covered. It is a common — and potentially very expensive — misconception.

Worth knowing: travel insurance loses its validity as soon as you deregister from Germany. Anyone relying on it stands without cover in an emergency. International health insurance fills exactly this gap.

Who is international health insurance for?

International health insurance is the right call for everyone living long-term or permanently outside Germany. Specifically:

• Emigrants settling in a new country
• Digital nomads travelling through multiple countries without a fixed address
• Expats posted abroad or working there
• Retirees abroad spending their later years in warmer regions
• Long-term travellers on the road for months or years
• Families emigrating with children and needing comprehensive cover

Whether you run your online business from Bali, start a new job in Portugal, or live as a retired couple in Spain — this insurance shape fits your life, not the other way around. Use our interactive emigration checklist to keep every step in view.

What options do you have as an emigrant?

As an emigrant without a German address, you essentially have three ways to secure medical cover.

1. International health insurance (recommended)

The most flexible and comprehensive solution. Worldwide cover, independent of residence, with individually configurable tariffs. No residence proof needed, contract concluded fully online, premiums by SEPA or credit card. In a claim, you submit bills digitally via an app or customer portal. Premiums start around EUR 80/month.

2. Local health insurance in the destination country

In some countries you can join the local healthcare system. Often cheaper, but cover ends at the border. For people who travel often or change countries, not a good fit.

3. Anwartschaft (entitlement preservation) at your former German PKV

If you plan to return to Germany at some point, you can take out an Anwartschaftsversicherung at your former PKV. It secures the right of return — but provides no active cover abroad. Useful as a supplement, not as a standalone solution.

"International health insurance is not just a piece of paper. It is your safety net when something happens abroad — and gives you the freedom to live where you want, without fear of unpayable medical bills." — Oliver Frankfurth

International health insurance without a German address: how to apply

Wondering how you can take out insurance without a registered address? International insurers are built precisely for mobile people. They operate globally and are not bound to national requirements like a registered address.

How it works:

1. Choose a provider: pick a carrier specialised in people without a fixed address — best through an independent broker comparing every relevant provider.
2. File the application online: an address must be entered — a foreign address, a correspondence address with friends, or your last known German residence usually suffices.
3. Pay premiums: by SEPA direct debit or credit card, directly to the insurer.
4. Use benefits: in a medical case, submit bills and receipts digitally via app or portal. Reimbursement runs on the cost-reimbursement principle.

The major advantage: tariffs adjust flexibly. As your country of stay, life situation or preferences change, your cover scales with you.

What does international health insurance cost?

Costs depend on your age, health status and chosen scope. A realistic orientation.

Indicative monthly premiums

What drives the price?

• Age: the older you are, the higher the premium. Joining at 30 is much cheaper than at 55.
• Health status: pre-existing conditions can lead to risk surcharges or exclusions. An honest health declaration is essential.
• Region: tariffs with USA and Canada coverage are significantly more expensive than tariffs for Southeast Asia or Europe. Typical "zone models" let you pick country groups.
• Scope: only emergency cover? Or including dental, prevention, pregnancy and psychotherapy?
• Deductible: a higher excess (e.g. EUR 500 or 1,000 per year) noticeably lowers monthly costs.

Practical tip: tariffs with USA cover deserve close inspection. US healthcare costs explode. If you are not living there long-term, save the surcharge and pick a tariff without North America. The more individual your tariff, the better the fit to your budget and lifestyle.

How to save on international health insurance

Price differences between providers are huge — sometimes several hundred euros per month for comparable cover. Independent comparison is therefore mandatory. Specialist insurance brokers like grenzenlos-sicher (advertising) not only help with the selection — they often unlock exclusive special conditions not available when going direct.

Three real cost examples

Concrete numbers beat ranges. Three real customer constellations.

Example 1: single, 30 years old, healthy, emigrating to Spain

• Basic cover without USA, optional comfort components
• Provider: APRIL International "MyHealth", comfort tariff
• Premium: ~EUR 95/month, EUR 500 deductible
• Includes: outpatient, inpatient, emergency, worldwide without USA/Canada

Example 2: family (35 + 32 + 2 children under 10), emigrating to Bali

• Comfort tariff with dental module
• Provider: grenzenlos-sicher recommends a family-specific comparison
• Premium: ~EUR 380/month total (children covered free of charge with Cigna Family)
• Includes: outpatient, inpatient, emergency, prevention, child vaccinations

Example 3: senior, 65 years old, emigrating to Thailand

• Premium tariff with prevention + dental
• Provider: Passportcard Senior 65+
• Premium: ~EUR 280/month, EUR 1,000 deductible
• Includes: outpatient, inpatient, prevention, dental, emergency repatriation

Key insight: family with 2 kids + USA cover can rise to EUR 700–1,000/month. Anyone who does not strictly need USA cover should actively deselect it — often saves EUR 200–400/month.

Provider comparison: who does what best?

In our consultations, 4–5 providers have established themselves as the standards for emigrants. Here is the line-up.

Through grenzenlos-sicher the independent comparison runs across every provider — you do not need to chase five carriers in parallel and reconcile tariffs.

APRIL International — pay only for what you need

APRIL International has the MyHealth system, which works like building blocks: you pick modules (outpatient, inpatient, prevention, dental, pregnancy, USA cover) and pay only for those. That makes the tariff attractive for many emigrants.

• Modular: no "full package" pressure
• Geographic zones: world without USA = cheaper
• Deductible: EUR 100–5,000/year selectable
• Family bonus: sibling discounts from 3 children

Weakness: premium adjustments at renewal can be sharp, especially at higher ages. Best negotiating base: through an independent broker like grenzenlos-sicher (advertising).

Passportcard — comfortable solution with strong customer service

Passportcard scores on two factors.

1. Very strong customer service — 24/7 app support, German-speaking, fast processing
2. Card system: you get a real insurance card (like a credit card) that many foreign clinics accept directly — no upfront payment needed

Ideal for: emigrants who value simple billing and live in Asia / Latin America (the card system is widely accepted there).

Weakness: premium tariffs with USA cover relatively expensive; not available for every senior.

Cigna Global — top for families

Cigna Global traditionally has the best family tariffs. Concretely: children up to 18 (sometimes 19) are insured free of charge, provided both parents are at Cigna.

For a four-person family, Cigna is often 20–30 % cheaper than equivalent tariffs at other providers. Particularly worth the comparison for families with 3+ children.

Weakness: premium pricing for USA-inclusive tariffs; less flexible on pre-existing conditions.

What does international health insurance cover?

Depending on tariff, international health insurance covers significantly more than just emergencies.

Outpatient treatment

Doctor visits, diagnostics, lab tests, medication, physiotherapy. Included in most tariffs from the basic level upwards.

Inpatient treatment

Hospital stays, surgery, intensive care. The core block of every international policy.

Dental

From routine check-ups to dentures, with different reimbursement rates depending on tariff. In basic tariffs often only after accidents; in premium tariffs comprehensive.

Prevention and check-ups

Preventive check-ups, vaccinations, health screenings. Particularly strong in premium tariffs.

Repatriation and evacuation

A major advantage of international policies: if treatment in the destination country is not possible, the insurer organises the medically necessary transport to Germany or another country. Many tariffs also include medical evacuation during natural disasters or political crises.

Temporary cover in Germany

Even on home visits you are covered. Most tariffs include stays of up to 6 weeks to 182 days per year in Germany — important for visits to family and friends.

Possible additional benefits

• Pregnancy and birth
• Psychotherapy
• Vision aids
• Alternative healing methods

Worth knowing: after signing you receive an insurance card that serves as proof to doctors, clinics and authorities. Many countries require exactly this proof for visas or residence permits.

Our recommendation: free consultation at grenzenlos-sicher

Advertising disclosure.

We have worked with grenzenlos-sicher since 2015 — our longest and most important partnership. Why? Because Robin and his team do exactly what we do not do: independent, licensed insurance advice specifically for emigrants, digital nomads and expats.

grenzenlos-sicher is now the largest broker for international insurance in Europe, with more than 5,000 consultations completed. The team consists of insurance brokers licensed in Germany, specialised exclusively in international insurance.

Why we recommend grenzenlos-sicher

Professional expertise: the team knows every relevant provider, every tariff and every trap. The consistently positive ProvenExpert reviews speak for themselves.

Best-price guarantee: through the size of the insured community, grenzenlos-sicher has its own framework agreements with special conditions. The result: often cheaper prices than going to the provider direct.

Post-sale support: your advisor stays your contact — by phone, email or messenger. No hotline marathon. In disputes, grenzenlos-sicher has contacts up to insurer board level and can achieve a lot more through its distribution power than you alone.

Fully free: the consultation, the comparison, the recommendation — all free for you. Compensation comes from the insurers, not from you.

Book a free insurance consultation

Known providers at a glance

Which provider fits you depends on your life situation. Here are two of the most well-known international health insurers, based on our daily work.

APRIL International

APRIL International is an international insurer with over 40 years of experience, more than 150,000 insured persons in 180 countries and over 2 million partner clinics.

Strengths:

• Building-block principle: you assemble your tariff individually — outpatient, inpatient, dental, prevention, pregnancy. You pay only for what you actually need.
• Unlimited tariffs: "MyHealth International" tariffs are valid indefinitely with automatic renewal, without renewed health checks.
• Digital settlement: claims via the Easy-Claim app, teleconsultations and direct cost coverage for inpatient treatment.
• Service quality: repeatedly awarded "Best Provider for IPMI" with top ratings in the Health & Protection Report.

Weaknesses:

• Dental benefits fully covered only in higher tariffs
• Complex tariff structure, hard to navigate without advice

Best for: digital nomads and expats wanting maximum flexibility on tariff design.

Passportcard

Passportcard offers an innovative payment model: instead of pre-payment and reimbursement, you receive a special Mastercard that the insurer loads with money in case of illness. You pay directly at the doctor — no paperwork, no waiting for reimbursement.

Strengths:

• No upfront payment: the wallet card is loaded in an emergency, you pay directly on site.
• 24/7 customer hotline: response time under 10 seconds, in multiple languages, German-speaking team in Hamburg.
• Transparency and comfort: no paperwork, no advance payment. Everything controllable via app.
• Tariffs for every need: from COMPACT (basic) over COMFORT to PREMIUM, including private room, transplants and birth.

Weaknesses:

• In some countries the acceptance network is limited
• Not every doctor accepts the card — then the classic process via app applies

Best for: expats and families wanting maximum comfort and fast service in emergencies.

Important: we explicitly recommend not making the provider choice alone. An independent broker like grenzenlos-sicher compares every relevant provider and finds the tariff that truly fits your situation.

USA specifics — what you need to know when moving to the USA

The USA is the most expensive territory for emigrants on health insurance. Three points are critical.

1. Affordable Care Act (ACA / "Obamacare"): Since 2019 the federal ACA insurance mandate has lapsed (the individual penalty is USD 0). Some states have their own mandates (California, New Jersey, Massachusetts, Rhode Island, Vermont, DC). If you live there, you should have an ACA-compliant plan.

2. Green Card holders: With permanent US residence, choose a US-domestic health plan — international tariffs are often not directly linked to US hospitals, which leads to upfront payments. Options: marketplace plans via healthcare.gov, employer insurance, local HMOs.

3. Medicare from 65: US seniors aged 65+ (also Green Card holders with 10+ years of contribution time) are entitled to Medicare — Part A (hospital, premium-free), Part B (doctor, ~USD 175/month), Part D (medication). For German emigrants without a 10-year US contribution record: no Medicare eligibility, so private international cover stays essential.

Practical tip: anyone moving to the US for 1–2 years (au pair, internship, short job) takes international cover with a USA module (~EUR 250–400/month). Anyone holding a permanent Green Card should switch to US plans — usually cheaper and better networked.

Senior tariffs — health insurance for 60+

From age 55 onwards, international health insurance gets significantly more expensive. Overview by age band:

• 55–60: surcharge ~30–50 % vs. 30-year-olds
• 60–65: surcharge ~80–120 % — a typical comfort tariff costs EUR 200–350/month
• 65–70: surcharge 120–180 % — premium tariffs often EUR 350–500/month
• From 70: many providers no longer accept new applicants

Strategies for senior emigrants:

1. Insure before emigration. Anyone emigrating at 58 who concludes the contract before deregistration enjoys 7 years of lower premiums vs. signing later at 65.
2. Keep Anwartschaft at the German PKV. So you can re-enter the PKV in an emergency (often ~EUR 30–50/month).
3. Check local cover in the destination country. In Spain, Portugal, Thailand there are sometimes cheaper local options for seniors than international policies.
4. Use advice: specialised senior tariffs from the carriers. grenzenlos-sicher (advertising) has senior comparisons.

Pre-existing conditions — what gets covered?

One of the most common emigrant concerns: "Do I even stand a chance at an affordable health insurance with pre-existing conditions?"

Standard treatment during the application:

1. Health questionnaire with every relevant pre-existing condition, surgery, medication
2. Insurer assessment — outcomes can be:
   • Full acceptance without surcharge (common for controlled chronic conditions like high blood pressure, mild asthma)
   • Acceptance with risk surcharge (5–30 % surcharge for moderate pre-existing conditions like type-2 diabetes, past heart issues)
   • Acceptance with benefit exclusion (the insurer covers everything except the specific condition — e.g. "spinal complaints excluded")
   • Rejection for severe pre-existing conditions (very rare, more in cases of ongoing cancer therapy etc.)

Strategy with pre-existing conditions:

• Ask several providers in parallel — assessment logic differs
• Sign the international cover BEFORE deregistration — assessment runs more favourably
• Keep Anwartschaft at the German PKV as a fallback
• Independent advice through grenzenlos-sicher — they know the assessment logic of each carrier

"We regularly see customers with pre-existing conditions get better terms through grenzenlos-sicher than by going direct to the insurer. Comes down to the broker's negotiating leverage." — Oliver Frankfurth

Repatriation, evacuation and temporary cover in Germany

Three additional benefits embedded in many international tariffs.

Repatriation home / to Germany:

• Medically necessary repatriation for severe illness
• Cost without insurance: EUR 10,000–50,000 (scheduled-flight ambulance, charter flight)
• Included in most premium tariffs

Evacuation to a better-equipped country:

• For inadequate medical infrastructure in the destination country (e.g. remote regions)
• Transport to a neighbouring country with better hospitals
• Standard in premium tariffs, optional in basic tariffs

Temporary cover in Germany:

• For home visits (typically 30–90 days/year)
• Acute treatment is covered
• Important: not every tariff includes this automatically — for frequent German trips, ask explicitly

Anwartschaft and return strategy

If you plan to return to Germany within the foreseeable future, the "what happens to my GKV or PKV" question is central. Three constellations in practice.

1. Statutory health insurance (GKV):

Membership ends with deregistration. There is generally no Anwartschaft option. For a return to Germany there are two routes:

• Compulsory insurance via an employer or receipt of unemployment benefit
• Voluntary membership — possible if you were in the statutory system at least 24 months over the past 5 years (§ 9 SGB V)
• If neither applies: catch-all insurance in the GKV (§ 5 SGB V), if your last health insurance status was in the GKV

In practice: anyone gone for more than 5 years without immediately taking up employment with compulsory insurance sometimes ends up in voluntary GKV with the minimum contribution (in 2026 ~EUR 230/month) — provided the "last insurance status" is documentable.

2. Private health insurance (PKV) — keep the Anwartschaft:

If you are in PKV, you can take out an Anwartschaftsversicherung (entitlement preservation). Two variants:

• Small Anwartschaft (EUR 10–30/month): secures your re-entry without a new health check. Aging reserves are frozen.
• Large Anwartschaft (EUR 40–80/month): in addition, aging reserves keep building — premium on return significantly cheaper.

The Anwartschaft is the most important insurance decision for PKV-insured people before emigration. Without it you get re-rated on return — with a higher entry age and possibly risk surcharges.

3. International policy with German cover:

Some providers (Cigna Global, BUPA Global, Allianz Care) offer tariffs that also provide cover on a return to Germany — either permanently or as a transition solution for 6 to 12 months. Useful when you do not know when you will come back, or when the GKV/PKV obligation only triggers after a settling-in period.

Recommended sequence before deregistration:

1. PKV-insured: apply for Anwartschaft (deadline usually 2 months before going abroad)
2. GKV-insured: check that the "last insurance status" is documented
3. Conclude the international policy before deregistration — assessment runs more favourably
4. Only deregister your residence once the international policy is active

What to watch for at conclusion

Waiting periods and pre-existing conditions

Many tariffs have waiting periods — for example, several months for dental treatment or pregnancy. Chronic pre-existing conditions must be declared and can lead to exclusions or surcharges. Some providers still offer solutions. An honest health declaration is the foundation for smooth benefits in a claim.

Notice periods and runtime

International health insurance is usually concluded as annual contracts with automatic renewal. Notice periods sit between 1 and 3 months before contract end. Some providers offer, against a surcharge, monthly cancellation options — useful when you do not yet know how long you will stay abroad.

Switching insurance abroad

A change is possible in principle but should be well planned. Only cancel the old policy once the new one is confirmed — coverage gaps can be expensive in an emergency. A new insurer means a new health check, which can change premiums or terms. An independent advisor helps with the right timing.

"Before your departure, secure the best possible cover and inform your German health insurance about your move and deregistration. That avoids unnecessary problems and keeps you optimally secured." — Oliver Frankfurth

Video: international health insurance — the complete guide

Frequently asked questions

What to do now

International health insurance ranks among the three most important decisions before deregistration — alongside the residence deregistration itself and clarifying your banking. Three steps for the next days.

1. Clarify the status of your current health insurance: PKV-insured → request Anwartschaft. GKV-insured → secure proof of last insurance status.
2. Get several offers — most easily through an independent broker like grenzenlos-sicher, working with every major international provider. The consultation is free for you.
3. Conclude the policy before deregistration, so no gap arises.

Related guides

• Leaving Germany in Retirement — health insurance at retirement age is its own topic (age bands, pre-existing conditions, Anwartschaft)
• Sell Your German Life Insurance — for a German life insurance that no longer fits abroad
• Health Insurance After Leaving Germany — the deeper cross-border view (Anwartschaft, KVdR, international options)
• How to Deregister from Germany — deregistration timing affects insurance status
• German Pension Refund — relevant for the insurance calculation in retirement
• Leaving Germany Checklist — full overview of every step
• Best Bank Account for Expats — for SEPA premiums abroad

---

Advertising: this article contains recommendations for our partner grenzenlos-sicher. The consultation is free for you. Please also see the broker's initial information under § 15 VersVermV and the information under § 60 (1) sentence 2 and (2) VVG.

Our service does not replace individual legal or insurance advice. For personal advice on your health insurance abroad we recommend the free consultation at grenzenlos-sicher.

Last updated: 26 May 2026.