Insurance · Health
Health insurance in Europe for expats: how it works country by country
Europe has three kinds of health systems. In the UK, Spain, Italy, Portugal and the Nordic countries you are covered because you live there. In Germany, France, Austria and Belgium you are covered through contributions taken from your salary. In the Netherlands and Switzerland you must buy a basic policy yourself from a private insurer. Which one you are in decides what you pay and what you have to do after you arrive.
Country by country
| Country | How you are covered | What it costs |
|---|---|---|
| Germany | Public insurance (GKV) for most employees; private (PKV) allowed above €77,400 salary or for the self-employed | 7.3% of salary plus half the add-on (average 2.9%), up to the €69,750 ceiling |
| France | Public cover (PUMa) after 3 months of stable residence, through work or residence | Included in salary contributions; most people add a top-up policy (mutuelle) |
| Netherlands | You must buy a basic policy (basisverzekering) within 4 months of registering | About €171–174 a month in 2027, plus a €400 yearly excess; allowance for low incomes |
| Switzerland | You must buy a basic policy within 3 months of arrival | Average CHF 488 a month for adults in 2027; see our Swiss guide |
| Belgium | Join a health fund (mutualité / ziekenfonds) through work | Social contributions from salary plus a small yearly fee |
| Austria | Public insurance (ÖGK and others) through work | Part of social contributions from salary |
| Spain | Public system through social security when you work; private needed for most visas without work | Included in contributions; private plans for visas often €50–150 a month |
| Portugal | National Health Service (SNS) after you register and get a user number | Free or small fees; many expats also buy private insurance |
| Italy | National Health Service (SSN) through work; others can join voluntarily | Voluntary enrolment from €2,000 a year |
| Ireland | Public HSE care for residents; about half the population also buys private cover | Private cover costs more if you first buy it after age 34 |
| United Kingdom | NHS for residents; visa holders pay a health surcharge | £1,035 a year per adult for most visas (£776 for students and children) |
| Sweden, Denmark, Finland | Residence-based public care once you are registered | Funded by tax; small fees for visits and medicines |
2026–2027 figures. Private insurance prices depend on age, cover and excess. Check the sources below and the insurer’s terms before you decide.
The gap after you arrive
Many systems only cover you once you are registered, employed or have lived there for a few months. Plan for the gap:
- Moving within the EU: your EHIC card from your old country covers necessary care during a temporary stay, but not once you have moved for good. Ask your old insurer when your cover ends.
- Pensioners with a state pension from another EU country can get an S1 form, which registers them in the new country’s system at the expense of the country paying the pension.
- Coming from outside the EU (US, UK, Canada, Australia): most residence visas need private health insurance that covers you from day one, often with no co-payments. Buy it before you apply.
Public or private: what to think about
- Germany: private insurance is often cheaper when you are young and single, but premiums rise with age and it is hard to go back to public insurance after 55. Families pay per person in private, while children are free in public insurance.
- Spain and Portugal: public care is good but waiting times for specialists can be long; private policies are cheap by northern standards.
- Ireland: buy private cover before your 35th birthday (or within 9 months of moving) to avoid a lifetime loading.
- Check whether a private policy covers pre-existing conditions, pregnancy, mental health and medicines, and whether it is accepted for your visa.
General information, not insurance advice. ExpatCents is not an insurer or broker and does not sell policies. Always read the policy terms before you sign.
See health contributions in your net salary →
Sources
This guide is general information based on the tax rules we could verify for 2026, not tax or financial advice. Rules change and personal situations differ, so check with the tax authority or a qualified adviser before you act. Spotted a mistake? Email [email protected].