Healthcare in Europe: what you need to know about medical insurance

When you are planning a move abroad, it is essential to understand how the healthcare system works in your destination country. Europe offers some of the best medical care in the world, but the conditions for accessing it and the cost of insurance vary widely from one country to another. In this article we take a closer look at the healthcare systems of Germany, France, Spain and Italy.

Germany

About 90% of the population is covered through public health insurers, while the rest rely on private insurance.

Public insurance (GKV)

Public health insurance in Germany is mandatory for anyone earning less than €66,600 a year (2024 figures). Contributions to the public system are calculated as a percentage of your income (around 14-15%) and split between employee and employer.

For example, someone earning €3,500 a month would pay roughly €525 a month into the GKV, with the employer covering about half.

Private insurance (PKV)

Private health insurance is available to those who earn above the threshold, as well as to freelancers and business owners.

For a young person with no chronic conditions, private cover can cost anywhere from €250 to €700 a month. People over 50 or with chronic illnesses may pay more than €1,000 a month.

France

The French system combines public insurance, which covers up to 70% of medical costs, with a supplementary private policy (Mutuelle) that picks up the rest.

Public insurance (Sécurité Sociale)

All residents of France are required to register with Sécurité Sociale after three months in the country. The bulk of medical costs is paid by the state. A visit to a GP, for instance, costs around €25, of which public insurance covers €17.5.

Contributions to Sécurité Sociale run at about 8% of income and are already built into payroll taxes. For someone earning €40,000 a year, that works out to roughly €3,200 a year, or about €267 a month.

Private insurance (Mutuelle)

A Mutuelle is typically taken out to cover the 30% that the state does not. It is essential for full protection in the event of hospitalisation or complex treatment.

Spain

Spain offers both public and private health insurance, making the system accessible to locals and expats alike.

Public insurance (SNS)

The public health system, SNS, is funded through taxes and gives residents free access to essential medical services.

Employers pay contributions of around 28% of an employee's salary, part of which goes towards healthcare. Employees usually do not pay for public insurance directly, except in the case of the self-employed, whose contributions can range from €200 to €300 a month.

Private insurance

Many expats and locals opt for private health insurance to get faster access to doctors and specialist services. For an adult, private cover can cost between €40 and €200 a month, depending on the level of coverage.

Italy

Italy's healthcare system is likewise split into public and private.

Public insurance (Servizio Sanitario Nazionale, SSN)

In Italy, all residents - including foreigners with a residence permit - are entitled to access the public health system, SSN. For employees, contributions are paid by the employer (around 10% of the worker's salary). For students, pensioners and those who are not working, contributions may be minimal or non-existent. The self-employed may pay around €1,500 a year.

Private insurance can cost between €50 and €300 a month, depending on age and health.

The takeaway

Healthcare in Europe provides access to high-quality medical services. In most countries the public system covers the basics, but for a fuller range of services - including specialist treatment and hospitalisation - a private policy is well worth having. Costs vary by country, age and health, so it pays to work out the likely expense in advance and choose the plan that suits you best.

2026 figures: Germany

From 1 January 2026 the threshold above which an employee may leave statutory insurance for private cover is EUR 77,400 a year, about $86,800. Contributions are calculated on income up to EUR 69,750 a year, about $78,200. The base rate is 14.6% plus an additional contribution set by each fund; the national average in 2026 is 2.9%. Employee and employer split the contribution, so even on a high salary the employee pays no more than about EUR 509 a month, around $570.

Spain: public cover by special agreement

People with no right to public healthcare through work or family can sign a special agreement with the health system. You must have lived in Spain for at least a year and be registered with the municipality. In 2026 the agreement costs $68 a month (EUR 60) under 65 and $176 a month (EUR 157) from 65, and gives access to the basic package of public health services.

Italy: voluntary enrolment in the health service

Foreigners who live in Italy but are not enrolled in the health service by law, such as people living on their own income, can enrol voluntarily. Since 2024 the annual contribution is based on the previous year's income from Italy and abroad, with a minimum of EUR 2,000 a year, about $2,250. Students without dependants or income pay a flat EUR 700 a year, about $785. The contribution covers a whole calendar year and cannot be paid retroactively.

Insurance when you move: how Murblz helps

Health insurance is part of the document file for almost every European residence permit, and a wrong policy is a common reason for refusal. Murblz specialists choose a policy that meets the consulate's and programme's requirements and advise when you can switch to the public system. Programmes are covered on the Spain digital nomad visa, Italy digital nomad visa and Germany freelance visa pages. The first consultation is free.

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