A great deal has been said about the quality of the German health system, here included. Less attention goes to what actually happens to membership on departure — and whether you get it back. The answer sits in section 6 SGB V, it turns on your age, and as of 1 January 2026 it has become narrower. This article sets out when membership ends, from what point return is barred, and which routes remain open.
What departure does to membership
Statutory health insurance is not an account you can leave dormant. Membership depends on compulsory insurance in Germany — usually through employment, or through the pensioners’ scheme once drawing a pension. Remove the connecting factor and membership ends.
For Georgia a second point applies: there is no social security agreement covering health insurance between Germany and Georgia. Within the EU, the EEA and Switzerland, and towards certain treaty states, such rules coordinate the systems — insurance periods are taken into account on both sides and treatment in the country of stay is covered. Towards Georgia none of that exists. The German scheme does not pay there, and residence in Georgia creates no claim against it.
In practice: anyone moving to Georgia organises cover entirely themselves. That is the known part, and it is the manageable one.
The door that closes at 55
The unknown part concerns return. Section 6 (3a) SGB V works like this: anyone who becomes subject to compulsory insurance after turning 55 is insurance-free — which here does not mean freedom but exclusion — where two conditions coincide:
- in the five years before compulsory insurance arises there was no statutory insurance, and
- for at least half that period the person was insurance-free, exempted from compulsory insurance, or self-employed as their main occupation.
Anyone who emigrates at 52, takes private cover and returns at 58 regularly meets both. Return to the statutory scheme is then excluded — not expensive, excluded. What remains is private insurance, whose premiums track entry age rather than income.
As of 1 January 2026 this construction has tightened. Article 3 of the Act on the Extension of Powers and Reduction of Bureaucracy in Care inserted a new section 6 (3b) SGB V. It covers persons who, after turning 55, establish cover abroad that is treated as equivalent to statutory insurance under inter-state or supranational rules. For them the relevant five-year period shifts: it is measured not from the date of return but from the start of that foreign cover.
The effect is unambiguous. Anyone who previously moved into an EU system, counted as statutorily insured there and relied on that on returning could satisfy the qualifying period. That route is closed.
What the system costs while you are in it
The counter-calculation belongs here, because membership is not free. For 2026 Germany applies a general contribution rate of 14.6 percent, an average supplementary rate of 2.9 percent and long-term care insurance of 3.6 percent, rising to 4.2 percent for the childless over 23. The contribution ceiling is EUR 5,812.50 per month, or EUR 69,750 a year.
For a childless member above the ceiling that produces a maximum contribution of roughly EUR 1,261 per month — employer and employee shares combined. Around EUR 15,100 a year before a single service has been used.
| Germany | Austria | Switzerland | |
|---|---|---|---|
| Financing the Swiss premium does not appear in the tax-and-contribution ratio | income-based contribution | income-based contribution | flat per-head premium |
| Ceiling 2026 above the ceiling income is contribution-free in Germany and Austria | EUR 5,812.50 per month | EUR 6,930 per month (ASVG) | none — premium independent of income |
| Burden 2026 Switzerland: Federal Office of Public Health, 2026 premiums, up 4.4% on 2025 | up to about EUR 1,261 per month | capped via the contribution ceiling | CHF 393.30 average, CHF 465.30 adults |
| Age bar on re-entry in Switzerland cover must be taken out within three months of taking up residence | from 55 under section 6 (3a) and (3b) SGB V | no comparable age threshold | none — insurance follows residence |
The Swiss figure deserves context, because it looks low: the premium is a flat per-head charge and not income-based. It weighs relatively more heavily on lower incomes and appears in no tax-and-contribution ratio. Anyone comparing locations by that ratio therefore systematically flatters Switzerland — see Switzerland: Low Taxes, High Dependency.
What the system delivers for these contributions is set out elsewhere: the highest per-capita health spending in the EU alongside a life expectancy that has fallen below the EU average for the first time, plus roughly 80 percent of hospitals running at a loss. The figures are in Government Ratio 50.3% and Germany Is Quietly Falling Apart.
What sits on the other side
Georgia has no compulsory contribution to a state health system. Private cover of good quality is in the order of EUR 50 to 150 per month. Against the German maximum contribution that is a difference nobody needs to talk down — but also not one to mistake for equivalent provision.
Two points belong with it. First: no compulsory system also means no safety net. Provision is organised and budgeted personally, and anyone who does not do so with discipline is left with nothing when it matters. Second, since 1 January 2026 a proof requirement applies on entry: health and accident insurance with minimum cover of GEL 5,000 for outpatient emergency treatment and GEL 30,000 for inpatient treatment, evidenced in English or Georgian. Entry is refused without it.
What follows from this
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Set your own age against the period
The only number that really counts is your age at a possible return. Under 55 the provision is practically moot. Anyone planning departure beyond their mid-forties should know it before leaving — not when they want to come back.
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Check the dormancy option before private cover ends
Anyone emigrating out of German private health insurance can preserve the status acquired through a dormancy policy. It costs a fraction of the full premium and preserves entry age and medical underwriting. That decision is taken at departure, not later.
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Choose foreign cover by length of stay, not by price
Travel health insurance covers weeks, not a change of residence. A permanent stay needs international health insurance or a local policy — and entry to Georgia has required proof of the minimum cover set out above since 2026 in any case.
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Model the return scenario once
Not every departure is final. Anyone who plays the return through once — age, employment, partner, qualifying periods — knows whether they face an open door or a closed one. That check belongs with a social insurance adviser or specialist lawyer in the country of origin.
The finding is the same as on the tax side, only in a different body of law: leaving is unbureaucratic, returning is not. Anyone planning both together keeps the choice. What the equivalent logic looks like in tax law — once on departure and for five years afterwards — is in Staying Does Not Get Cheaper and Five Years After You Leave, the Tax Office Still Inherits. Why a structure without genuine residence achieves nothing at all is in “Stateless” Is Not a Solution.
Frequently asked questions
Does my German statutory health insurance end when I move to Georgia?
As a rule yes. Membership of the statutory scheme depends on compulsory insurance in Germany; giving up your residence and the underlying employment ends it. There is a further point: no social security agreement covering health insurance exists between Germany and Georgia. The statutory scheme does not pay in Georgia, and residence in Georgia creates no claim against it.
What does the age-55 rule in section 6 (3a) SGB V say?
Anyone who becomes subject to compulsory insurance after turning 55 is "insurance-free" — meaning excluded from the statutory scheme — if they were not statutorily insured in the preceding five years and were, for at least half that time, insurance-free, exempted from compulsory insurance, or self-employed as their main occupation. Both conditions must be met together. Anyone privately covered abroad regularly meets them after a few years.
What changed on 1 January 2026?
A new paragraph 3b was inserted into section 6 SGB V by article 3 of the Act on the Extension of Powers and Reduction of Bureaucracy in Care. It covers persons who, after turning 55, establish cover abroad that is treated as equivalent to statutory insurance under inter-state or supranational rules. For them the five-year period is no longer measured from the date of return but from the start of that foreign cover. A route back that previously existed has been closed.
Does the new paragraph 3b affect a move to Georgia?
Usually not directly, because it attaches to cover treated as equivalent to the German statutory scheme under inter-state or supranational rules — principally the EU, the EEA and Switzerland, plus treaty states. No such agreement exists with Georgia. What remains decisive for you is paragraph 3a: time outside the statutory scheme accumulates, and from age 55 it determines whether return is possible.
What routes back into the statutory scheme remain?
Mainly three. First, returning before the age of 55 — the bar does not apply. Second, employment subject to compulsory insurance, provided the qualifying periods in paragraph 3a do not stand in the way. Third, family insurance through a statutorily insured spouse or civil partner; section 6 (3a) sentence 4 expressly treats marriage or civil partnership as equivalent. Whether any of these routes works in an individual case should be settled in advance, not in the year of return.
What does cover in Georgia cost?
Private health insurance of good quality is in the order of EUR 50 to 150 per month. Separately, a proof requirement has applied at entry since 1 January 2026: health and accident insurance with minimum cover of GEL 5,000 for outpatient emergency treatment and GEL 30,000 for inpatient treatment. Entry is refused without proof.
This article is general information and does not constitute legal, tax or insurance advice. The legal references relate to section 6 of Book Five of the German Social Code as in force since 1 January 2026; paragraph 3b was inserted by article 3 of the Act on the Extension of Powers and Reduction of Bureaucracy in Care. The 2026 contribution rates and contribution ceiling come from the Federal Ministry of Health, and the maximum contribution is calculated from them. The Austrian contribution ceiling follows the 2026 social insurance values, and the Swiss premium figures the Federal Office of Public Health (2026 premiums, published 23 September 2025). The Georgian proof requirement on entry follows the travel and safety guidance of the German Federal Foreign Office. Whether a return to the statutory scheme is possible in an individual case belongs in the hands of a specialist adviser in the country of origin. As of August 2026, subject to changes in the law.