Neutral overview (no medical advice). GKV reimburses prescription medication under § 31 SGB V with Zuzahlung (10 % · min €5 / max €10 per pack, § 61 SGB V; annual cap § 62 SGB V). Recognised Incoming products (Care Expatriate) cover prescribed medication for acute new events only — pre-existing chronic medication is excluded per AVB and § 19 VVG.

Health insurance and medication in Germany — what to watch out for (neutral overview)

Entry age 41–60: from €68/monthEntry age 61–74: from €246/month

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Sources: § 31 SGB V (medication benefits) · § 34 SGB V (OTC exclusion) · § 61 SGB V (Zuzahlung) · § 62 SGB V (hardship cap) · § 5 SGB V (KVdR 9/10) · § 19 VVG · § 5 AufenthG · EU Reg. 883/2004 (Form S1) · HanseMerkur Care Expatriate AVB · HanseMerkur Care Economy AVB · GKV-Spitzenverband

The 10 medication-insurance points foreign retirees in Germany should know

Quick answer: "How does health insurance cover prescription medication in Germany?" — GKV reimburses prescribed medication under § 31 SGB V; patient pays the Zuzahlung (10 % · min €5 / max €10 per pack, § 61 SGB V), with an annual cap of 2 % of gross household income (1 % chronic, § 62 SGB V). Recognised Incoming products (Care Expatriate from €68/mo · €246/mo, Care Economy from €1.00–€2.95/day) reimburse prescribed medication for an acute new event per AVB; pre-existing chronic medication is excluded under § 19 VVG. This is an insurance overview only — therapy questions belong to the treating physician.

• 1. Point 1 — Prescription medication on GKV (§ 31 SGB V)
  GKV reimburses prescribed medication directly at the pharmacy; patient pays the Zuzahlung. Mandatory medication for the chronic stack is covered when GKV is open.
• 2. Point 2 — Zuzahlung mechanics (§ 61 SGB V)
  10 % of the pack price, minimum €5 and maximum €10 per pack — never more than the actual pack price. Applies per pack, not per prescription.
• 3. Point 3 — Hardship cap (§ 62 SGB V)
  Annual cap 2 % of gross household income (1 % for the chronically ill). Once reached, the GKV exempts the patient from further co-payments for the rest of the calendar year.
• 4. Point 4 — OTC and lifestyle drugs (§ 34 SGB V)
  GKV does NOT reimburse most OTC medication for adults; lifestyle drugs and named exclusions are out. Limited exceptions for serious illness on the GBA list.
• 5. Point 5 — Care Expatriate — what it pays for medication
  PRESCRIBED medication for the treatment of an acute new event during the contract term, per AVB and chosen tariff tier. From €68/month (entry age 41–60) · €246/month (entry age 61–74).
• 6. Point 6 — Pre-existing chronic medication — strict exclusion
  Excluded per AVB and § 19 VVG on every recognised Incoming product (Care Expatriate, Care Economy, Care Visa Protect). The chronic stack remains personal cost until GKV/KVdR opens.
• 7. Point 7 — § 19 VVG disclosure at sign-up
  Every regularly taken medication must be disclosed in writing. Concealment leads to retroactive contract rescission and loss of the recognised insurance proof — putting the residence permit at risk.
• 8. Point 8 — Imported medication and equivalents
  Imported medication may not be reimbursed if a German equivalent exists. Bring a written summary (German + English) of dose and substance for the German treating physician to issue a local prescription.
• 9. Point 9 — Pharmacy receipts and reimbursement workflow
  GKV: direct settlement at the pharmacy + Zuzahlung paid in cash/card. Incoming (Care Expatriate, Care Economy): patient pays at the pharmacy and submits the original receipt + prescription to the insurer for reimbursement per AVB.
• 10. Point 10 — When GKV opens for the full chronic stack
  Via KVdR under the 9/10 rule (§ 5 Abs. 1 Nr. 11 SGB V), § 9 SGB V (voluntary) or EU Form S1 (EU Reg. 883/2004). Outside these doors, GKV cannot enrol a foreign retiree.

Three lanes for medication in Germany — GKV (full chronic stack), Care Expatriate (acute prescribed), Care Economy (short bridge)

One wrong insurance choice can cost you money, time and your application deadline

A medical incident can become expensive fast — but the wrong certificate can also delay your visa, enrollment, residence permit or work start.

• Wrong or incomplete proof can delay your visa, enrollment or authority process.
• Cheap home-country policies may miss the exact coverage, dates or repatriation wording required.
• The cheapest policy can become expensive if it is the wrong proof for your situation.

Before you apply, check: coverage amount, validity dates, destination area and repatriation cover.

Why act before family visit or residence paperwork

Older visitors often face age-based pricing and eligibility limits. Waiting too long can make the right option harder to choose.

Recommended tariffs for the medication-insurance question — Care Expatriate (acute prescribed), Care Economy (short bridge). Chronic medication from day one only via GKV/KVdR or EU Form S1.

Wondering when GKV is open instead? Retirees in Germany — when statutory vs private. Have chronic conditions to plan around? Retirees with chronic conditions — typical misconceptions. Confused about Krankenversicherung vs Pflegeversicherung? Health insurance vs long-term care insurance. For the full overview see the foreign-retirees hub.

Frequently Asked Questions