Refugees & Asylum Seekers

Healthcare for refugees and asylum seekers in Germany is governed by a separate legal framework — the Asylbewerberleistungsgesetz (AsylbLG) — which provides more limited coverage than regular statutory health insurance (GKV) during the first months. Understanding what you're entitled to, when coverage expands, and how to eventually transition into full GKV is essential for protecting your health and that of your family. This guide walks through every stage.

First 18 Months — AsylbLG §4 and §6

During the first 18 months after arriving in Germany and registering as an asylum seeker, your healthcare is governed by §4 and §6 of the AsylbLG. This provides restricted coverage — not the full range of services available to GKV members.

What is covered under §4 AsylbLG:

• Treatment of acute illnesses and pain — if you're sick or in pain, you have the right to see a doctor and receive necessary treatment
• Pregnancy and maternity care — prenatal checkups, birth, postnatal care, and midwife services are fully covered from day one
• Vaccinations — all recommended vaccinations (Schutzimpfungen) as per STIKO guidelines are covered
• Preventive care for children — the U-Untersuchungen (pediatric screening exams) are available from the start
• Medications — prescribed drugs for acute conditions, including bandages and therapeutic supplies

What is NOT covered in the first 18 months:

• Dental prosthetics — dentures, crowns, and bridges are not covered unless needed to treat acute pain
• Psychotherapy — generally not available except in acute psychiatric emergencies (a significant gap given the trauma many refugees experience)
• Chronic disease management — ongoing treatment for conditions like diabetes, hypertension, or asthma may be limited to acute interventions only
• Elective treatments — physiotherapy, occupational therapy, speech therapy, and other non-emergency treatments are typically excluded
• Specialist referrals — may require prior approval from the Sozialamt (social welfare office), which can cause delays

§6 AsylbLG — Additional benefits:

§6 allows the Sozialamt to approve additional treatments beyond the §4 minimum if they are deemed indispensable for securing health. This includes treatments for chronic conditions or mental health care when the Sozialamt agrees it's necessary. However, approval is discretionary and varies significantly between municipalities.

Gesundheitskarte for Refugees

How you actually access medical care as a refugee depends heavily on which Bundesland (federal state) you live in. There are two systems in use across Germany:

Electronic health card (eGK) states:

Several Bundesländer have introduced the elektronische Gesundheitskarte (eGK) for refugees, allowing direct access to doctors without prior Sozialamt approval. States that issue an eGK from day one include:

• Berlin
• Bremen
• Hamburg
• Brandenburg
• Schleswig-Holstein
• Thüringen
• NRW (in many cities and municipalities)

With the eGK, you can go directly to any doctor who accepts the card — just like a regular GKV member. The card is issued through an agreement between the state and a designated Krankenkasse (often AOK or another local Kasse). The coverage is still limited to AsylbLG §4 benefits, but access is far easier.

Behandlungsschein (paper voucher) states:

In states without the eGK system, you must obtain a Behandlungsschein (treatment voucher) from the Sozialamt before visiting a doctor. This process is significantly more cumbersome:

• You go to the Sozialamt, explain your symptoms, and request a voucher
• The Sozialamt issues a Behandlungsschein — typically valid for one quarter (three months) or sometimes for a single visit
• You take the voucher to the doctor, who then bills the Sozialamt directly
• For specialist visits, you may need a separate approval — which can take days or weeks
• Emergency care is always available without a voucher — go to the Notaufnahme (emergency room) if needed

After 18 Months — §2 AsylbLG (Analogleistungen)

After 18 months of receiving AsylbLG benefits, your healthcare entitlement upgrades significantly under §2 AsylbLG. This provision grants you Analogleistungen — benefits analogous to those provided under SGB XII (social welfare), which are equivalent to full GKV coverage.

What changes after 18 months:

• You receive full GKV-equivalent coverage under SGB V — the same Leistungskatalog (benefits catalog) as any statutory health insurance member
• Psychotherapy becomes available through the regular GKV approval process
• Dental prosthetics are covered with the standard Festzuschuss (fixed subsidy) system
• Chronic disease management programs (Disease Management Programs / DMP) become accessible
• Rehabilitation and therapeutic services (Physiotherapie, Ergotherapie, Logopädie) are covered
• Prescription medications for all conditions, not just acute ones

How it works administratively:

• In most cases, coverage is still administered through the Sozialamt, not directly through a Krankenkasse
• However, many municipalities issue an eGK at this stage if they didn't before, since the coverage level is now equivalent to GKV
• The Sozialamt covers the costs but the scope of services is identical to regular GKV — doctors must provide the same treatments they would for any insured patient

Transition to Full GKV

The transition from AsylbLG-based healthcare to full membership in the regular statutory health insurance system (GKV) happens when your legal status changes. This is a critical moment in your integration journey.

When you transition to GKV:

• Asylum is granted (Anerkennung) — when you receive a positive decision on your asylum application (Asylberechtigung, Flüchtlingsschutz, or subsidiärer Schutz), you leave the AsylbLG system entirely
• Subsidiary protection (subsidiärer Schutz) — also triggers full integration into the regular social security system, including GKV
• Employment — if you find a job subject to social insurance contributions (sozialversicherungspflichtige Beschäftigung), you become a mandatory GKV member through your employer, just like any other employee in Germany
• Bürgergeld — if you receive Bürgergeld (formerly ALG II / Hartz IV) after recognition, the Jobcenter pays your GKV contributions and you become a full GKV member

Choosing a Krankenkasse:

• When you transition to GKV, you have free choice of any open Krankenkasse — AOK, TK, Barmer, DAK, IKK, and many others
• Core benefits are identical across all Kassen (mandated by law), but they differ in Zusatzbeitrag (supplementary contribution rate), bonus programs, and extra services
• Some Kassen offer multilingual service — TK and AOK, for example, provide information in multiple languages
• Your employer or Jobcenter will ask which Kasse you've chosen — if you don't specify, they may assign one

Mental Health for Refugees

Mental health is one of the most pressing healthcare concerns for refugees. Studies show that approximately 40-50% of refugees in Germany experience post-traumatic stress disorder (PTSD), depression, or anxiety disorders — often resulting from war, persecution, flight, and the stresses of the asylum process itself. Accessing mental health care is essential for recovery.

Access under AsylbLG §4 (first 18 months):

• Psychotherapy is generally not covered under §4 — only acute psychiatric emergencies qualify
• The Sozialamt can approve psychotherapy under §6 AsylbLG on a case-by-case basis, but approval rates vary widely between municipalities
• Psychiatric medication can be prescribed for acute conditions, but long-term prescriptions may face hurdles
• Some courts have ruled that denying psychotherapy to traumatized refugees violates their rights — but enforcement is inconsistent

After 18 months (§2 AsylbLG / Analogleistungen):

• Full access to psychotherapy through the regular GKV approval process (Psychotherapie-Richtlinie)
• All approved therapy formats: Verhaltenstherapie (CBT), tiefenpsychologisch fundierte Psychotherapie (psychodynamic therapy), analytische Psychotherapie (psychoanalysis), and systemische Therapie (systemic therapy)
• The standard process applies: probatorische Sitzungen (trial sessions), then Antrag (application to the Kasse), then Kurz- or Langzeittherapie

Psychosoziale Zentren (PSZ):

Germany has a network of approximately 45 Psychosoziale Zentren specifically for refugees and torture survivors. These centers offer:

• Low-threshold access — often without needing a Behandlungsschein or insurance card
• Therapy with qualified interpreters — PSZ staff are experienced in working with interpreters during sessions
• Cultural mediation — therapists understand the cultural contexts of their patients
• Social counseling in addition to psychological support
• Find your nearest PSZ through the BAfF (Bundesweite Arbeitsgemeinschaft der Psychosozialen Zentren für Flüchtlinge und Folteropfer)

Children's Healthcare

Refugee children have access to better healthcare coverage from day one than adults under the AsylbLG system. German law prioritizes children's health and development regardless of immigration status.

What is available from day one:

• Full preventive care (U-Untersuchungen) — the complete series of pediatric screening exams (U1 through U9, plus J1 for adolescents) is covered from birth. These are crucial for detecting developmental issues early.
• Full vaccination program — all STIKO-recommended vaccines are available immediately, including catch-up vaccinations for children who missed doses in their home country or during flight
• School health checks (Schuleingangsuntersuchung) — mandatory health screening before school enrollment, fully covered
• Acute illness treatment — same as for adults under §4, covering all acute conditions and pain
• Pediatric care access — children can see a Kinderarzt (pediatrician) for both acute and preventive visits

Dental care for children:

• Preventive dental care is covered — including fluoride treatments, dental sealants (Fissurenversiegelung), and regular checkups
• Treatment of acute dental pain and necessary dental work (fillings, extractions) is covered under §4
• Orthodontic treatment may require §6 approval or may need to wait until after 18 months

Pregnancy and Maternity Care

Pregnancy is one area where refugee women receive comprehensive coverage from day one, regardless of how long they have been in Germany. The AsylbLG explicitly includes maternity care in §4 as essential treatment.

What is covered:

• Full prenatal care (Schwangerschaftsvorsorge) — regular checkups with a gynecologist or midwife, including ultrasound examinations and blood tests
• Midwife care (Hebamme) — you have the right to a midwife throughout pregnancy, during birth, and for postnatal care (Wochenbettbetreuung) for up to 12 weeks after delivery
• Hospital birth — full coverage for hospital delivery, including emergency caesarean section if needed
• Medications and supplements — prescribed prenatal vitamins, iron supplements, and other pregnancy-related medications
• Postnatal care — follow-up appointments, breastfeeding support, and Rückbildungskurs (postnatal recovery course)
• Pregnancy-related complications — treatment for gestational diabetes, preeclampsia, and other complications is fully covered

Finding a midwife:

• Finding a Hebamme can be challenging due to a nationwide shortage — start looking as early as possible
• Ask your social worker, refugee support organization, or the local Gesundheitsamt (health department) for help
• The Hebammenzentrale in your city can help match you with an available midwife
• Some midwives specialize in caring for refugee women and can communicate in multiple languages or work with interpreters

Interpreting Services

Language barriers are one of the biggest obstacles to healthcare access for refugees. Unfortunately, Germany does not guarantee a legal right to a professional interpreter at medical appointments — but there are options.

The current situation:

• There is no federal law requiring the provision (or funding) of interpreters for medical appointments
• Some Bundesländer and municipalities fund interpreter services — availability varies dramatically by location
• Doctors are not required to provide interpreters, and most practices do not have multilingual staff
• Using children as interpreters for their parents is strongly discouraged by medical professionals — it places an unfair burden on the child and can lead to miscommunication about serious health matters

Available interpreter services:

• Gemeindedolmetscherdienste (community interpreter services) — many cities have trained volunteer or professional community interpreters who can accompany you to medical appointments, often free of charge
• SprInt (Sprach- und Integrationsmittler) — a network of trained language and integration mediators who provide professional interpreting in medical and social service settings
• Phone interpretation services — some hospitals and larger medical practices offer telephone-based interpretation. Several Bundesländer have funded phone hotlines for medical interpreting
• Refugee support organizations — many local organizations maintain lists of volunteer interpreters for common languages (Arabic, Farsi/Dari, Tigrinya, Kurdish, Ukrainian, etc.)

Duldung (Toleration) Status

If your asylum application is rejected but deportation is temporarily suspended, you receive a Duldung (toleration). This is not a residence permit — it's a suspension of deportation, often renewed every few months. Despite this precarious status, you retain healthcare rights.

Healthcare under Duldung:

• The same AsylbLG rules apply — Duldung holders receive healthcare under the AsylbLG, identical to asylum seekers
• §4 AsylbLG coverage applies during the first 18 months — acute illness, pain, pregnancy, vaccinations, children's preventive care
• The 18-month clock still counts — time spent under Duldung counts toward the 18-month threshold for Analogleistungen (§2 AsylbLG)
• After 18 months, you receive full GKV-equivalent coverage through Analogleistungen, just like asylum seekers who have waited the same period
• If you've been in the AsylbLG system for more than 18 months (including time as an asylum seeker before the Duldung), you're already eligible for §2 Analogleistungen

Special situations:

• Beschäftigungsduldung (employment toleration) — if you're working, you may be integrated into the regular social insurance system including GKV through your employer
• Ausbildungsduldung (vocational training toleration) — similar protections; if your training is subject to social insurance, you may access GKV
• Kettenduldung (chain toleration — repeated renewals) — the 18-month periods accumulate continuously; your healthcare entitlements don't reset with each renewal

Unaccompanied Minors

Unaccompanied minor refugees (unbegleitete minderjährige Flüchtlinge / UMF) receive special protections under German law that go well beyond the standard AsylbLG framework.

Key protections:

• Jugendhilfe (youth welfare) takes priority — unaccompanied minors are placed under the care of the Jugendamt (youth welfare office), which is responsible for their well-being, including healthcare
• Full healthcare access — through Jugendhilfe (SGB VIII), unaccompanied minors typically receive comprehensive healthcare coverage that goes beyond the restricted AsylbLG §4 provisions
• Mental health support — given the particular vulnerability of unaccompanied minors, access to psychotherapy and psychological support is generally facilitated more readily
• A legal guardian (Vormund) is appointed to represent the minor's interests, including healthcare decisions
• Specialized housing — placement in Jugendhilfe facilities (Wohngruppen, Pflegefamilien) rather than mass reception centers, with integrated health support

Transition at age 18:

• When an unaccompanied minor turns 18, they may transition from Jugendhilfe to the regular AsylbLG system — this can mean a reduction in healthcare coverage
• Jugendhilfe can be extended to age 21 (or even 27 in exceptional cases) under §41 SGB VIII if the young person still needs support
• The Vormund or Jugendhilfe caseworker should help plan the transition and ensure continuity of care

Practical Guide to Accessing Care

Knowing your legal entitlements is one thing — actually accessing healthcare as a refugee in Germany can be another challenge entirely. Here's a practical guide to navigating the system.

How to access care step by step:

1. Determine your coverage type — are you under AsylbLG §4 (first 18 months), §2 Analogleistungen (after 18 months), or full GKV (after recognition)?
2. Get your access document — either the eGK (electronic health card) or a Behandlungsschein from the Sozialamt
3. Find a doctor — see below for tips on finding doctors who treat refugees
4. Bring to appointments: your eGK or Behandlungsschein, any medical records you have (even from your home country), a list of medications you take, and an interpreter or someone who speaks German if possible
5. For emergencies: go directly to the Notaufnahme (emergency room) — no Behandlungsschein or eGK is needed. Emergency care is always provided first and billing is sorted out later

Finding doctors who treat refugees:

• Medibüros and Medinetz — a nationwide network of volunteer-run medical offices that provide healthcare to refugees, undocumented people, and others without insurance. They arrange doctor visits, coordinate interpreters, and advocate on your behalf. Find your nearest one at medibueros.org or medinetze.de
• Clearingstellen — some cities have healthcare clearinghouses that help connect refugees with appropriate medical providers
• Refugee support organizations — local Flüchtlingshilfe groups often maintain lists of doctors experienced in treating refugees, including those who speak common refugee languages
• Gesundheitsamt (public health office) — the local health department offers vaccinations, tuberculosis screening, and other basic health services, often with interpreter support
• Hospital outpatient clinics (Ambulanzen) — university hospitals and larger hospitals often have specialized refugee health outpatient departments

If you are denied care:

• Emergency care cannot be denied — any hospital must treat you in an emergency, regardless of insurance status
• If the Sozialamt denies a Behandlungsschein or refuses to cover a treatment, you can file a Widerspruch (objection) — get help from a refugee legal aid organization
• Medibüros, Medinetz, and Pro Asyl can help advocate for your healthcare rights
• In some cities, Ärzte der Welt (Doctors of the World) and Ärzte ohne Grenzen (Médecins Sans Frontières) operate clinics for people with limited healthcare access