Often, yes. Abroad you usually have to pay the doctor upfront at private practices and outside the EU. With the European Health Insurance Card (EHIC) on the back of your German health card, doctors in the public system of another EU country usually treat you without payment. In hospital, your travel health insurance often gives a payment guarantee via its emergency line, in one tariff up to EUR 13,000.
What travel health insurance costs and what an emergency can cost.
Example
Typical range
Annual policy for one person, low-cost tariffs
from about EUR 8 a year
Annual policy, trips up to 56 days
about EUR 10 to 20 single, EUR 20 to 35 for families
Hospital payment guarantee in one tariff
up to EUR 13,000
Medical flight home from overseas
can exceed EUR 100,000
As of October 2026, from the sources listed.
The doctor fee and the health fund refund in the example are guide values from our quoting
practice.
Worked example
Ear infection, private practice in Mallorca
A child gets earache on holiday. The family goes to the practice recommended by the hotel and pays on the spot.
Bill from the private practice incl. medicine
about EUR 180
Refund from the health fund at the German rate
about EUR 30 to 50
Left to pay without travel health insurance
about EUR 130 to 150
Left to pay with travel health insurance
usually EUR 0 against receipts
You advance the EUR 180 either way; you usually get it all back only with your own policy. Guide values from our quoting practice.
When you have to pay the doctor upfront
Whether you pay upfront abroad depends on where you are treated. The EHIC only works with doctors admitted to the public health system of the country you visit. Many practices in holiday resorts are private, and a doctor recommended by the hotel is often one of them.
At a private practice you pay the bill on the spot, in cash or by card, and claim the money back later from your insurer.
Situation
Pay upfront?
Who refunds
Public system doctor in the EU with EHIC
usually no, only local co-payments
your health fund via the EHIC
Private doctor or clinic in the EU
yes
health fund up to the German rate, the rest your travel health insurance
Doctor outside the EU, such as the USA or Thailand
yes
your travel health insurance, the health fund only in exceptions
Hospital after calling the insurer emergency line
often no, payment guarantee
your travel health insurance directly
Medical flight back to Germany
organised for you
only your travel health insurance
Why your German health fund does not refund everything
If you hand in a bill from another EU country, your health fund (Krankenkasse) pays at most what the same treatment would have cost in Germany. It may also deduct admin costs. Local co-payments stay with you.
Outside the EU and EEA, statutory health insurance generally pays nothing, so the upfront payment to the doctor is yours unless you have travel health insurance (Auslandsreisekrankenversicherung).
How to keep upfront payments small
Call the emergency number of your travel health insurance before you are admitted to hospital. The insurer then settles the costs with the clinic, so you do not have to advance large sums yourself.
For outpatient visits to a doctor abroad, keep a few hundred euros free on your credit card. Do not sign a cost commitment before speaking to your insurer.
Receipts you need for the refund
The bill from the doctor abroad should show the diagnosis, the date, each treatment and the amount paid, ideally in German or English. Without a diagnosis your insurer will ask again and the refund of your upfront payment takes longer.
Keep prescriptions and pharmacy receipts and take photos of everything while you are still away.
Step by step
Check that the EHIC on your health card is valid before you travel.
Take out travel health insurance and save its emergency number in your phone.
Ask the doctor whether they accept the EHIC or bill privately.
Call the insurer before any hospital admission.
Keep bills with diagnosis and send them in after you return.
Checklist
EHIC valid
Travel health insurance including the flight home
Emergency number saved
Credit card with free limit
Bills with diagnosis and date
Common mistakes
Thinking the EHIC means you never pay upfront
Going to hospital without calling the insurer first
Accepting bills without a diagnosis
Relying on the German health fund outside the EU
Questions and answers
Frequently asked
Do I pay the doctor in Spain or Italy?
At public system doctors the EHIC is usually enough.
Private practices ask for payment upfront.
How long does the refund take?
That depends on the insurer.
Complete bills with diagnosis speed it up a lot.
What if I cannot pay the bill?
Call the emergency number of your travel health insurance.
For hospital treatment it settles the costs with the clinic.
Does the health fund pay outside the EU?
Generally not.
Only in narrow exceptions, for example if you provably cannot get private cover,
for at most six weeks a year.
Do I pay the dentist upfront too?
Almost always.
Travel health insurance then refunds the treatment for acute pain.
