Objectives:The study aims to investigate the significance of legal status for well-being and access to and use of needs-based health care by asylum seekers and refugees in Germany.Methods:Using a mixed-method-design, we first conducted a cross-sectional study to explore access to health care and unmet needs of refugees and asylum seekers and legal status. Data were analysed using descriptive statistics. For the qualitative study a heterogeneous sample was recruited from the quantitative data. Interviews were analysed using a deductive-inductive approach.Results:Quantitative results showed that health care utilisation was associated with an unsecure legal status but not with unmet care needs. The in-depth qualitative study revealed that the legal status determines experiences of structural violence that can negatively affect well-being and associated access to health care.Conclusion:An insecure legal status can affect access to health care for refugees and asylum seekers. In order to improve health, changes in living conditions and the removal of access barriers are necessary.