Private health insurance Germany eligibility: who can choose PKV?

GKV (gesetzliche Krankenversicherung) is the public health insurance system. Contributions are income-based: 14.6% of your gross salary plus an average additional rate of 2.9%, charged on income up to the contribution ceiling of €69,750 in 2026. Your employer pays roughly half.

PKV (private Krankenversicherung) is the private alternative. Premiums are calculated on your age, health status, and the benefits you choose, not your income.

The law keeps most employees in GKV automatically. This is called compulsory insurance (Versicherungspflicht). The reasoning is straightforward: the public system is solidarity-based, and lower earners need the protection of income-proportional contributions. PKV is only available to people who fall outside that obligation.

If you want a broader overview of how both systems compare and what each covers, our guide to private health insurance in Germany is a good starting point.

The annual income threshold (Jahresarbeitsentgeltgrenze, JAEG) is the number that determines whether an employee is compulsorily insured in GKV. Once your regular gross annual salary exceeds it, you are free to choose PKV instead.

There is no income threshold for this group. Self-employed people and freelancers (Freiberufler) can choose PKV from the day they register as self-employed. Voluntary GKV membership is generally only possible if you were publicly insured for at least 24 months in the last five years or for 12 months immediately before; periods in another EU/EEA public system can count.

In GKV, self-employed people pay the full contribution themselves because there is no employer to share the cost. The minimum contribution is calculated on a notional income floor set by law, even if you earn less. This is one practical reason many self-employed people compare both options carefully.

PKV premiums are not tied to income, which means a low-revenue year does not reduce your premium. That is a planning point worth taking seriously before you commit.

One exception: artists and publicists insured through the Künstlersozialkasse (KSK) are generally kept within the public system, with the KSK acting as the employer-equivalent for contribution purposes.

Decide on your insurance when you register your business. Cover must be continuous, and a gap in coverage creates both a legal problem and a financial one. Our dedicated page on health insurance for freelancers goes into the full comparison in more detail.

Employees above the income threshold do not need a formal exemption application. They are simply outside compulsory GKV and can choose PKV freely. The practical step is handing a certificate of PKV cover to your employer on or before your first working day.

A formal exemption application to a public insurer is required mainly for students. The three-month window from the start of compulsory insurance is the only time you can make this switch.

Typical documents you will need: an employment contract showing your gross annual salary (for employees), a certificate of PKV cover issued by your chosen private insurer, proof of university enrolment (for students), and a notice of exemption from the public insurer (for students, once approved).

Private insurers assess your health status before accepting you. Answer all health questions fully and accurately. Incomplete or incorrect answers can lead to claims being rejected later.

Get advice before you arrive in Germany, not after. Decisions made in the first days of employment or enrolment are hard to undo.

Imagine you are a software engineer moving to Germany from the UK. Your employment contract shows a gross annual salary of €85,000. Because this is above the 2026 threshold of €77,400, you are not subject to compulsory GKV from day one.

You contact a private insurer before your start date, complete the health questionnaire, and receive a certificate of cover. On your first working day, you hand that certificate to your HR department. Your employer then contributes up to €508.59 per month toward your PKV premium.

Your spouse is not employed in Germany. In GKV, they could be covered for free under family insurance. In PKV, they need their own separate policy at an additional monthly premium. If you have two children, that is two more individual PKV policies to factor in. This cost difference is one of the most important calculations to run before committing to PKV.