Health insurance in Germany for families

This guide is for families moving to Germany who need to understand how health insurance works for every household member, not just the main earner. It covers employees above the income threshold who qualify for private cover, self-employed parents who can always choose PKV, and families weighing the genuine trade-offs between both systems.

It is also for families where one partner does not work, where children are involved, or where a baby is expected soon. If you are a single person without dependants, see our overview of private health insurance in Germany for a simpler starting point.

PKV is Germany's private health insurance system. Unlike the public GKV, PKV premiums are not calculated as a percentage of your salary. Each insurer sets a premium based on your age at entry, your current health status and the level of benefits you choose.

Every family member gets their own individual contract. A spouse adds one premium, each child adds another. There is no equivalent of GKV's free family coverage in PKV.

The upside of individual contracts is genuine flexibility. You can choose a comprehensive plan with a private hospital room for one parent and a simpler children's plan for the kids, tailoring cover to each person's actual needs. The downside is that every adult applying for PKV goes through a health assessment. Pre-existing conditions can raise premiums or lead to exclusions. Children face a health check too, except newborns registered within the two-month window.

How health insurance for your spouse works in Germany depends almost entirely on whether they are employed and what they earn.

A spouse with their own employment has their insurance status determined independently of yours. If they earn above the €77,400 threshold, they may choose PKV. Below it, they are in GKV by default.

A spouse with no or low income is where the systems diverge sharply. In GKV, a non-earning or low-earning spouse can be covered for free under Familienversicherung, provided you are also in GKV and they earn no more than €565 per month in 2026 (or €603 for mini-job income). If you switch to PKV, that free coverage ends immediately. Your spouse then needs either their own private contract or their own voluntary GKV membership, both of which cost money.

If both parents are in GKV, all children are covered for free. Health insurance for children in Germany under PKV means a separate premium for each child, which adds up quickly with two or more kids.

Self-employed and freelancers can choose PKV regardless of income level. If you run your own business or work freelance, the income threshold does not apply to you.

Total PKV cost for a family is the sum of each person's premium. Children's premiums are generally lower than adults' because they are younger and statistically lower risk. With three or four children, though, those premiums accumulate quickly.

For comparison, GKV charges 14.6% of gross salary as the general contribution rate, plus an average additional rate of around 2.9%, giving roughly 17.5% in total. This is calculated only on income up to the contribution ceiling of €69,750 per year in 2026 (rising to €76,500 from 2027, pending Bundesrat approval). A family with several children pays that same percentage regardless of family size. That is the structural advantage of GKV for larger families.

Your employer pays half of your private premium, up to €508.59 per month for health insurance and €104.63 per month for long-term care in 2026. That cap is per employee, not per family. If both partners are employed and each has their own PKV, each receives their own employer contribution separately.

For a detailed breakdown of what you personally would pay, see our guide on the cost of private health insurance.

PKV is not automatically the right answer for families. There are clear situations where GKV is likely cheaper and simpler.

Single earner, non-working spouse, two or more children: free Familienversicherung for the spouse and all children is hard to beat. Every private premium you would otherwise pay goes straight into savings.

Planning more children: each new child adds another private premium. If your family is likely to grow, factor in the cumulative cost over the years.

Income close to the threshold: if your salary drops below €77,400 (or €84,150 from 2027), you may be required to return to GKV. Switching back from PKV after age 55 becomes very difficult in practice.

Short or uncertain stay in Germany: private premiums are priced for long-term contracts. If you might leave Germany within a few years, the cost-benefit calculation looks different.

PKV tends to make more sense when both partners are employed with high incomes and each qualifies independently, when you have one child and a straightforward health profile, or when faster access to senior consultants and a private room in hospital is a priority. For a side-by-side comparison of both systems across all the key criteria, our guide on private vs public health insurance goes into the full detail.

Sort out cover for every family member before your residence registration date (Anmeldung) and your work start date. Proof of health insurance is required for your visa or residence permit and your employer will ask for it on day one.

International private medical insurance (IPMI) can bridge the gap during your move, but check carefully whether your specific policy meets German residency requirements. Many IPMI plans do not qualify as substitute cover under German law for residents.

Check what extras each family member needs. Orthodontic treatment for children, for example, is handled differently in PKV and GKV, and it is worth comparing before you commit. You can find specifics on dental insurance in our dedicated guide.