Private vs public health insurance Germany: which fits your life?

Germany runs two separate systems: public (GKV) and private (PKV) health insurance. Both provide solid medical cover, but they follow completely different financial logic and the decision can shape your finances for decades. This guide gives you a neutral, side-by-side comparison so you can see which system fits your situation.

Get English advice

Salary threshold for PKV (2026): €77,400
Base GKV contribution rate: 14.6 %
Switching back largely ruled out: Age 55

By André Disselkamp, Co-Founder & Insurance Specialist · Insurancy · DVA-certifiedPublished November 3, 2026

Key takeaways

Health insurance is mandatory from day one. You need proof of valid cover to register with an employer and to obtain a residence permit. No gaps are allowed.
Income decides your options as an employee. Employees can only choose PKV if their gross annual salary exceeds €77,400 in 2026. Below that threshold, GKV is compulsory. The limit is planned to rise to €84,150 from 2027, subject to Bundesrat approval.
GKV and PKV price things very differently. GKV contributions are a percentage of your income. PKV premiums depend on your age, health status and chosen tariff, not your salary.
Free family cover is a GKV-only feature. A non-earning spouse and children are covered under your GKV membership at no extra cost. In PKV, every family member needs their own contract and pays their own premium.
Switching back from PKV gets harder with age. From age 55, returning to GKV is largely ruled out under Section 6(3a) SGB V. The earlier you make this decision, the more options you keep open.

GKV vs PKV vs IPMI: the key criteria at a glance

A structured overview of all three systems expats in Germany encounter, across the criteria that matter most.

Versicherer	Eligibility	Cost logic	Family cover	Pre-existing conditions	Specialist access	Switching back	Profile
GKV (public)Default choice for most expats	Mandatory below €77,400 salary; voluntary above	% of income, capped at contribution ceiling	Spouse + children free (Familienversicherung)	Must accept you regardless of health	GP: straightforward; specialist: waits can be longer	N/A	Details zu GKV (public)
PKV (private)	Employees above €77,400; self-employed; civil servants	Age, health and tariff at entry; no salary link	Each member needs own contract and premium	Health check required; surcharges or exclusions possible	Commonly faster specialist access reported	Restricted; largely ruled out from age 55	Details zu PKV (private)
IPMI (international)	Highly mobile professionals; must meet German legal requirements	Risk-based, varies by insurer and coverage level	Depends on policy; varies widely	Underwriting applies; varies by insurer	Depends on network and policy	Cancel per policy terms; not tied to German salary rules	Details zu IPMI (international)

Values for 2026: income threshold €77,400 (2027: €84,150, Bundesrat approval pending), contribution ceiling €69,750, employer PKV subsidy up to €508.59 a month. Source: Federal Ministry of Health.

How these figures were compiled

The comparison above is based on the statutory rules that govern GKV and PKV in Germany. Salary thresholds (Jahresarbeitsentgeltgrenze) and contribution ceilings (Beitragsbemessungsgrenze) are set by law and published annually. The figures used here reflect the values in force for 2026. The planned 2027 figures are drawn from publicly available government announcements and are subject to Bundesrat approval.

PKV employer subsidy caps are set by statute and reviewed annually. IPMI coverage terms vary by insurer and contract; the table reflects general market practice, not any specific policy. If any of these figures have been updated since this page was last reviewed, the official sources take precedence.

The criteria that actually matter for expats

Understanding the difference between GKV and PKV means looking past the headline names and into the mechanics that affect your day-to-day life and long-term finances.

How health insurance works in Germany

Health insurance is a legal requirement for everyone living in Germany. You need proof of valid cover to obtain a residence permit and to register with an employer. There are no gaps allowed. Public health insurance (GKV) is run by more than 90 statutory insurers called Krankenkassen. They all offer largely identical, legally defined benefits based on a solidarity principle: higher earners subsidise lower earners, and healthy members subsidise those who are sick. One well-known example is TK (Techniker Krankenkasse), which many expats choose because it offers English-language customer service and a digital-first experience. The benefits TK provides are set by law, just like every other public insurer, so your choice of Krankenkasse mainly affects service quality and convenience, not your core medical cover. PKV works differently. Private insurers offer individual contracts, and your benefits are defined in that contract rather than by statute. Premiums are calculated on a risk basis, not on solidarity. If you're arriving in Germany temporarily, waiting for a job to start, or on a short assignment, you may first need incoming health insurance as a bridge before you can join GKV or PKV. This is short-term cover designed specifically for that gap. A third option, IPMI (international private medical insurance), is used by highly mobile professionals who work across multiple countries. IPMI is only accepted in Germany as a substitute for GKV or PKV if it meets specific legal requirements, and that is not always the case.

Who can choose private health insurance

Not everyone in Germany can simply opt into PKV. Your eligibility depends on your employment status and income. Employees earning above the income threshold (Jahresarbeitsentgeltgrenze) can access PKV: it is only available to employees whose gross annual salary exceeds €77,400 in 2026. The threshold is planned to rise to €84,150 from 2027, though that still needs Bundesrat approval. Fall below the threshold and you are compulsorily insured in GKV, with no choice. Self-employed people and freelancers can choose PKV freely, regardless of income. Civil servants (Beamte) typically receive partial state reimbursement of medical costs called Beihilfe, and take out a PKV plan to cover the remainder. Students: GKV is the standard route. Opting out of GKV as a student locks you into PKV for the rest of your studies, which is rarely the better deal. If you're unsure whether you qualify, our dedicated page on who can get private health insurance walks through the rules in detail.

Cost logic: income-based vs risk-based

GKV contributions are calculated as a percentage of your gross income. The general rate is 14.6 % plus an average additional rate of 2.9 % (the Zusatzbeitrag, which varies by insurer). Your employer pays roughly half. Contributions are only calculated on income up to the contribution ceiling (Beitragsbemessungsgrenze) of €69,750 per year in 2026 (planned at €76,500 from 2027, subject to Bundesrat approval). Any income above that ceiling is not counted, so your GKV contribution is capped regardless of how much you earn. PKV works the other way around. Your premium depends on your age when you join, your current health and the tariff you choose. It has nothing to do with your salary. A pay rise does not increase your PKV premium, but ageing does: premiums tend to rise over time. To limit those increases in later life, German law requires PKV insurers to build ageing reserves (Alterungsrückstellungen), a form of pre-funding. If you switch providers, only part of these reserves can be transferred (for contracts since 2009, roughly the amount attributable to the basic tariff), which is one reason changing PKV insurer mid-life is rarely straightforward. Your employer contributes to your PKV premium up to a legal maximum of €508.59 per month in 2026, plus €104.63 per month for long-term care insurance (Pflegeversicherung). The employer contribution can never exceed half your actual premium. For a detailed breakdown of what you'd actually pay, see our page on the cost of private health insurance.

Family cover, switching back and retirement

Family insurance in GKV is one of the system's most valuable features for families. A spouse or registered partner without their own income (or with only low income) and children without income are covered under your GKV membership at no additional premium. For a family with one earning parent and several children, this can represent substantial savings. PKV and families work very differently. Every family member needs their own individual contract and pays their own premium. If one parent is privately insured, earns above the income threshold and earns more than the publicly insured parent, the children generally cannot be enrolled in GKV family insurance for free. This is one of the most commonly underestimated costs when families consider switching to PKV. Switching back from PKV to GKV is possible in limited circumstances. If your salary falls below the income threshold, you generally become compulsorily insured in GKV again. However, from age 55, returning to GKV is largely ruled out under Section 6(3a) SGB V. The legal intent is to prevent people from enjoying PKV benefits during their high-earning years and then shifting back to the solidarity system just before retirement when their health costs rise. In GKV, access to cheaper statutory health insurance for pensioners (KVdR, Krankenversicherung der Rentner) requires that you have spent a sufficient proportion of your working life in GKV. Expats who arrive in Germany later in their careers may not qualify. As voluntary members they then pay contributions on all their income, including private pensions, rent and investment returns, which usually costs more. In PKV, your premium continues to be due in retirement, and your employer subsidy ends when you stop working. If you receive a German statutory pension, the pension insurance pays a subsidy towards your PKV premium instead, which is usually lower. A statutory surcharge of 10 % on your premium is collected from age 21 to 60 to fund partial premium relief in old age, but the premium itself remains a private obligation.

GKV vs PKV: the trade-offs side by side

Both systems provide solid medical cover. The difference lies in who pays what, who is covered, and what happens decades from now.

Criterion	Most expats start hereGKV (public)Solidarity-based, income-linked contributions, unconditional acceptance	PKV (private)Risk-based premiums, individual contracts, broader tariff options
Eligibility	Mandatory for employees below €77,400; voluntary membership also possible above threshold	Available to employees above €77,400, all self-employed, freelancers and civil servants
Pricing basis	Percentage of income, capped at the contribution ceiling; employer pays roughly half	Age, health status and tariff at entry; premiums tend to rise over time as you age
Family cover	Non-earning spouse and children covered for free under Familienversicherung	Every family member needs their own contract and pays their own premium
Pre-existing conditions	Must accept you regardless of medical history; no surcharges or exclusions	Health declaration required; surcharges, exclusions or application refusal possible
Specialist access	GP access straightforward; specialist appointments can involve longer waits	Privately insured patients commonly report faster specialist access
Billing process	Insurance card; provider bills insurer directly; no upfront payment required	You pay the invoice first, then claim reimbursement from your insurer
Retirement outlook	Access to KVdR (cheaper pensioner cover) if sufficient working life in GKV; expats arriving late may not qualify	Premium continues in retirement; employer subsidy ends, a pension insurance subsidy applies if you draw a German state pension; 10 % surcharge from age 21 to 60 for partial relief

In short: GKV is the safer default; PKV can pay off for young, healthy, high-earning expats who plan to stay long term.

Rule of thumb: when PKV is the better choicePKV tends to suit young, healthy, high-earning singles or couples without children who plan to stay in Germany long term. GKV is usually the better fit if you have a non-earning partner or children, have pre-existing conditions, or are uncertain about how long you will stay. For highly mobile professionals working across multiple countries, IPMI is worth exploring as a third option, provided it meets Germany's legal requirements for substitute cover. Before deciding, think through your likely situation in 10, 20 and 30 years. Your family plans, career trajectory and expected length of stay all affect which system works in your favour over a lifetime.

Which system fits your situation?

A quick orientation. Your personal situation decides, so talk to André before you choose.

Your situationYou are employed and earn less than €77,400 a year (2026)GKVGKVPublic health insurance is compulsory for you.
Your situationYou want to insure a partner without own income or childrenGKVGKVFamily members without own income above the limit are covered at no extra cost.
Your situationYou earn above the threshold or are self-employed and plan to stay for yearsPKVPKVYour premium depends on age, health and the benefits you choose; employees get up to €508.59 a month from the employer (2026).
Your situationYou are a student, a job seeker or not sure yetAdviceAdviceYour options depend on your status and visa. André checks them with you, free and in English.

Limits and gaps to know before you decidePKV is not universally better. Some tariffs cover less in certain areas than you might expect, so reading the contract terms matters. The reimbursement model (you pay first, claim later) catches many expats off guard and requires short-term liquidity. Only part of the ageing reserves built up with one PKV insurer transfers to a new PKV provider, making mid-life insurer switches financially painful. Expats who spend many years in PKV may not meet the insurance history required for KVdR (cheaper pensioner cover) in retirement. IPMI is only accepted as a substitute for GKV or PKV in Germany if it meets specific legal requirements; check before relying on it. Switching back to GKV from PKV after age 55 is largely ruled out by law.

Frequently asked questions about GKV vs PKV

Your question is not here?André and the team are happy to help.

Ask a question

Can I switch from private back to public health insurance in Germany?

Yes, but only in limited circumstances. If your salary drops below the income threshold (€77,400 in 2026), you generally become compulsorily insured in GKV again. From age 55, Section 6(3a) SGB V largely rules out a return to GKV, even if your salary falls below the threshold, so the earlier you make this decision, the more options you have.

Is TK health insurance a good option for expats?

TK (Techniker Krankenkasse) is a popular public insurer among expats because it offers English-language customer service and a well-regarded app. The core benefits are set by law and are identical across all GKV insurers. Your choice of Krankenkasse mainly affects service quality and digital convenience, not your medical cover.

Can I use travel or incoming insurance instead of GKV or PKV?

Incoming health insurance covers you while you wait to start a job or join a statutory insurer, but it does not count as permanent cover and is not accepted as a substitute for GKV or PKV for residence permit purposes beyond a short initial period. It is a bridge, not a long-term solution.

Do pre-existing conditions affect private health insurance?

Yes. PKV insurers require a health declaration when you apply. Depending on your medical history, they can charge a risk surcharge, exclude specific conditions from cover or, in some cases, decline your application altogether. GKV must accept you regardless of your health status, with no surcharges.

Do I have to pay extra for my family in private health insurance?

Yes. In PKV, every family member, including children, needs their own contract and pays their own premium. This is a fundamental difference from GKV, where a non-earning spouse and children are covered under your membership at no additional cost through Familienversicherung.

What is the income threshold for PKV, and will it change?

Employees can only opt into PKV if their gross annual salary exceeds €77,400 in 2026. The threshold is planned to rise to €84,150 from 2027, though that still requires Bundesrat approval. Self-employed people and civil servants face no income threshold.

Get a free, personalised comparison in English

GKV, PKV or IPMI: the right answer depends on your age, health, salary, family situation and how long you plan to stay in Germany. Book a free consultation with André Disselkamp, co-founder of Insurancy, for an independent comparison across insurers with no tied-agent bias.

Book English consultation

Sources

Federal Ministry of Health: Km1 januar 2026.pdf, Abruf November 2026
German Federal Ministry of Justice: § 204 VVG 2008, Abruf November 2026
German Federal Ministry of Justice: § 10 SGB 5, Abruf November 2026
German Federal Ministry of Justice: § 240 SGB 5, Abruf November 2026
German Federal Ministry of Justice: § 106 SGB 6, Abruf November 2026
German Federal Ministry of Justice: § 149 VAG 2016, Abruf November 2026
German Federal Ministry of Justice: § 6 SGB 5, Abruf November 2026

Verdict

PKV suits young, healthy, high-earning singles; GKV is the safer default for families and those with pre-existing conditions.

GKV covers a non-earning spouse and all children for free under Familienversicherung; PKV does not.
PKV premiums depend on age and health at entry; GKV accepts everyone regardless of medical history.
Switching from PKV back to GKV is legally restricted from age 55, so the decision has long-term consequences.
Self-employed people and civil servants can access PKV freely; employees need a salary above €77,400 (2026).

André Disselkamp

Free checklist

Health insurance checklist for moving to Germany

Every step from visa to residence permit on two pages, so you don't miss a document.

5.083 reviews

Your tailored quote in 2 minutes

Free advice in English from André, our expat specialist. No obligation.

Your free comparison