Permanent German health insurance: GKV vs PKV

Cover is mandatory, and the two systems

Living in Germany without health insurance is not an option: cover is legally required, and you must show proof to obtain or extend a residence permit and to start most jobs. There are two systems. The statutory public system (GKV) covers around 90% of the population through non-profit sickness funds (Krankenkassen). The private system (PKV) is used by higher earners, the self-employed, civil servants and some others.

In the GKV, the catalogue of covered services is broadly standardised by law, so funds compete mainly on service, extra benefits and their supplementary contribution rate. In the PKV, the cover and price depend on your chosen tariff, your age and your health at the time you join.

How GKV works: income-based, employer-split, family co-insurance

GKV contributions are a percentage of your gross income up to an income ceiling (the Beitragsbemessungsgrenze), not a flat fee. The general contribution rate is 14.6%, plus an income-related supplementary contribution (Zusatzbeitrag) that varies by fund. For employees, the employer pays roughly half of the total contribution, which is a major advantage of the public system.

A key benefit of the GKV is family co-insurance (Familienversicherung): a non-working or low-earning spouse and your children can usually be insured at no extra premium, provided their own monthly income stays below the legal limit (in 2026 generally 565 EUR per month, or 603 EUR for a mini-job). This can make the GKV far cheaper than the PKV for families with one earner.

Because contributions are capped at the income ceiling, the most you pay in the GKV is limited even if you earn well above it. This predictability, combined with family cover and guaranteed acceptance regardless of health, is why many expats stay in the public system.

When you may choose PKV, and why caution is needed

You may opt out of the GKV into private insurance only if you fall outside compulsory insurance. For employees, that means earning a gross salary above the compulsory-insurance threshold, the Versicherungspflichtgrenze (also called the Jahresarbeitsentgeltgrenze, JAEG), which is 77,400 EUR per year in 2026 (about 6,450 EUR per month). The self-employed and freelancers, as well as civil servants, can generally choose PKV regardless of income.

PKV can offer richer benefits and, for a young, healthy, high-earning single person, sometimes lower premiums than the GKV. But there are serious caveats. PKV premiums are based on individual risk, can rise significantly with age, and each family member must be insured separately and pay their own premium; there is no free family co-insurance. Crucially, switching back from PKV to GKV becomes very difficult once you are older than 55 or remain a high earner, which can leave you locked into rising private premiums in retirement.

This is why the GKV-versus-PKV decision deserves careful, individual analysis rather than a quick choice based only on this year's premium. Your age, health, income trajectory, family plans and how long you intend to stay in Germany all matter.

Practical steps and common pitfalls

To enrol in the GKV, choose a Krankenkasse and apply; your employer then registers you and arranges contributions. If you qualify for and choose PKV, you apply directly to a private insurer and provide your salary and health information. Either way, keep your confirmation of cover, as you will need it for your residence permit and your employer.

Common pitfalls include assuming travel or expat short-term policies satisfy the legal requirement (they often do not for long-term residents), underestimating how hard it is to return to the GKV after going private, and not realising that crossing the income threshold can change your eligibility. Always confirm the current year's threshold and rates before deciding.