GKV or PKV: public vs private health insurance in Germany
12 October 2026
Germany has two health insurance systems: GKV (gesetzliche Krankenversicherung, public or statutory health insurance) and PKV (private Krankenversicherung, private health insurance). Most employees have no choice and are insured in GKV. The self-employed, civil servants (Beamte) and employees earning above the threshold, which is €77,400 gross a year in 2026, can choose. Below we cover who can choose, what health insurance in Germany costs, what happens to your family, whether you can go back to GKV and what changes in 2027 and 2028.
The short answer
- Health insurance is mandatory for everyone living in Germany (§ 193 Abs. 3 VVG).
- Employees earning up to €77,400 a year (2026) are compulsorily insured in GKV. The self-employed, Beamte and employees above the threshold can choose PKV.
- Contributions are calculated differently. In GKV they depend on income (up to a ceiling); in PKV on your age when you join, your health and the plan you choose.
- Family. In GKV a spouse without income and children with low income are insured free of charge. From 2028 a 2.5% surcharge for spouses will apply, with a number of exceptions. In PKV each family member pays separately.
- PKV is a long-term decision. You can return to GKV under certain conditions, and after 55 usually no longer. So before switching, it pays to calculate how your contributions will develop with age and once children arrive.
- From 2027 the threshold for switching to PKV is planned to rise to €84,150 a year.
How GKV and PKV differ
The two systems work on different principles. In GKV your contribution is a share of your income, and the benefits are set by law and the same for everyone insured. PKV follows the equivalence principle (Äquivalenzprinzip): your premium is based on your personal risk and on the benefits you choose (BMG).
| GKV (public) | PKV (private) | |
|---|---|---|
| Who can join | everyone who must or may: most employees, students, family members | self-employed, Beamte, employees above the threshold (€77,400 in 2026) |
| What the contribution depends on | income, up to a maximum of €5,812.50 a month (2026) | age when joining, health and plan |
| Health check | no | yes, when joining |
| Benefits | set by law, the same for everyone | per contract, you can choose more or less |
| Family | spouse and children can be insured free of charge (income up to €565 a month, €603 with a Minijob); from 2028 a 2.5% surcharge for spouses, with exceptions | a separate premium for each family member |
| Paying the doctor | the fund pays directly, you show your card | you usually pay the bill and claim it back (Kostenerstattung) |
| Employer | pays half of the contribution | contributes up to half, capped at what it would pay in GKV |
| Going back | — | a long-term decision: you can return to GKV if you become compulsorily insured again, after 55 usually no longer |
Sources: BMG, GKV contributions, BMG, people insured in GKV, § 10 SGB V.
Who can choose PKV
Employees: the €77,400 threshold and what changes from 2027
The compulsory insurance threshold (Jahresarbeitsentgeltgrenze, JAEG) is €77,400 gross a year in 2026, or €6,450 a month (BMG). Compulsory GKV insurance ends at the end of the calendar year if your income exceeded the threshold that year and will be above the new threshold the following year (§ 6 Abs. 4 SGB V). If you start a new job where your salary is above the threshold from the outset, you are not compulsorily insured in GKV from day one, with no need to wait for the end of the year.
For 2027 the federal cabinet approved a new threshold on 7 October 2026: €84,150 a year. The Bundesrat (the upper house of parliament) still has to approve it (BMAS). So to switch to PKV on 1 January 2027, you need income above €77,400 in 2026 and, if the threshold is approved, above €84,150 in 2027. People who are already privately insured on 31 December 2026 because their income was above the threshold will not face the additional increase: a separate threshold of €80,550 a year is planned for them in 2027 (§ 6 Abs. 8 SGB V as amended by the GKV contribution stabilisation act; this figure also awaits Bundesrat approval).
What counts is your regular annual pay. Which payments are included, such as bonuses, is checked by your employer's payroll department. When compulsory insurance ends, your health insurance fund (Krankenkasse) sends you a notice: you can stay in GKV as a voluntary member (freiwillig versichert) or switch to PKV. To move to PKV straight away, you must declare your exit within two weeks of that notice. If you do nothing, you stay in GKV as a voluntary member (BMG). How a higher income affects taxes and the way money is split within a family is covered in our article family income up: taxes and allocation.
Self-employed, freelancers and business owners
There is no income threshold for the self-employed, so PKV is open to them. If you were in GKV before becoming self-employed (through a job or family insurance), your cover automatically continues as voluntary insurance unless you declare your exit within two weeks of the fund's notice (§ 188 Abs. 4 SGB V). A business owner who has just arrived and has no German insurance history can often only choose PKV. The fund checks this case by case.
For GmbH shareholders, status (employee or self-employed) depends on the shareholding and the contract and has to be checked individually. More on the finances of business owners in our article how a GmbH owner can prepare for a mortgage.
Newcomers to Germany and the Blue Card
Health insurance in Germany for foreigners is required from the date of entry: without it you won't get a visa or residence permit. GKV or equivalent PKV both qualify. If your salary is below the threshold, you are compulsorily insured in GKV. The minimum salary for the EU Blue Card is below this threshold, so many Blue Card holders start out compulsorily insured in GKV. This applies to everyone who starts a job as an employee, including Blue Card holders from India, Turkey or the US.
If this is your first job in Germany and your salary is above the threshold, you can choose PKV or join GKV voluntarily. You must notify the fund that you are joining GKV within three months of starting work (§ 9 Abs. 1 Nr. 3 and Abs. 2 SGB V). If you miss the deadline, the route into GKV may close.
Students
Student GKV (KVdS) applies until the end of the semester in which you turn 30. In 2026 the contribution is €87.38 a month plus the fund's additional contribution, and long-term care insurance (Pflegeversicherung) adds €30.78, or €35.91 if you have no children (GKV-Spitzenverband). When you enrol you can opt out of GKV and go private (the application is due within three months of enrolment), though the exemption applies for your whole course of study and you can't return to student GKV until you finish.
Beamte
Civil servants are usually privately insured, and part of their medical costs is reimbursed by their employer through Beihilfe (a medical cost allowance for civil servants).
What GKV costs in 2026
The GKV contribution consists of the general rate of 14.6% (with entitlement to sick pay) and the fund's additional contribution (Zusatzbeitrag). The average additional contribution in 2026 is 2.9%, and each fund, whether TK, AOK or Barmer, sets its own (BMG). Current rates for all funds are in the GKV-Spitzenverband list. Employee and employer split the contribution in half.
Contributions are calculated on at most €5,812.50 a month (€69,750 a year). At the average additional contribution, the maximum contribution is €1,017.19 a month, half of which the employee pays. Long-term care insurance is paid on top: 3.6%, plus 0.6% for people over 23 without children.
Example. €4,000 gross a month, average additional contribution of 2.9%: 4,000 × 17.5% = €700 a month, of which the employee pays €350. Your fund's additional contribution may differ, and so will the amount.
If you're wondering what AOK health insurance costs in Germany: the general 14.6% rate at AOK is the same as at any other fund. Only the additional contribution differs, and it varies between the regional AOKs.
Self-employed people in GKV pay the full contribution themselves. The minimum assessment base in 2026 is €1,318.33 a month, giving a minimum contribution of €230.71 with sick pay entitlement or €222.80 without. The maximum is €1,017.19 and €982.31 respectively. All of this is at the average additional contribution, plus long-term care insurance (BMG).
What PKV costs and what drives the price
There is no standard price for private health insurance in Germany. The premium is calculated individually, and it depends on:
- Age when joining. The younger you are when you join, the lower your starting premium.
- Health. There is a health check (Gesundheitsprüfung) when you join. Depending on the result, surcharges or a rejection are possible.
- Scope of the plan. Outpatient care, hospital, dental: each module affects the price.
- Deductible (Selbstbehalt). The share of costs you pay yourself. The higher it is, the lower the premium.
- Sick pay (Krankentagegeld). In PKV it has to be added to the plan separately.
- Changes over time. Premiums can rise (Beitragsanpassung). Part of the premium goes into an old-age reserve.
As a reference point: the basic plan (Basistarif), which every private insurer must offer, by law cannot cost more than the maximum GKV contribution, i.e. €1,017.19 a month in 2026 (BMG). Your employer contributes up to half of the PKV premium, capped at what it would pay in GKV.
You can only find out what PKV would cost you after a calculation based on your age, health and the cover you need.
Family and children: where the difference is biggest
GKV. Your spouse and children are insured free of charge if their income is no more than €565 a month (€603 with a Minijob) and other conditions are met (§ 10 SGB V). Children are covered up to 18, up to 23 if they are not working, and up to 25 if they are in education.
From 2028 the member will pay a surcharge of 2.5% of their own income for a spouse in family insurance. There are exceptions, for example if there is a child under 12 in the family, or if the spouse cares for a relative, has reached retirement age or has Pflegegrad 3–5 (care level) themselves (BMG, § 242b SGB V in BGBl. 2026 I Nr. 228). On contributory income of €4,000 a month, the surcharge comes to €100 a month, and the member pays it alone, with no employer share.
An important detail for mixed families. If the parents are married, one of them is outside GKV (for example in PKV), and that parent's total income is above €6,450 a month (the 2026 threshold divided by 12) and higher than the GKV partner's income, the children cannot be insured free of charge in GKV (§ 10 Abs. 3 SGB V). They will need their own cover. This rule does not apply to unmarried couples.
PKV. A separate premium is paid for each child and for a spouse without income.
Sick pay: who pays when you can't work
- Employees. For the first six weeks your employer keeps paying your salary; after that, in GKV the fund pays sick pay (Krankengeld).
- Self-employed in GKV. You are entitled to sick pay only at the general rate of 14.6%. At the 14.0% rate there is no entitlement.
- PKV. Krankentagegeld (daily sick pay) has to be added to the plan separately. Without it, you will have no income while you are ill.
Can you go back from PKV to GKV?
You can't simply return because you want to. You can return if you become compulsorily insured in GKV again: for example, if your salary falls below the threshold, you move from self-employment into a job or you receive unemployment benefit. Another route is family insurance through a spouse in GKV, if your own income is no more than €565 a month (§ 10 SGB V). Once you become compulsorily insured in GKV, you can terminate your PKV contract early (Sonderkündigungsrecht).
After 55 a return is usually no longer possible, so a decision on PKV needs to be made with the long term in mind. If you are 55 or older, have not been in GKV for the last five years and were exempt from it for at least half of that time (for example, privately insured because of high income or self-employed), you cannot return even if you become compulsorily insured again (§ 6 Abs. 3a SGB V).
If in 2027 the higher threshold ends up above your salary, you will be compulsorily insured in GKV again. In that case you can apply for an exemption (Befreiung) within three months and stay in PKV (§ 8 SGB V).
In old age and retirement
Health insurance for pensioners also works differently in GKV and PKV. According to the BMG, in old age income-based GKV contributions are generally lower than risk-based PKV premiums. In GKV the contribution is calculated on your pension: 14.6% plus the additional contribution, with the pension insurance paying half of the rate. The conditions for pensioners' GKV (KVdR) depend on your prior insurance period and are checked individually.
In PKV the premium does not depend on the size of your pension. The old-age reserve softens premium increases, though it does not rule them out entirely.
Supplementary insurance on top of GKV
If you aren't eligible for PKV or don't want to switch, you can add private supplementary insurance to GKV: for dental care, hospital stays (single room, treatment by the chief physician), glasses and more. It is a common choice for people who care more about specific services than about changing systems.
If you're considering dental insurance in Germany, note that from 1 January 2027 the fund's fixed subsidy for dentures and crowns (Festzuschuss Zahnersatz) drops from 60% to 50% of the cost of standard treatment (Regelversorgung), and with a bonus booklet (Bonusheft) from 70% to 60% or from 75% to 65% (BGBl. 2026 I Nr. 228). If your fund approved the treatment plan before 1 January 2027, the previous shares apply.
Common expat mistakes
- Choosing PKV at 30 because it's cheap, without factoring in a future family, children and old age.
- Missing the three-month window to join GKV voluntarily after a first job in Germany.
- Counting on one-off bonuses to cross the threshold. Only payments you are regularly entitled to count, such as a contractual 13th month's salary. One-off bonuses usually don't count; payroll checks the details.
- Living for years on travel or "incoming" insurance. It may fall short for a residence permit and for the insurance obligation under § 193 VVG.
- Not keeping an eye on the fund's additional contribution. If your fund raises it, you have the right to switch funds.
FAQ
Is health insurance mandatory in Germany?
Yes, for everyone living in Germany. Employees earning up to the threshold are compulsorily insured in GKV. Everyone else chooses between voluntary GKV and PKV.
What income do you need to switch to private health insurance?
In 2026, from €77,400 gross a year (€6,450 a month). €84,150 is planned for 2027, pending Bundesrat approval. There is no threshold for the self-employed.
Which is cheaper, GKV or PKV?
It depends on income, age, health and family. For a young, healthy person without children PKV is often cheaper at first, while a single-income family usually does better with free family insurance in GKV. Only an individual calculation gives a precise answer.
Can you go back from PKV to GKV?
Yes, if you become compulsorily insured in GKV again, or through family insurance. After 55 a return is usually no longer possible, so before switching to PKV it pays to calculate how your contributions will develop with age and once children arrive.
Do you need a health check?
Not for GKV. For PKV, yes: your health affects the premium, and a surcharge or rejection is possible.
What changes in 2027 and 2028?
The threshold for switching to PKV is planned to rise to €84,150 a year, and the GKV contribution ceiling to €76,500 a year. From 2028 a surcharge of 2.5% of the member's income will apply for spouses in GKV family insurance, with exceptions.
Next step
Boiko Wealth Management works as an independent insurance intermediary (Versicherungsmakler) and has no insurance products of its own. We'll check whether you have a choice, calculate GKV and PKV for your income, age and family, and compare plans from different private insurers. If PKV isn't right for you, we'll tell you so. The decision on leaving GKV is tied to 31 December and the 2027 threshold, so it's worth sorting out before the end of the year.
More on how we work on our services page.