Public vs private health insurance in Germany: who can choose

Who needs it

This guide only matters if you are allowed to choose. Everyone else is in the public system (GKV) by law.

You may choose private health insurance (PKV) if you are:

• An employee earning above the threshold. The Versicherungspflichtgrenze (also called Jahresarbeitsentgeltgrenze, JAEG) is €77,400 per year (€6,450 per month) in 2026. It changes every January.
• Self-employed or a freelancer. You can join the GKV voluntarily or choose PKV.
• A civil servant (Beamter). The state pays part of your medical costs (Beihilfe), and most civil servants insure the rest privately.
• A student who opts out of the GKV. See student health insurance.

If you are an employee below the threshold, public insurance is mandatory, even if you had private cover before.

When

• New job above the threshold: you can usually choose from the start, if your expected regular annual pay is above the threshold.
• Salary rises above the threshold later: compulsory insurance ends at the end of that calendar year. It only ends if your pay is also above the new threshold that applies from 1 January.
• Starting self-employment: decide before you start. There must be no gap in cover.

How the two systems differ

Employees in PKV get an employer subsidy of up to half the premium. It is capped at what the employer would pay for public insurance (§ 257 SGB V).

Possible advantages of private insurance

• For young, healthy people with high income, the premium can be lower than the public contribution.
• Some tariffs include extras, such as a single room in hospital or treatment by the senior doctor.
• You choose the level of cover in your contract, including deductibles.

Possible disadvantages of private insurance

• Family costs. Each child and a non-working spouse need their own contract. In the GKV they are often free.
• Rising premiums. Premiums can go up over time, and you keep paying even with low income in retirement.
• Health questions. Wrong or missing answers in the questionnaire can later cost you your cover.
• Paperwork. You often pay bills first and claim them back.
• Lock-in. Leaving PKV is not your free choice. See below.

Going back to public insurance

You cannot simply switch back from PKV to GKV because you want to. The main ways back:

• You become an employee earning below the threshold (under age 55). Public insurance becomes mandatory again.
• You receive unemployment benefit (Arbeitslosengeld I), in most cases.

For the self-employed, going back is especially hard while you stay self-employed.

The age-55 rule

If you become compulsorily insured after turning 55, you usually stay out of the GKV. This applies if you had no public insurance in the five years before, and for at least half of that time you were privately insured or exempt (§ 6 (3a) SGB V). In practice, anyone who chooses PKV should expect to stay private for life.

Common problems

I earn above the threshold. Do I have to go private?

No. You can stay in the GKV as a voluntary member. Many people above the threshold do.

Does private insurance work for my visa?

It can. Your cover must meet German standards (§ 193 VVG). Check what your embassy or immigration office accepts before you sign.

What happens if my salary drops below the threshold?

As an employee under 55, you are usually back in compulsory public insurance. Keep paying your private contract until the public cover has started, so there is no gap. A Krankenkasse can confirm your status.

Who can give me personal advice?

Anfänger does not recommend individual tariffs. Neutral options: a Verbraucherzentrale (consumer advice centre) insurance consultation, or an independent fee-based adviser (Versicherungsberater). Brokers and agents are paid commission by insurers.