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Updated: September 30, 2026 · Settling in

Private or public health insurance in Germany: what to choose in 2026

Current as of 30 September 2026.

People moving to Germany often pick health insurance on two criteria: what it costs and whether it will be accepted for the visa. After the move, other questions appear. Who pays for a spouse and children? What happens if income drops? Will a chronic condition be covered? Can you change systems in a few years?

Public and private insurance follow different rules for calculating contributions, covering family members and moving between systems. So the comparison has to cover more than today's payment: it has to cover your costs as your life changes.

What GKV and PKV mean

GKV (gesetzliche Krankenversicherung) is the statutory health insurance system, usually called public insurance. You sign up through a Krankenkasse such as TK, AOK or another sickness fund. Contributions depend on your assessable income, and the core medical services are defined by law.

PKV (private Krankenversicherung) means private health insurance. In this article, PKV means full health insurance for living in Germany. The price at the time you sign depends on your age, your health and the cover you choose. What gets reimbursed is fixed in the terms of the tariff. More on the differences: Verbraucherzentrale.

Expat or incoming insurance is a separate product. You can't treat it as equivalent to full PKV just because a private company sells the policy. Temporary cover for new arrivals has to be checked separately for its duration, its exclusions and the requirements that apply to your stay.

The main comparison

Feather has a comparison of public and private insurance and a search for options available in your situation. These are RE-LOCATE affiliate links. Feather acts as an insurance broker; the final terms are set by the contract with the insurer you choose.

Who is allowed to choose private insurance

For employees, the general threshold in 2026 is €77,400 in regular annual gross salary, or €6,450 a month if paid evenly. This is the Jahresarbeitsentgeltgrenze, the threshold above which GKV membership stops being compulsory. It is about regular annual earnings: a one-off large payment on its own doesn't prove you may switch to PKV.

If compulsory insurance ends, you can stay in GKV as a voluntarily insured member. Moving to PKV is not required. If you get a raise in your current job, compulsory insurance usually ends at the end of the year, provided the following year's threshold is also met. Check the exact date with your employer and your fund. Rules on switching: BMG.

To check quickly whether you may switch and from what date, use our PKV calculator.

Freelancers and other self-employed people are not subject to the €77,400 salary threshold that applies to employees. The insurer does, however, assess whether it will offer a contract and may set income requirements of its own. So a minimum income quoted by a broker should not be read as a universal threshold in German law. Feather's terms and examples.

An EU Blue Card does not in itself entitle you to choose PKV: the immigration salary requirements and the health insurance rules are assessed separately.

What public insurance costs in 2026

The general health insurance rate is 14.6%, plus the additional contribution set by your fund (Zusatzbeitrag). The average additional contribution announced for 2026 is 2.9%. That is a planning benchmark, not a single rate for every fund. For an ordinary employee, the health contribution is split equally with the employer. Self-employed people without a special subsidy scheme have no employer share.

For voluntarily insured self-employed people, the minimum assessment base in 2026 is €1,318.33 a month. The rate without entitlement to Krankengeld is usually 14.0% plus Zusatzbeitrag; with Krankengeld cover it is 14.6% plus Zusatzbeitrag. Pflegeversicherung is paid on top. Rates and minimum contributions: BMG.

Contributions are not charged on unlimited income. The Beitragsbemessungsgrenze in 2026 is €5,812.50 a month, or €69,750 a year. Income above that ceiling doesn't increase the base for health and long-term care insurance. Don't confuse it with the €77,400 threshold that decides whether an employee may leave compulsory GKV. Contribution assessment ceiling: BMG.

Why you have to add Pflegeversicherung to the price

Pflegeversicherung is compulsory insurance against the need for long-term care. In the social system the basic rate is 3.6%, rising to 4.2% for people without children from the age of 23 unless an exemption applies. Parents of several children under 25 get reductions. Outside Saxony the standard employer share is 1.8%; the childless surcharge is paid by the employee. Financing of Pflegeversicherung, how contributions are split.

Examples of an employee's monthly costs

Our calculation with a Zusatzbeitrag of 2.9%, for an employee aged 23 or over without children, outside Saxony. Only the employee's share is shown.

In the second row, both amounts are calculated on the ceiling of €5,812.50, not on the full salary. A different fund, having children or working in Saxony will change the result.

What private insurance costs and how to compare offers

There is no single PKV price. An advertised price for a young, healthy person tells you nothing about what insurance will cost you specifically, especially with a chronic condition or when moving with a family.

To compare properly, ask for the full make-up of the payment: health insurance, the compulsory private Pflegepflichtversicherung, the Krankentagegeld you need and any surcharges. The obligation to take out private long-term care insurance stays in place with PKV too. On the private system: BMG.

The employer contributes to a suitable PKV policy for an employee: usually up to half of the assessable premium, but with a fixed cap. The maximum contribution (Zuschuss) to the health portion in 2026 is €508.59 a month. Long-term care is calculated separately. TK's explanation for employers.

Selbstbehalt means the deductible, the share of costs you take on yourself. A higher deductible can lower the monthly premium, but the employer does not pay your deductible costs. Reducing it later can be harder: that counts as extending your cover and may require a new health assessment. How the deductible works: PKV-Verband.

In practice the comparison should look like this: your annual premiums after the employer's contribution + the possible deductible + uncovered services + family cover. A no-claims bonus shouldn't be counted as guaranteed income.

Family: where the difference can be biggest

In GKV, if the conditions are met, a spouse or registered partner and children can be insured free of charge. An unregistered partner doesn't qualify simply by living with you.

Family cover is assessed against income and other conditions. In 2026 the usual limit on regular total income is €565 a month, or €603 for a Minijob. Salary alone isn't the whole picture: other income can count too. Conditions for family cover: TK.

In PKV, health cover for each family member is paid for separately. So an offer that looks attractive for a single working adult can turn out expensive for a family with a non-working spouse and two children.

There is one important quirk for mixed families. If one spouse is in GKV and the other isn't (in PKV, for example), free family cover for their shared children can be excluded. That happens when the second parent's income is both higher than the GKV member's income and above the statutory threshold: €6,450 a month in 2026. In that case you have to look at paid cover for the child, and it doesn't have to be PKV. The rule for children: TK.

Treatment, doctors and invoices: what changes in practice

Private patients sometimes have more options for booking specialists, but nobody can promise a fast appointment in every city and every specialty. Broader access also doesn't mean every invoice will be reimbursed in full. The terms have to be read in the specific tariff. Comparison of service and billing: Feather.

Pay particular attention when comparing psychotherapy, dental prosthetics, rehabilitation, medicines, medical aids and inpatient treatment. What matters isn't just the list of services but the reimbursement percentage, the annual limits, whether prior approval is needed and which levels of doctors' fees are accepted.

With PKV, your contract with the doctor and your contract with the insurer are two different relationships. You receive the invoice and submit it for reimbursement; a dispute with the insurer doesn't automatically cancel your obligation to the doctor. You can often send the invoice to the insurer before paying it, but you still have to keep track of the payment deadline. Direct billing is possible for some inpatient services. Payment and reimbursement: PKV-Verband.

If you only want particular extras, such as broader dental cover, you can consider GKV combined with a Zusatzversicherung. There's no need to move to the private system entirely just for that. Supplementary insurance: Verbraucherzentrale.

Illness, lost earnings and parental leave

Health insurance pays for treatment. Replacing lost income is a separate matter.

An employee in GKV with the relevant entitlement usually receives Krankengeld once the period of employer-paid salary ends. It is not the same as full salary: percentage caps and an assessment ceiling apply. Self-employed people need to check separately whether their chosen cover includes this entitlement. Krankengeld rules: BMG.

In the private system, check the Krankentagegeld: the daily amount and when payments start. Simply holding a health policy doesn't mean it will replace your earnings during a long illness. Notes on additional income protection.

During Elternzeit, private premiums normally continue to be paid. In GKV the situation is often better for a previously compulsorily insured employee with no other contributory income, but voluntary GKV doesn't always become free: contributions may remain and a spouse's income may be taken into account. So the parental leave budget has to be worked out in advance for both parents. Insurance during Mutterschutz and Elternzeit: Verbraucherzentrale.

What a freelancer who is only just moving should consider

The line "you can just pick any Krankenkasse" doesn't fit every new arrival. Access to voluntary GKV depends among other things on your previous insurance and the grounds on which you join. For someone starting self-employed work immediately after moving from outside the EU, access to the system has to be confirmed separately. High earners starting work in Germany for the first time are subject to their own joining rules. Who can join GKV voluntarily: TK.

With voluntary GKV, a self-employed person may have not only business income counted but other income too, such as rent and investment returns. Zero income doesn't mean a zero payment: the minimum assessment base applies. Income used to calculate contributions: BMG.

Contributions on self-employment income may first be charged provisionally and then recalculated once the year's income is documented. Keep a reserve in the budget for the top-up payment and send the fund the evidence it asks for on time. How contributions for the self-employed are calculated: BMG.

One more reason to settle the insurance question in your first months: for permanent residence the authority checks both full German insurance and pension provision, and contributions accumulate over years. Berlin, for example, has worked since 1 July 2025 on an expected pension of at least €1,612.53 a month from the age of 67 with at least 12 years of contributions, or capital of at least €232,204, for permanent residence for a self-employed person. An incoming policy is not suitable for permanent residence at all. How much pension provision Berlin asks for

For more on the residence basis itself, read our article German freelance visa.

Can you return from PKV to GKV

You can't return simply because private insurance has become more expensive. As a rule you need grounds, such as compulsory insurance arising from a change of employment. A drop in freelance income usually doesn't create such grounds.

After the age of 55 the restrictions are especially significant. The law also looks at the absence of GKV over the last five years and at your insurance or professional status for at least half of that period. So "after 55 a return is always impossible" is too absolute, but you can't count on a free move back shortly before retirement either. Conditions for returning: BMG.

If your premium rises, the first option is a different tariff with your existing insurer. That is not the same as changing company: what matters is keeping your ageing reserves, comparability of cover and a possible new health assessment if you extend the services. Changing a private tariff: Verbraucherzentrale.

What happens in retirement

A PKV premium doesn't automatically scale down to a small pension. Ageing reserves help finance future costs, but they don't guarantee an unchanged price. The options for transferring reserves when changing insurer are limited. Ageing reserves: BMG.

Someone receiving a German state pension can, if the conditions are met, claim a contribution (Zuschuss) towards private insurance. This is not a promise to pay half of any tariff: the amount depends on the pension and is capped at a share of the actual premium. Pensioners pay for long-term care insurance themselves. Insurance for pensioners: Deutsche Rentenversicherung.

GKV has an important quirk of its own: compulsory pensioners' insurance (Krankenversicherung der Rentner, KVdR) and voluntary insurance as a pensioner are different statuses. For KVdR the authorities usually check GKV membership for at least nine tenths of the second half of the period from the start of working life to the pension application. If you move to Germany late in your career, the question of insurance periods needs to be looked at separately. KVdR conditions: Deutsche Rentenversicherung.

Insurance for the visa and insurance for living: the same policy?

Not always. A policy that works for a particular stage of entry can't automatically be assumed to be enough for the residence permit that follows, or for an extension.

The Berlin LEA states that GKV membership proves adequate medical protection. With private insurance, they check whether the cover meets the stated requirements. The residence permit information sheet lists restrictions on exclusions, reimbursement limits, termination terms and the deductible; in particular, a deductible above the usual benchmark of €300 a year may require an individual assessment. So a cheap tariff with a large deductible has to be checked from the immigration angle as well. LEA information sheet on health insurance.

Special rules apply to temporary stays and to certain residence grounds. Check the specific policy against the requirements of the consulate and the authority handling your application. For the first stage you can look at Feather Expat Health Insurance (affiliate link). That is not a guarantee that any given tariff is suitable for any given residence permit.

When you move to your main insurance, align the dates so that cover runs without a gap. For the other tasks after arrival, read our checklist of first steps.

How to decide

First, get confirmation of which options are actually open to you. Then compare them across three scenarios: life today, a drop in income or the birth of a child, and retirement age.

For each offer, check:

1. The full cost for the whole family, including long-term care insurance.
2. Your share after the employer's contribution, and the cost without such a contribution.
3. The deductible, limits and exclusions for the treatment you need.
4. Income protection during a long illness.
5. Contributions during Elternzeit and during a break from work.
6. Whether the documents are suitable for your visa or residence permit.
7. What switching means for a future return to GKV.

If you're moving with a family or your income is unstable, start by calculating the GKV option available to you. If your income is consistently high and you're considering PKV, compare several full tariffs and the long-term budget. Neither system wins for everyone at once.

Compare GKV and PKV with Feather →

Check the available options and request a quote →

Both links are affiliate links. Check the insurance terms and your individual quote with the broker or insurer. If you need help with the sequence of the move and the documents for your visa or residence permit, book a RE-LOCATE consultation; support after arrival until you receive your residence permit is described on the support service page.

This article describes the general rules as of the date given. Your individual choice depends on your insurance history, employment, family and contract terms.

FAQ

Do you have to move to PKV on a salary above €77,400?

No. With the relevant status you can stay in GKV voluntarily.

Does private insurance always cover treatment better?

No. You have to compare the specific terms: a cheap tariff can contain significant restrictions.

Can a child be added free of charge to the other parent's GKV?

Not always. In a mixed family, marital status, income and the parents' insurance status all matter.

Can you save money by staying on an expat policy for years?

First you need to check whether such cover is permissible for your status and whether it covers the medical services you need. The advertised price of a temporary product doesn't make it a substitute for full GKV or PKV.

What should you check before terminating your current contract?

Written confirmation of the new insurance, agreed dates, acceptance terms and cover for every family member. Don't leave a gap between policies.