Health Insurance in Germany (2026): Public vs Private, Costs and How to Get Covered
How health insurance works in Germany: public vs private, what you pay at your salary, who can go private and how to sign up. Free calculator.
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Health insurance in Germany is mandatory for everyone who lives here, expats included, from day one. There are two systems: public health insurance (GKV, Gesetzliche Krankenversicherung) and private health insurance (PKV). Most people have no choice: an employee earning under €77,400 a year (2026) must join public insurance. Private cover is open above that line, to the self-employed, to civil servants and to exempt students, and which system fits then depends on your age, health and family.
Figures checked against the official 2026 social insurance values (SV-Rechengrößenverordnung 2026) and the statute texts.
- Mandatory: yes, for every resident from day one, including expats.
- Employees below €77,400 a year (€6,450 a month, 2026; planned €84,150 from 2027): public insurance (GKV) is compulsory. Above it, you can choose private. The 2027 figure was approved by the federal cabinet and still needs Bundesrat approval, expected in November 2026.
- Self-employed, freelancers and civil servants: can choose private at any income.
- Public cost: 14.6% of gross pay plus a fund surcharge (average 2.9%) and 3.6% care insurance, roughly half paid by your employer. At €55,000 gross you pay about €484 a month with a child or €511 if childless, and never more than about €613 or €648.
- Private cost: based on age, health and plan, not income, with up to €613.22 a month paid by your employer. It can cost less than public for healthy higher earners, but each family member pays their own premium and returning to public is restricted, especially from age 55.
Calculate what you pay: public vs private
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Answer 4 quick questions. We'll show your exact public health insurance (GKV) cost and a realistic private health insurance estimate side by side — based on 2026 rates.
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Which type of health insurance applies to you?
Employees below the income threshold are in public insurance, and above it they choose between public and private. Self-employed people and freelancers can go private at any income. The threshold is €77,400 a year in 2026 (planned €84,150 from 2027). Not sure which row fits? Take the 60-second public or private quiz for a first indication.
What is the difference between public and private health insurance?
Public insurance charges a share of your salary up to a cap and usually covers a spouse and children with no or low income for free. Private insurance prices your age, health and plan instead of income, asks health questions and needs a policy for each family member.
Public health insurance
Best for families on one income, lower earners and anyone who wants cost tied to salary.
- Cost
- A share of your salary, capped. Employer pays half of the health part.
- Family
- Spouse and children with no or low income are usually insured for free
- Who can join
- Every employee, most students
Private health insurance
Best for higher earners, the self-employed and civil servants who want more cover.
- Cost
- Based on age, health and plan, not income. Employers pay up to half.
- Family
- Each family member needs their own plan
- Who can join
- Employees above €77,400 a year (2026), self-employed, civil servants
| Factor | Public (GKV) | Private |
|---|---|---|
| Cost basis | Percentage of gross income, up to a cap | Age at entry, health and chosen plan |
| Income cap | Contributions stop at €69,750 a year | Not applicable |
| Who can join | All employees; compulsory below €77,400 a year (2026) | Employees above €77,400 (2026), self-employed, civil servants |
| Employer share | Half of the health contribution | Half of the premium, up to €508.59 a month (health) plus €104.63 (care) |
| Family | Spouse and children with no or low income are usually free | Everyone pays their own premium |
| Health questions | None | Yes, can lead to surcharges, exclusions or refusal |
| Premium over time | Moves with your income | Rises with medical costs; a statutory 10% surcharge applies from the calendar year after you turn 21 until the year you turn 60 |
| Dental | Fixed subsidy towards dentures (see below) | Depends on the plan |
| Switching back | Not applicable | Possible only when you become compulsorily insured; largely blocked from age 55 |
| Changing provider | 12 months minimum, 2 months notice | Possible; compare plans and terms carefully first |
See the full public vs private comparison for more detail.
What does health insurance cost in Germany in 2026?
In public insurance an employee pays about 8.75% of salary for health cover (7.3% plus half of the 2.9% average surcharge), up to a cap of €69,750 a year, plus care insurance. Private premiums depend on age, health and plan, not salary. The examples below show what employees and freelancers pay.
In the public system, the 2026 general rate is 14.6% of gross pay (§241 SGB V). Each fund adds its own surcharge (Zusatzbeitrag). The official average is 2.9% (Federal Ministry of Health), and funds charged from about 2.2% to 4.4% in early 2026, so your own figure depends on the fund you choose. Employer and employee each pay half of the health part. Care insurance is 3.6%, shared equally, but if you are 23 or older and childless you pay an extra 0.6% yourself.
Example 1: employee on €55,000 a year
Monthly gross pay: €55,000 / 12 = €4,583.33. This is below the cap, so the full salary counts. The example uses the 2.9% average surcharge.
| Your share | Rate | Per month |
|---|---|---|
| Health insurance | 7.3% | €334.58 |
| Fund surcharge, your half | 1.45% | €66.46 |
| Care insurance, with one child | 1.8% | €82.50 |
| Total, with one child | 10.55% | €483.54 |
| Care insurance, childless (23+) | 2.4% | €110.00 |
| Total, childless | 11.15% | €511.04 |
Your employer pays another €483.54 a month on top. These figures use the average surcharge. A fund with a lower surcharge costs less, and you can compare funds for free.
Example 2: employee on €90,000 a year (above the cap)
The assessed income stops at €69,750 a year, which is €5,812.50 a month. Earning more does not raise your public contribution.
| Your share | Rate | Per month |
|---|---|---|
| Health insurance plus surcharge, your half | 8.75% | €508.59 |
| Care insurance, with one child | 1.8% | €104.63 |
| Total, with one child | €613.22 | |
| Care insurance, childless (23+) | 2.4% | €139.50 |
| Total, childless | €648.09 |
At this income you can choose private health insurance. Your employer then pays half of your private premium, but at most €508.59 a month for health cover plus €104.63 for care cover (€613.22 combined). For example, if a premium were €600 a month (an illustration, not a quote), you would pay €300 and your employer €300. If both the health and care premiums were high enough to reach the caps (together about €1,226), the employer share would stay at €613.22.
Example 3: freelancer with €4,000 a month of income
Self-employed people in the public system pay both halves. This example uses the rate without sick pay (14.0% plus the 2.9% average surcharge = 16.9%).
| Item | Rate | Per month |
|---|---|---|
| Health insurance plus surcharge | 16.9% | €676.00 |
| Care insurance, with one child | 3.6% | €144.00 |
| Total, with one child | €820.00 | |
| Care insurance, childless (23+) | 4.2% | €168.00 |
| Total, childless | €844.00 |
The range for freelancers is wide. The minimum assessed income is €1,318.33 a month, which gives about €270 to €278 a month. At the cap of €5,812.50 a month the cost is about €1,192 (with a child) or €1,226 (childless). Choosing sick pay (17.5% instead of 16.9%) adds a little. Private premiums for freelancers do not depend on income, so for healthy, higher-earning freelancers they can be the cheaper route, depending on age, health and plan. See the freelancer guide.
How the public share grows with salary (employee, childless, 2026)
What about private premiums? They are not tied to salary. For a healthy employee in their 30s, premiums are typically a few hundred euros a month before the employer subsidy, but the real figure depends on age, health, deductible and plan. Only a personal quote gives a reliable number. The younger and healthier you are at entry, the lower the starting premium. Basic-coverage premiums are tax deductible. There is also a safety net: the Basistarif must accept eligible applicants without risk surcharges, and its premium is capped at €1,017.19 a month in 2026.
Who can choose private health insurance?
Employees above the income threshold, self-employed people and freelancers, civil servants and students who apply for an exemption can choose private health insurance. Employees below the threshold, most people on unemployment benefit (ALG I) and family members covered for free must stay public. The threshold is €77,400 a year in 2026 (planned €84,150 from 2027).
Employees become exempt at the end of the calendar year in which their regular pay exceeds €77,400 (€6,450 a month) in 2026 (planned €84,150 from 2027), as long as they are also expected to exceed the next year's threshold. New hires whose contract is above the threshold can go private immediately. Read the full eligibility guide and what changes with the 2027 threshold.
What is public health insurance (GKV) in Germany?
Public health insurance covers most people in Germany. Employees are enrolled when they start a job, and the contribution comes straight out of your salary. Your spouse and children are usually covered for free if they have no or only low income (in 2026 up to €565 a month, or €603 with a minijob).
The main limits are fewer extras: standard hospital rooms, limited dental cover and no say over how the plan is built.
Full guide: Public health insurance in Germany (GKV) →
What is private health insurance in Germany?
Private health insurance is available to employees above €77,400 a year (2026; planned €84,150 for 2027) and to all self-employed people and freelancers. Your premium is based on your age and health at sign-up, not on your salary. You answer health questions, and the insurer can charge a surcharge, exclude conditions or decline you. Each family member needs their own policy.
Full guide: Private health insurance in Germany →
What does health insurance cover?
Public insurance covers statutory benefits at contracted doctors, standard ward hospital care and a fixed subsidy towards dentures, with small co-payments for prescriptions. Private plans can add a single room, the chief physician and a wider choice of doctors, but cover depends on the plan. Compare the written terms, not the label of the plan.
| Area | Public (GKV) | Private |
|---|---|---|
| GP and specialists | Statutory benefits at contracted doctors | Depends on the plan; often a wider choice of doctors |
| Hospital | Standard ward care | Plans can include a single room and chief physician |
| Prescriptions | Covered, with small statutory co-payments | Depends on the plan and any deductible |
| Dental | Fixed subsidy of 60% of the standard treatment for dentures, 70% with 5 years of an unbroken bonus booklet (Bonusheft), 75% with 10 years | Depends on the plan; many people add a dental top-up |
| Vision | Limited | Depends on the plan |
Private plans differ a lot from one another. Compare the written terms, not the label of the plan. A deductible lowers the premium, but you pay that part yourself.
What health insurance do you need when you first arrive in Germany?
If you arrive without a job, you need a bridge policy: short-term expat or incoming insurance that covers you until you have a job or register as self-employed. A residence permit requires sufficient health insurance (§ 2 Abs. 3 AufenthG). Travel or incoming insurance is generally not enough for a long-term permit.
Travel or incoming insurance is accepted only in limited cases, such as Schengen and short-stay visas (minimum €30,000 cover), the period before a job starts, and some job-seeker and language-course visas. Practice varies by immigration office. Providers include Feather, Expatrio and Care Concept.
EU citizens: your EHIC card covers medically necessary treatment during a temporary stay. It is not a replacement for German insurance once you live here. More detail is in our expat health insurance guide and our moving to Germany guide.
Do students need health insurance in Germany?
Yes. Enrolling at a German university requires valid health insurance, and public student insurance is the usual and cheapest route, at about €143 to €148 a month in 2026. It ends at the end of the semester in which you turn 30, and you can apply within 3 months of enrolment for an exemption to go private.
- The 2026 cost: contributions are based on a fixed amount of €855 a month, charged at 7/10 of 14.6% (10.22%). That is €87.38 for health insurance plus your fund's surcharge (about €24.80 at the 2.9% average). Care insurance adds €30.78 (€35.91 if you are 23 or older and childless). The total is about €143 to €148 a month, depending on the fund. This assumes the base stays at €855 for winter semester 2026/27; a BAföG reform is still pending.
- Age limit: student insurance ends at the end of the semester in which you turn 30, with extensions for recognised reasons. After that you can continue publicly on a voluntary basis, often at the minimum contribution, or go private.
- Exemption: you can opt out of public student insurance to go private, but you must apply within 3 months of enrolment and the decision is irrevocable for your entire course of study.
- EU/EEA students: a valid EHIC from your home country may cover you, but plan for a German policy if you stay long term.
- Non-EU students: you need German public student insurance, or an accepted private plan, both to enrol and for your visa.
Detailed guides by topic
Each guide below covers one topic in full: costs, comparisons and step-by-step advice.
Is private health insurance worth it in Germany?
Private health insurance is often worth it for younger, healthy employees above the income threshold and for self-employed people in good health. Public insurance usually fits employees below the threshold and families with children. Private cover is a long-term decision that is much easier to enter than to leave.
| Your situation | Usually the better fit | Why |
|---|---|---|
| Employee, salary below €77,400 | GKV | Public insurance is compulsory |
| Employee, salary above €77,400, younger and healthy, no children | Often private | Premium is based on age and health, and the employer pays up to half |
| Employee, salary above €77,400, older or with health issues | Depends | Get a comparison; premiums rise with age and surcharges are possible |
| Self-employed, good health | Often private | Public insurance charges the full rate on your profit |
| Just arrived, no job yet | Expat insurance | Bridge until you have employment |
| Family with children | Often GKV | Spouse and children with no or low income are usually free |
Remember that private cover is a long-term decision. It is much easier to enter than to leave.
How do you get health insurance in Germany?
Employees joining GKV choose a provider, apply online, give the membership confirmation to their employer and receive an insurance card by post. Moving to private means checking eligibility, getting quotes, completing the health questionnaire, signing and only then cancelling GKV. Freelancers register their business first.
If you're joining GKV as an employee
- Choose a provider: TK, Barmer, or AOK are all solid. Go to their website and fill in the application (TK has an English version).
- Receive your membership confirmation: the insurer sends you a letter within a few days.
- Give it to your employer: they handle the rest. Your contribution is deducted directly from your paycheck.
- Receive your insurance card (Gesundheitskarte): arrives by post within 2–3 weeks.
If you're moving from public to private health insurance
- Check eligibility: confirm your regular pay is above €77,400 a year (2026) and you are exempt (or are a new hire with a contract above it), or that you are self-employed.
- Get quotes: use an independent consultant to compare several providers side by side.
- Complete the health questionnaire: be honest. Leaving out pre-existing conditions can put your cover at risk later.
- Sign the private health insurance contract: ask for written confirmation of the start date.
- Cancel your GKV: give notice (2 months) and send proof of your new cover. Do not cancel before the private contract is confirmed.
If you're self-employed and new to Germany
- Register your business (Gewerbeanmeldung or Freiberufler registration at the tax office).
- Get private health insurance quotes. You can apply at any income, subject to the health questions.
- Or join GKV voluntarily and pay the full rate yourself (see Example 3 above).
Can you switch between public and private health insurance?
Yes, within limits. Public funds bind you for 12 months, with 2 months' notice. Public to private works only if you qualify. Private back to public is possible under 55 when you become compulsorily insured again, but from age 55 it is largely blocked.
- Between public funds: you are bound for 12 months (§175 SGB V). Notice is 2 full months to the end of the second calendar month. If your fund raises its Zusatzbeitrag, you get a special right to leave without waiting out the 12 months, up to the end of the month in which the increase takes effect.
- Public to private: only if you qualify (see above). Read our switching guide.
- Private back to public, under 55: possible when you become compulsorily insured again, for example as an employee below €77,400 or on unemployment benefit (ALG I).
- From age 55: if you were not publicly insured in the previous 5 years and were exempt, not subject to compulsory insurance or self-employed for at least half of that time, you stay out of the public system. In practice, returning after 55 is largely blocked.
- Losing your job: if you receive ALG I and are under 55, you are generally compulsorily insured in GKV again. Talk to an adviser before cancelling a private contract.
What changes in health insurance in 2027?
The planned 2027 income threshold for private health insurance is €84,150 a year, up from €77,400. The planned health insurance contribution cap is €76,500 a year, up from €69,750. The average Zusatzbeitrag has not been set yet. None of this is final until the Bundesrat approves it, expected in November 2026.
Not final yet. The federal cabinet approved the 2027 figures on 7 October 2026 (Bundesrat document 576/26). The Bundesrat still has to approve them, expected in November 2026, and part of the package depends on a pending change to the social code.
- 2027 income threshold for private health insurance: €84,150 a year (€7,012.50 a month), up from €77,400 (Bundesrat-Drs. 576/26, draft). It includes a legislated extra rise of €3,600 on top of wage growth.
- Planned 2027 contribution cap for health insurance: €76,500 a year (€6,375 a month), up from €69,750. The care insurance cap is still disputed.
- The average Zusatzbeitrag for 2027 has not been set yet. The official figure is due by 1 November 2026.
Care insurance reforms are also under discussion for 2027, but details are not confirmed. We update this page when the figures are final.
Frequently asked questions
Is health insurance mandatory in Germany?
How much does health insurance cost per month in Germany?
Public vs private health insurance: which is better?
Can foreigners get private health insurance in Germany?
What is the 2027 income threshold for private health insurance?
Can I switch from private health insurance back to public?
How much does public health insurance cost for freelancers?
Do I need German health insurance for a visa?
Sources
Primary sources checked on 19 October 2026. Figures are the official 2026 values; 2027 values are a Bundesrat draft until approved.
- Deutsche Rentenversicherung: Sozialversicherungs-Rechengrößen 2026 (income threshold €77,400, contribution ceiling €69,750)
- Federal Ministry of Health: Beiträge der gesetzlichen Krankenversicherung and Bundesanzeiger, 10 Nov 2025: average additional contribution 2026 (2.9%)
- §241 SGB V and §243 SGB V: general and reduced contribution rates
- §6 SGB V: exemption from compulsory insurance, 55+ rule
- §175 SGB V: choice of fund, 12-month binding period and notice
- §257 SGB V: employer subsidy for privately insured employees
- Bundesrat-Drs. 576/26: values for 2027 (Bundesrat approval pending)
Get a free comparison
The German health insurance market has many private insurers and a huge number of plan combinations. Comparing them yourself takes weeks and requires understanding complex German contracts.
The smarter move: work with independent consultants who advise in English and can tell you within 15 minutes whether private health insurance makes sense for your situation.
