Public Health Insurance in Germany (GKV): Costs, Coverage and How to Join
How public health insurance in Germany works: 2026 rates, what it covers, best insurer for expats and how to sign up. Includes worked cost examples.
Public health insurance in Germany is called gesetzliche Krankenversicherung, or statutory health insurance (GKV). It is the system most residents are in, and for most people who move to Germany for a job, it is where you start.
Everyone pays a percentage of income, and everyone gets the same core benefits whatever they earn or however often they see a doctor. This guide covers what it costs in 2026, who has to join, what it covers, which fund to pick and how to sign up.
| Contribution rate | 14.6% base rate plus a fund-specific supplemental rate (Zusatzbeitrag). The official average is 2.9%. Split 50/50 with your employer. |
|---|---|
| Care insurance | 3.6% (you pay 1.8%, or 2.4% if you are childless and 23 or older) |
| Contribution ceiling | €5,812.50 a month (€69,750 a year) |
| Most an employee pays | About €613 a month, or about €648 if childless |
| Who must join | Employees earning below €84,150 a year (€7,012.50 a month, 2027 threshold) |
| Who can go private | Employees above €84,150, and self-employed people at any income |
| Best fund for expats | TK: English app, online sign-up, 2.69% supplemental rate (Jan 2026) |
Rates are the 2026 figures. The 2027 values are still draft, see the note in the "Public or private" section.
Who is covered by public health insurance?
Health insurance is mandatory in Germany, and a residence permit requires adequate cover. Employees below the income limit are in GKV automatically. Your status decides whether you must join, may join or can choose.
| Your status | GKV? | What to know |
|---|---|---|
| Employee earning below €84,150 a year | Compulsory | You join from your first day of work. Your employer pays half. |
| Employee earning above €84,150 a year | Your choice | Stay in GKV (voluntary) or go private. New hires above the limit can choose immediately. |
| Self-employed or freelancer | Your choice | Voluntary GKV or private health insurance, at any income. You pay the whole contribution. |
| Student | Compulsory | Reduced rate. Ends at the end of the semester in which you turn 30, with extensions for recognised reasons. You can apply for an exemption within 3 months of enrolment, but it is irrevocable. |
| Receiving unemployment benefit (ALG I) | Compulsory | You stay in GKV. Register with your Krankenkasse. |
| Retiree | Usually yes | Depends on your insurance history. Ask your fund to confirm. |
Travel or incoming insurance is only accepted in limited cases, such as Schengen and short-stay visas (minimum €30,000 cover) or the period before a job starts. It is generally not enough for a long-term residence permit. Practice varies by Ausländerbehörde, so check with yours.
How much does public health insurance cost in 2026?
GKV contributions are a percentage of your gross salary up to a ceiling, not a flat fee. The ceiling (Beitragsbemessungsgrenze, BBG) is €5,812.50 a month (€69,750 a year). Income above it is not charged.
Rate breakdown
| Component | Total rate | You pay (employee) | Employer pays |
|---|---|---|---|
| Health insurance, base rate | 14.6% | 7.3% | 7.3% |
| Supplemental rate (Zusatzbeitrag), at the 2.9% average | 2.9% | 1.45% | 1.45% |
| Care insurance (Pflegeversicherung) | 3.6% | 1.8% | 1.8% |
- Supplemental rate: each fund sets its own. The 2.9% is the official 2026 average. Funds charge different rates, from about 2.18% to 4.39% in January 2026 lists. TK charges 2.69%.
- Childless surcharge: from age 23, you pay an extra 0.6 percentage points of care insurance on your own, so 2.4% in total. Your employer still pays 1.8%.
- Children: from the 2nd to the 5th child under 25, your care insurance rate drops by 0.25 percentage points per child, up to 1.0 point in total.
- Saxony: care insurance is split differently there (you 2.3%, employer 1.3%).
At the average supplemental rate, your health insurance share is 7.3% + 1.45% = 8.75%. Add 1.8% care insurance and your total is 10.55% (11.15% if childless and 23 or older).
Worked examples for employees
Monthly figures at the 2.9% average supplemental rate, with care insurance at 1.8% (child rate) or 2.4% (childless).
| Gross salary a month | Health (8.75%) | Care insurance | Your total | Employer pays |
|---|---|---|---|---|
| €3,000 | €262.50 | €54.00 (€72.00 childless) | €316.50 (€334.50 childless) | €316.50 |
| €5,000 | €437.50 | €90.00 (€120.00 childless) | €527.50 (€557.50 childless) | €527.50 |
| €6,500 (capped at €5,812.50) | €508.59 | €104.63 (€139.50 childless) | €613.22 (€648.09 childless) | €613.22 |
The maths for the third row: €5,812.50 × 8.75% = €508.59, and €5,812.50 × 1.8% = €104.63. Anything you earn above €5,812.50 a month adds nothing. Your own fund's supplemental rate will move these figures slightly. At TK (2.69%), your health share is 7.3% + 1.345% = 8.645%, so €259.35 on €3,000 gross.
The choice of fund matters less than people expect. On €3,000 gross, the employee half of the supplemental rate is €40.35 at TK (2.69%) and €48.00 at DAK (3.2%), a difference of €7.65 a month.
Self-employed and voluntary members
If you are self-employed or a voluntary member without an employer, you pay both halves. Without a Krankengeld entitlement (sick pay), the reduced base rate of 14.0% applies plus the supplemental rate, so 16.9% at the 2.9% average. With a Krankengeld entitlement, the rate is 17.5%.
| Self-employed, 2026 | Health insurance | Care insurance | Total a month |
|---|---|---|---|
| Minimum (income base €1,318.33), 16.9% | €222.80 | €47.46 (€55.37 childless) | €270.26 (€278.17 childless) |
| Example: €5,000 a month profit, 16.9% | €845.00 | €180.00 (€210.00 childless) | €1,025.00 (€1,055.00 childless) |
| Maximum (income base €5,812.50), 16.9% | €982.31 | €209.25 (€244.13 childless) | €1,191.56 (€1,226.44 childless) |
| Maximum with Krankengeld, 17.5% | €1,017.19 | €209.25 (€244.13 childless) | €1,226.44 (€1,261.31 childless) |
The minimum applies even if your income is lower, because contributions are calculated on at least €1,318.33 a month. The exact amount also depends on your fund's supplemental rate.
Students
Students pay a reduced rate on a fixed base of €855 a month (the BAföG standard rate). The health rate is 7/10 of 14.6%, which is 10.22%, so €87.38. Add your fund's supplemental rate (about €24.80 at the 2.9% average) and care insurance of €30.78 (€35.91 if you are childless and 23 or older). The total is about €143 to €148 a month, depending on the fund. After your student status ends, you can stay in GKV voluntarily, often at the minimum contribution above.
Important: if your fund raises its supplemental rate, you have a special right to leave (Sonderkündigungsrecht), see "How to switch" below.
What does public health insurance cover?
GKV covers all medically necessary treatment. The benefits catalogue is set by law, so every fund must cover the same core services.
- GP and specialist visits
- Hospitalization (shared room, ward doctor)
- Prescription medications (small co-payment)
- Mental health therapy (psychotherapy)
- Maternity care and childbirth
- Preventive check-ups (Vorsorge)
- Basic dental check-ups and fillings
- Fixed subsidy towards dentures
- Physiotherapy and rehab
- Emergency care anywhere in Germany
- EU-wide emergency coverage (EHIC card)
- Private or chief physician (Chefarzt)
- Single room in hospital
- Full cost of dental implants and crowns
- Vision correction (glasses/contacts for adults)
- Alternative medicine (homeopathy, osteopathy)
- Most cosmetic procedures
- Long-term worldwide travel coverage
Co-payments and dental
You pay a small co-payment on prescriptions and for hospital days. The pharmacy or hospital shows the exact amount, and it is capped by law. Dental care is the main gap. For dentures, GKV pays a fixed subsidy (Festzuschuss) of 60% of the standard treatment. It rises to 70% if your Bonusheft shows 5 years of regular check-ups and 75% after 10 years. Hardship cases can get up to 100%.
A dental top-up policy can close the gap. Waiting periods are commonly 8 months for dentures and orthodontics, or 3 months for general treatment, and many tariffs cap benefits in the first years. Existing or ongoing treatment is excluded. See our health insurance overview for related guides.
Best public health insurers for expats
All funds offer the same legally mandated core benefits. What varies is the supplemental rate, digital services, English-language support and a few optional extras. For most expats, the choice comes down to convenience and language. Rates below are from January 2026 lists, so check your fund's current rate before you sign.
- ✓ English-language app and website
- ✓ Excellent digital services (e-AU, digital card)
- ✓ Online-only registration, no branch visit needed
- ✓ Below the 2.9% official average rate
- ✓ Huge member base, accepted everywhere
- ✓ Regional, strong local network
- ✓ Rate differs between regional AOKs, so compare yours
- ✗ Little English support
- ✗ More bureaucratic than TK in most regions
- ✓ National, branches across Germany
- ✓ Decent digital services
- ~ Partial English content online
- ✗ Fewer English-speaking staff than TK
- ✓ National coverage
- ✓ Good app
- ✗ Little English support
- ✗ Higher rate than TK
- ✓ National coverage
- ✗ Originally for craft trades (Handwerk), less suited for office workers
- ✗ Little English support
The cheapest funds charged about 2.18% (BKK firmus) and the most expensive about 4.39% (BKK24) in January 2026. The official list of every fund's rate is published by the GKV-Spitzenverband.
Our recommendation: For most expats, TK (Techniker Krankenkasse) is the best public health insurance option. The English-language app, digital services and below-average supplemental rate make it the easy choice if you do not speak German fluently. Sign up at techniker.de.
How to sign up for public health insurance
Signing up is straightforward, especially with TK, which handles the process online in English.
For most expats, TK is the best starting point. You can also choose AOK, Barmer, DAK or IKK classic. All offer the same core coverage.
TK's online application is available in English. You will need your Anmeldung confirmation (address registration), passport or ID, and your employer's details.
Upload your employment contract, your Anmeldebestätigung (residence registration) and your tax ID if you have it. Your fund then confirms your membership.
Your electronic health card (eGK) arrives by post. In the meantime, your insurer can give you a provisional coverage confirmation you can use right away.
Send your employer the Mitgliedsbescheinigung (membership certificate) from your Krankenkasse. They start deducting and paying contributions from your next payroll.
How to switch public health insurance funds
You can change from one GKV fund to another. The rules are the same for every fund:
- Minimum membership: 12 months with your current fund.
- Notice: 2 full months, ending at the end of the second calendar month after you give notice.
- How: sign up with the new fund. Since 2021 the new fund handles the switch with your old one electronically.
- Special termination right (Sonderkündigungsrecht): if your fund raises its supplemental rate, you can leave without waiting out the 12 months, up to the end of the month in which the increase takes effect. Your fund must tell you about this right.
To move from public to private health insurance, different rules apply. See switching from public to private health insurance.
Family insurance and sick pay
Family insurance (Familienversicherung): a spouse and children can be covered at no extra premium if they meet the income and status conditions. This is a real saving for families with one earner. Conditions differ from case to case, so confirm with your fund before relying on it.
Sick pay (Krankengeld): if you are ill for a long time, your employer first continues your salary, then your fund pays Krankengeld. Employees get this by default. Self-employed people get it only on the 17.5% rate, not on the reduced 14.0% rate. The full rules are in our sick pay in Germany guide. For how the care insurance line above works, see long-term care insurance in Germany.
Pros and cons of public health insurance
- Family members can be insured at no extra premium
- No health questionnaire, pre-existing conditions covered
- Simple: one rate, automatic enrollment
- Premium depends on income, not age or health
- Employer pays half of the contribution
- Guaranteed acceptance for people who qualify
- High earners pay up to about €613 a month (about €648 if childless)
- Self-employed people pay the full amount, up to about €1,191 to €1,261 a month
- Specialist appointments can take longer to get
- Shared rooms in hospital by default
- Ward doctor, not your choice of physician
- The average supplemental rate rose again in 2026
Public or private: who should look at the alternative?
GKV makes sense if you are new to Germany, if your salary is below the income limit, or if you have a family with a non-working spouse and children.
If you earn above €84,150 a year (€7,012.50 a month) from 1 January 2027 (€77,400 in 2026) as an employee, or you are self-employed, you can compare it with private health insurance. The 2027 figure was approved by the federal cabinet and still needs Bundesrat approval, expected in November 2026. Employees become exempt at the end of the calendar year in which they exceed the limit, as long as they are expected to exceed it the next year. Private premiums depend on your age and health at entry, your deductible and your plan, not on your income. Your employer adds a subsidy of up to €613.22 a month (€508.59 health plus €104.63 care insurance), capped at half of your actual premium.
Weigh the downsides too. Private insurers ask health questions and can apply surcharges, exclusions or refuse you. Premiums rise as you age. From age 55, returning to GKV is largely blocked if you had no GKV cover in the previous 5 years and were exempt, not compulsorily insured or self-employed for at least half of that time.
Earning above €84,150 a year? You may qualify for private health insurance. The right answer depends on your age, health and family plans. Compare public vs private health insurance in detail → or check who qualifies for private health insurance.
Planned for 2027 (draft, not yet final): the government draft would raise the income limit to €84,150 a year and the contribution ceiling to €76,500 a year. The Bundesrat still has to approve it. The 2027 average supplemental rate has not been set yet. Until it is final, use the 2026 figures above.
Public health insurance in Germany: FAQ
Is public health insurance mandatory in Germany?
Yes. Everyone living in Germany needs health insurance, and a residence permit requires adequate cover. Employees earning below €84,150 a year (the 2027 threshold, €77,400 in 2026) must join public health insurance (GKV) from their first day of work. Above that income, employees can choose GKV or private health insurance, and self-employed people can choose either whatever they earn.
How much is public health insurance in Germany per month?
For an employee, your share is about 10.55% of gross salary in 2026 (7.3% base rate, about 1.45% of the average supplemental rate, and 1.8% for nursing care), or 11.15% if you are childless and 23 or older. That is about €316 a month on €3,000 gross and about €527 on €5,000. The maximum is about €613 a month (€648 if childless) because contributions stop at €5,812.50 of monthly income.
What does public health insurance cover in Germany?
All medically necessary treatment set by law: GP and specialist visits, hospital care in a shared room, prescription medicines, psychotherapy, maternity care, preventive check-ups and rehab. Dentures get a fixed subsidy of 60% of the standard treatment, rising to 70% with a 5-year Bonusheft and 75% with 10 years. Private doctors, single hospital rooms and most extras are not included.
Which public health insurance is best for expats?
TK (Techniker Krankenkasse) is the usual pick for English speakers: English app and website, online sign-up and a supplemental rate of 2.69% in January 2026, below the 2.9% official average. All funds pay the same legally set core benefits, so compare the supplemental rate, English support and digital service.
Can I switch from public to private health insurance?
Only in some cases. Employees can switch once their regular annual pay is above €84,150 (from 2027). They become exempt at the end of the calendar year in which they exceed it, as long as they are expected to exceed the limit again the next year. Self-employed people and freelancers can switch at any income. Private health insurance involves health questions and premiums set by age and health, and returning to GKV after 55 is largely blocked.
What happens if I lose my job, am I uninsured?
No. If you receive unemployment benefit (ALG I) you are compulsorily insured in GKV. If you do not, you can continue in GKV voluntarily, and the minimum contribution is about €270 to €286 a month in 2026, depending on your rate (with or without sick pay) and whether you have children. Tell your Krankenkasse as soon as your job ends so there is no gap in cover.
Do students and freelancers need public health insurance?
Students are compulsorily insured in GKV at a reduced rate of about €143 to €148 a month in 2026, until the end of the semester in which they turn 30 (longer for recognised reasons). They can apply for an exemption within 3 months of enrolment, but it cannot be undone. Freelancers must have health insurance but can choose between voluntary GKV and private health insurance.
Is health insurance in Germany free for spouse and kids?
Often, yes. Under family insurance (Familienversicherung), a spouse and children can be covered at no extra premium in GKV if they meet the income and other conditions. The rules depend on each person's income and status, so check the details with your fund before you rely on it.
Sources and method
Figures checked on 14 October 2026. Income limit, ceiling and income base: Sozialversicherungs-Rechengrößenverordnung 2026 (Deutsche Rentenversicherung). Contribution rates: §241 SGB V, §243 SGB V. Average supplemental rate: Bundesanzeiger, 10 Nov 2025. Residence requirement: §2 AufenthG. Euro amounts in the examples are calculated from these rates, at the 2.9% average supplemental rate, and rounded to the cent. Your fund's own rate will change them slightly.
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