Public vs Private Health Insurance in Germany (2026): Costs, Coverage and Who Should Choose What
Public or private health insurance in Germany? Compare 2026 costs, coverage, family rules and the €77,400 threshold (planned €84,150 for 2027), with worked examples.
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Public or private health insurance is the first big money decision for many people who start a job in Germany. For a lot of employees it is not a choice at all, and for the rest the right answer depends on income, age, health and family.
This guide gives the 2026 rules and numbers first, then helps you work out which system fits your situation. Public insurance is called GKV (gesetzliche Krankenversicherung) below.
Quick answer for 2026
- Who decides: an employee earning below €77,400 per year (2026; planned €84,150 from 1 January 2027) must be in public insurance. The planned 2027 figure was approved by the federal cabinet and still needs Bundesrat approval, expected in November 2026. Above that, or if you are self-employed or a freelancer, you can choose.
- Public cost: 14.6% general rate (§241 SGB V) plus an average extra contribution of 2.9% (Federal Ministry of Health) (it differs by fund), split half and half with your employer. Long-term care adds 3.6%. Income above €5,812.50 per month is not charged.
- Private cost: set by your age and health when you join, the plan and any deductible. It does not depend on your income.
- Family: spouse and children can be insured free in public insurance if they have no or low income. In private insurance each person pays their own premium.
- Switching back: possible under 55 when you become liable for compulsory public insurance again. From 55 it is largely blocked.
Facts checked 14 October 2026 against the 2026 social security figures and the Social Code (SGB V).
Which type of health insurance applies to you?
Your status decides your options. An employee below €77,400 must be in public insurance, an employee above it can choose, and self-employed people and freelancers can choose at any income. A one-income family may also weigh free family cover. The public or private quiz takes about a minute.
Employee below €77,400
Public insurance is mandatory from your first working day. You pick the fund, not the system.
Employee above €77,400
You can choose voluntary public insurance or private insurance. New hires above the limit can choose straight away.
Self-employed or freelancer
You can choose at any income. Public contributions are income-based and have a monthly minimum.
Family with one income
Free family cover in public insurance can flip the answer. Price both options for the whole household.
If you are on a residence permit, you need adequate health insurance at the level of public cover. Travel insurance is generally not enough for a long-term permit.
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How do public and private health insurance compare?
Public insurance charges a share of income up to the €5,812.50 monthly ceiling, covers a non-earning spouse and children for free and asks no health questions. Private insurance prices age and health at entry, needs a policy per family member and asks health questions. Employers share the cost in both, up to a cap for private.
| Feature | Public (GKV) | Private |
|---|---|---|
| Who can join | Compulsory for employees below €77,400/yr; voluntary above it | Employees above €77,400/yr, self-employed, civil servants, exempt students |
| Premium basis | Share of income, up to the €5,812.50/month ceiling | Age and health at entry, plan, deductible |
| Employer contribution | Pays half of the contribution | Pays half of your premium, up to €613.22/month combined for health and care |
| Family coverage | Free for non-earning spouse and children | Each family member needs their own policy |
| Health questions | None, open enrolment | Yes. Surcharges, exclusions or refusal are possible |
| Sick pay | Krankengeld is part of the standard cover for employees | Optional daily sick pay (Krankentagegeld) that you choose and pay for separately |
| Long-term care | Public care insurance, 3.6% of income (employee 1.8%, plus 0.6 points if childless from age 23) | Private care insurance is compulsory; the employer pays half, up to €104.63/month |
| Specialist appointments | Often longer waits for non-urgent appointments | Private patients often get appointments sooner; varies by region and doctor |
| Hospital | Standard ward | Single or double room and chief physician if the plan includes it |
| Dental | Fixed subsidy for dentures: 60%, 70% with 5-year Bonusheft, 75% with 10 years | Depends on the plan; many include higher dental benefits |
| Therapy and mental health | Standard statutory benefits | Depends on the plan; check session limits and any exclusions |
| Medication co-pay | Statutory co-payments apply | Set by your plan and deductible |
| Worldwide cover | Limited outside the EU | Depends on the plan; many include worldwide cover |
| Switching back | N/A (you are already in GKV) | Possible under 55 in specific cases; largely blocked from 55 |
What does each system really cost?
Public insurance costs a percentage of gross pay up to the 2026 ceiling of €5,812.50 per month, so an employee pays at most about €613.22 with a child or €648.09 childless. Private premiums depend on age, health, plan and deductible, not income. Employers pay half of either, with a private cap of €613.22 combined.
How public insurance is calculated
Your contribution is a percentage of gross pay, up to a ceiling. In 2026 the ceiling is €5,812.50 per month (€69,750 per year, Deutsche Rentenversicherung). Earn more and the contribution does not rise.
- General rate: 14.6%, half paid by you (7.3%) and half by your employer (7.3%).
- Extra contribution (Zusatzbeitrag): the official 2026 average is 2.9%, also split half and half. Each fund sets its own rate, so yours will differ.
- Long-term care: 3.6%, of which you pay 1.8%. If you are childless and 23 or older, you pay an extra 0.6 points, so 2.4% in total.
- Monthly pay: €90,000 / 12 = €7,500.00, which is above the ceiling, so the base is €5,812.50.
- Health insurance, total: 17.5% x €5,812.50 = €1,017.19. Your half: €508.59.
- Long-term care, total: 3.6% x €5,812.50 = €209.25. Your share with a child: 1.8% = €104.63. Childless: 2.4% = €139.50.
- Your maximum: €508.59 + €104.63 = €613.22 with a child, or €508.59 + €139.50 = €648.09 childless. Your employer pays the other half of the health and care contribution.
- This uses the 2.9% average. Your fund's rate will move the result a little.
- Monthly pay: €100,000 / 12 = €8,333.33, again above the ceiling, so the base stays €5,812.50.
- Your maximum is the same as at €90,000: about €613.22 with a child or €648.09 childless.
- Takeaway: public insurance stops getting more expensive once you pass €69,750 per year. The higher your income, the more attractive private insurance can look.
Self-employed members and other voluntary members without an employer pay both halves themselves. In 2026 the minimum contribution is roughly €270 to €286 per month, based on a minimum income of €1,318.33. The maximum is roughly €1,192 to €1,261 per month including long-term care. Where you land depends on whether you choose the Krankengeld option, whether you have children and your fund's rate.
Students in public insurance pay about €143 to €148 per month in total, based on a fixed base of €855. See our guide on private health insurance for students for the exemption rules.
What drives private premiums
Private premiums are priced for the individual, not as a share of income. The main drivers are:
- Age at entry and health: the insurer assesses you when you apply and can add risk surcharges or exclusions.
- Plan level: hospital room, dental, therapy limits and similar benefits.
- Deductible (Selbstbehalt): a higher deductible lowers the premium but raises what you pay when you claim.
- Legal surcharge: a statutory 10% surcharge (§149 VAG) applies from the calendar year after you turn 21 up to the year you turn 60. It builds reserves that cushion premium increases from age 65 and reduce premiums from age 80.
We do not quote a typical euro range here, because it moves too much with age, health and plan. Ask for a written quote based on your own details. See our private health insurance cost guide for the components in detail.
The employer subsidy
If you are privately insured as an employee, your employer pays half of your premium, capped at the amount they would pay for public insurance (§257 SGB V). In 2026 that cap is €508.59 per month for health and €104.63 for long-term care, so €613.22 combined.
- Employer pays the lower of: half of your actual premium, or €613.22.
- The cap only bites if your total premium exceeds €1,226.44 per month (2 x €613.22).
- Below that, you pay half of your private premium and your employer pays half.
Basic-coverage premiums are tax-deductible as special expenses. Optional extras such as a single room or dental top-ups are only partly deductible.
Do premiums rise over time in both systems?
Yes. Public insurance rises through the extra contribution and the ceiling: the official average extra contribution rose by 0.4 percentage points from 2025 to 2026, to 2.9%. Private premiums also rise as medical costs rise, and insurers can adjust them. We have no confirmed official figure for the 2026 private increase, so we quote none.
The difference is who carries the risk. In public insurance, higher costs show up as higher rates on your income. In private insurance, higher costs show up as higher premiums on your plan, and a bigger premium is harder to carry on a lower income in retirement. Ask any insurer how the premium developed on the plan you are considering, and compare that against your expected income.
The 2027 figures raise the income limit for choosing private insurance to €84,150 per year and the contribution ceiling to €76,500. The federal cabinet approved them on 7 October 2026, but they are not final and depend on pending legislation. The Bundesrat still has to approve them, and the 2027 average extra contribution has not been set. Check the current figures before you decide near the end of the year.
How does coverage differ between public and private insurance?
Public insurance covers treatment on a standard ward, a fixed subsidy for dentures and statutory psychotherapy. Private plans can add a single or double room, chief physician treatment and higher dental benefits, but terms vary widely by tariff. Private patients are often offered appointments sooner, depending on region and specialty.
Doctors and waiting times
Both public and private patients see the same doctors in many practices. Private patients are often offered appointments sooner, but this varies by region and specialty. Doctors in either system can have waiting lists.
Hospital
Public insurance covers treatment on a standard ward. Private plans can include a single or double room and treatment by the chief physician. Check what your plan states, because it varies widely.
Dental
For dentures, public insurance pays a fixed subsidy of 60% of the standard treatment. This rises to 70% with 5 years of an unbroken Bonusheft and 75% with 10 years. Hardship cases can receive up to 100%. Public members can add a dental top-up policy. Waiting periods of around 3 to 8 months are common, though many newer tariffs have none and cap benefits in the first years. Ongoing or planned treatment is typically excluded.
Mental health and therapy
Public insurance covers psychotherapy under the statutory rules. Private plans vary: some are generous, others limit sessions or exclude pre-existing conditions. Read the tariff terms before you sign, not after.
Does family cover change the public vs private choice?
Yes, it is the biggest reason higher earners stay in public insurance. Under GKV, a non-working or low-earning spouse and dependent children are insured free through Familienversicherung. In private insurance every person needs their own policy and premium, and the employer subsidy cap does not grow with each family member.
See public health insurance in Germany for the rules on who qualifies for free family cover.
Who should choose GKV?
GKV suits employees below €77,400, families with a non-working spouse and children, people with unstable income or significant pre-existing conditions, people close to age 55, and newcomers who need immediate cover. It asks no health questions and has no exclusions.
- Your salary is below €77,400/year: as an employee you do not have a choice; GKV is mandatory
- You have a non-working spouse and children: free family coverage can make GKV significantly cheaper overall
- You expect income instability: if your salary might drop below the threshold, GKV is a safer base
- You are close to age 55 or above: switching back to GKV becomes largely blocked, so think hard before you leave
- You have significant pre-existing conditions: GKV asks no health questions and has no exclusions; private insurers may add surcharges or exclude treatments
- You are new to Germany and need immediate coverage: GKV enrolment is quick, and private underwriting can take longer
Who should choose private health insurance?
Private health insurance suits employees above €77,400, the self-employed and freelancers, civil servants, and healthy people without dependants who want plan-level control. Premiums are priced at entry age and health, so joining young and healthy tends to help. Families with several non-earning members should compare carefully first.
- You earn above €77,400 as an employee: you can compare, and a young, healthy applicant may get strong cover at a competitive price
- You are self-employed or freelance: GKV is income-based with no employer share, so it can get expensive at higher income
- You have no dependants, or your family members also have income: the family cost argument does not apply
- You want plan-level control: room, dental, deductible and sick pay can be set to your needs
- You are in good health and young: premiums are priced at entry age and health, so joining earlier and healthy tends to help
- You are a civil servant (Beamter): Beihilfe plus a residual private policy is the standard route
Which should you choose in your situation?
The best fit depends on salary, family, age and health. Employees below €77,400 have no choice and stay public. Single, young, healthy employees above it often find private competitive. Families with a non-working spouse and children, people near 55 and people with pre-existing conditions should compare carefully.
| Your situation | Likely fit | Main reason |
|---|---|---|
| Employee, €90k, single, young and healthy | Compare, private often competitive | Above the €77,400 limit; premium priced on age and health, employer pays half up to €613.22 |
| Employee, €90k, spouse not working, 2 kids | Compare carefully | GKV covers family free; private needs a premium for each person |
| Self-employed, any income | Compare both | GKV has a minimum of roughly €270 to €286 per month and no employer share; private depends on age and health |
| Employee, €65k | GKV | Below the €77,400 threshold, no choice |
| Employee, €85k, age 50, healthy | Compare carefully | Entry premiums are higher at older ages and returning to GKV gets harder at 55 |
| Employee, €85k, significant pre-existing conditions | Depends on conditions | Private insurers may add surcharges, exclude conditions or decline |
| Student | Usually GKV | About €143 to €148 per month; exemption is irrevocable for the whole course |
| Civil servant (Beamter), any income | Private | Beihilfe covers part of costs, private insurance covers the rest |
Can you switch later?
Going private is easy to start and hard to undo, so decide with the exit in mind. You can switch from public to private once you are above the income limit or self-employed. Going back to public is possible under 55 when you become liable for compulsory insurance again, but from 55 it is largely blocked.
- Switching from public to private: possible once you are above the income limit or self-employed. See how to switch from public to private and who qualifies.
- Back to public, under 55: possible when you become liable for compulsory insurance, for example as an employee earning below the limit or on ALG I.
- The age-55 rule: if you are 55 or older, you stay exempt when you had no public cover in the last 5 years and were exempt, self-employed or not subject to compulsory insurance for at least half of that time. In practice, returning is largely blocked.
- Changing public funds: you are bound for 12 months, with 2 months' notice. If your fund raises its extra contribution, you have a special right to leave early.
Frequently asked questions
Is private health insurance cheaper than public in Germany?
It can be, but not always. Public premiums are a share of your income: 14.6% general rate plus an average 2.9% extra contribution in 2026, capped at an income of €5,812.50 per month. Private premiums depend on your age and health when you join, the plan and any deductible. Healthy people who join young often pay less, while families with several dependants often find public cheaper because spouse and children can be covered at no extra cost.
What income do I need to go private in 2026?
As an employee you need a regular gross income above €77,400 per year (€6,450 per month) in 2026. The planned 2027 figure is €84,150 per year (€7,012.50 per month, from 1 January 2027); it was approved by the federal cabinet and still needs Bundesrat approval, expected in November 2026. You then become exempt from compulsory public insurance at the end of the calendar year in which you exceed the limit, provided you are expected to exceed the next year's limit too. New hires who start above the limit can choose immediately. Self-employed people and freelancers can choose at any income.
Can I switch back from private to public health insurance?
Sometimes. If you are under 55, you can return when you become liable for compulsory public insurance again, for example as an employee earning below the income limit or when you receive unemployment benefit (ALG I). From age 55 it is largely blocked if you had no public cover in the last 5 years and were exempt, self-employed or not subject to compulsory insurance for at least half of that time.
Is family covered for free in private health insurance?
No. In public insurance a non-earning spouse and children can be insured at no extra cost through Familienversicherung. In private insurance every family member needs their own policy and their own premium.
Are pre-existing conditions covered?
In public insurance there are no health questions and no exclusions. Private insurers ask health questions before they offer a policy and can add a risk surcharge, exclude a condition or decline the application. The Basistarif must accept applicants without risk surcharges, with a premium capped at about €1,017 per month in 2026 (the public maximum).
Do freelancers have to go private?
No. Freelancers and self-employed people may choose between voluntary public insurance and private insurance at any income. Public insurance for the self-employed is income-based, with a minimum contribution of roughly €270 to €286 per month and a maximum of roughly €1,192 to €1,261 per month in 2026, including long-term care, depending on the Krankengeld option and whether you have children.
Does public insurance cover dental care?
Partly. For dentures, public insurance pays a fixed subsidy of 60% of the standard treatment. It rises to 70% with 5 years of an unbroken Bonusheft and 75% with 10 years. Hardship cases can receive up to 100%. A separate dental top-up policy covers more, but waiting periods, annual caps in early years and exclusions for ongoing treatment are common.
Which is better for expats?
It depends on income, family and plans. If you earn below €77,400 (2026) as an employee, public insurance is mandatory and the question does not arise. Above that limit, or if you are self-employed, compare both with your own numbers: age, health, dependants and how long you plan to stay. Also remember that a residence permit requires adequate health insurance at the level of public cover.
Sources and review
Written by the Living in Germany editorial team. Figures reviewed on 14 October 2026.
- Deutsche Rentenversicherung: Sozialversicherungs-Rechengrößen 2026: income limit €77,400 and contribution ceiling €69,750 (2027 figure of €84,150 approved by the federal cabinet, Bundesrat-Drs. 576/26, Bundesrat approval pending).
- Federal Ministry of Health and Bundesanzeiger of 10 November 2025: official average extra contribution 2026, 2.9%.
- Social Code V (SGB V): 6, 55, 175, 240, 241, 242a, 243, 257.
- Social Code XI (SGB XI): section 55, 61 for long-term care.
- Insurance Supervision Act (VAG): section 149 and 152 for the 10% surcharge and the Basistarif.
- Residence Act (AufenthG), section 2(3) for the health insurance requirement.
- §10 EStG: tax deduction of premiums.
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