Public vs Private Health Insurance in Germany
GKV or PKV? We compare German public and private health insurance side by side, costs, coverage, eligibility, and who should choose which.
It's the question every expat faces when they land a job in Germany: public or private health insurance? GKV or PKV?
The honest answer is: it depends. There is no single right choice for everyone. But for a significant share of expats, particularly those earning above €77,400 and under 45, PKV is the better option financially and in terms of coverage quality.
This guide lays out the comparison clearly and helps you figure out which system makes sense for your specific situation.
Side-by-side comparison
| Feature | GKV (Public) | PKV (Private) |
|---|---|---|
| Who can join | Everyone | Employees ≥€77,400/yr or self-employed |
| Monthly cost (€80k salary) | ~€620/month (your share) | €200–420/month depending on age |
| Premium basis | % of salary (income-based) | Age + health status + plan chosen |
| Employer contribution | ✓ Pays ~50% of GKV contribution | ✓ Subsidy up to ~€450/month |
| Family coverage | ✓ Free for non-earning spouse and children | ✗ Each family member needs own policy |
| Specialist waiting times | 3–8 weeks typical | Usually same week |
| Hospital room | Shared room, ward doctor | Private room option, chief physician |
| Dental | Basic check-ups only | Extended, crowns, implants, orthodontics |
| Vision (adults) | Not covered | Often included (glasses, contacts) |
| Worldwide coverage | EU emergency (EHIC) only | Worldwide, including non-emergency |
| Can be cancelled by insurer | No, legally protected | No, legally protected for life |
| Switching back | N/A (you're in GKV) | Possible under specific conditions |
| Health questionnaire required | No, open enrolment | Yes, pre-existing conditions may affect terms |
Who should choose GKV?
- Your salary is below €77,400/year: you don't have a choice as an employee; GKV is mandatory
- You have a non-working spouse and children: GKV's free family co-insurance can make it significantly cheaper overall
- You expect income instability: if your salary might drop below the threshold, GKV is a safer base
- You're close to age 55 or above: PKV premiums at this age are often comparable to GKV, and switching back becomes harder
- You have significant pre-existing conditions: GKV has no exclusions; PKV may load your premium or exclude certain treatments
- You're new to Germany and need immediate coverage: GKV enrollment is instant; PKV takes 2–4 weeks
Who should choose PKV?
- You earn ≥€77,400 as an employee: especially if you're under 40, the savings and coverage upgrade are substantial
- You're self-employed or freelance: GKV costs €900–1,300+/month for the self-employed; PKV often starts under €300
- You have no dependants, or your family members also have income: the family cost argument doesn't apply
- You value faster specialist access: weeks vs days makes a real difference when you're unwell
- You want better dental and vision coverage: these aren't optional extras in a good PKV plan
- You're in good health and under 40: best time to join; premiums are lowest and Alterungsrückstellungen build up most effectively
Decision guide by situation
| Your situation | Recommended | Main reason |
|---|---|---|
| Employee, €90k, age 32, single, healthy | PKV | Save ~€300–400/month; better coverage; best age to join |
| Employee, €90k, married with 2 kids, spouse not working | Compare carefully | GKV family coverage may offset PKV savings, model both scenarios |
| Self-employed, €70k, age 35 | PKV | GKV at this income costs ~€900–1,100/month; PKV ~€280–350/month |
| Employee, €65k, age 28 | GKV | Below the €77,400 threshold, no choice |
| Employee, €85k, age 50, healthy | Compare carefully | PKV premiums at 50 are higher; savings are smaller, still worth checking |
| Employee, €85k, significant pre-existing conditions | Depends on conditions | A broker can assess whether coverage terms work out favourably |
| Civil servant (Beamter), any income | PKV | Civil servants receive Beihilfe, PKV is the standard choice |
The family consideration, the most important factor many people miss
The biggest reason high-earning expats sometimes stay in GKV is family. And it's a legitimate reason to think carefully before switching.
Under GKV, a non-working or low-earning spouse and dependent children are insured for free. This is called Familienversicherung, one of GKV's most valuable features.
Under PKV, every person needs their own policy. A non-working spouse might pay €150–250/month for their own PKV. Each child costs €80–150/month. Add it up for a family of four and the cost difference between GKV and PKV can narrow significantly, or even reverse.
The key takeaway: families should not assume GKV is automatically better. Model both scenarios with a broker. The result often surprises people.