Contents (11 sections)
- Private health insurance in Germany with a family: the key difference
- Family insurance in public health insurance: who is covered for free
- Private health insurance for spouse and children: what it costs
- The numbers: a family of four in 2027
- One parent private, one public: the children rule
- Your employer's contribution for family members
- From 2028: the surcharge for family-insured spouses
- When private health insurance can still work for a family
- Your family joins you later: what to plan
- Five questions for families before choosing
- Family on the way? Decide before you switch
- In public insurance a spouse or registered partner without income (up to €565 a month in 2026) and children living in Germany are family-insured free of charge (§ 10 SGB V).
- In private insurance every family member pays a premium; children's tariffs typically cost €120 to €250 a month each (broker analysis, September 2026).
- Family of four on one salary of €90,000 in 2027: public costs the earner €656.63 a month, private about €920 after the employer contribution (own calculation, scenario).
- If one parent is private and earns more than the publicly insured spouse and above €7,012.50 a month (2027), the children can't be family-insured for free (§ 10 (3) SGB V).
- From 2028 public insurance adds a surcharge of 2.5 percentage points for family-insured spouses – unless, for example, a child under 12 lives in the household.
With a family, private health insurance in Germany is usually the more expensive choice: every family member pays a premium, while public insurance covers a spouse without income and children living in Germany free of charge (§ 10 SGB V). For a family of four on one salary of €90,000, public insurance costs the earner €656.63 a month in 2027, private about €920 after the employer contribution (own calculation, scenario as of October 2026).
Private health insurance in Germany with a family: the key difference
The two systems treat families in opposite ways. Public insurance (gesetzliche Krankenversicherung, GKV) charges a contribution on the earner's income – and covers the spouse and children on top through family insurance (Familienversicherung). Private insurance (private Krankenversicherung, PKV) has no family insurance: every person signs an own policy, answers own health questions and pays an own premium.
| Question | Public (GKV) | Private (PKV) |
|---|---|---|
| Spouse without income | Insured free of charge | Own policy, own premium |
| Children | Insured free of charge (with one exception for mixed couples) | Own policy per child, typically €120 to €250 a month |
| Long-term care insurance for children | Included | No premium for children |
| Employer contribution | About half of the earner's contribution | Half of all premiums, but only up to one overall maximum |
| Newborns | Family-insured | Covered without health questions if registered within two months |
| Cost driver | Earner's income | Number of people and their entry ages |
Family insurance in public health insurance: who is covered for free
Family insurance covers the spouse or registered civil partner and the children of a publicly insured member – not an unmarried partner. Each family member must meet these conditions (§ 10 SGB V):
- Lives in Germany: residence or habitual stay in Germany. A family that stays in your home country is not covered.
- Not insured otherwise: not compulsorily or voluntarily insured themselves and not exempt from compulsory insurance.
- Not mainly self-employed.
- Low own income: at most €565 a month in 2026 (€590 in 2027, own calculation from the draft values); for a mini-job up to €603 (2026).
- Children's age: up to 18, up to 23 if not working, up to 25 while in school, training or university – longer for children with a disability who can't support themselves.
As soon as your spouse takes a regular job above these limits, they are insured through their own job – then family insurance no longer matters for them.
Private health insurance for spouse and children: what it costs
In private insurance each adult pays an adult premium based on their own entry age and health. For a 35-year-old, Stiftung Warentest found full-cover tariffs from €649 to €1,137 a month (Finanztest 3/2025). Children pay children's tariffs:
- Typical range: €120 to €250 a month per child according to a broker analysis (transparent-beraten.de, 4 September 2026).
- Insurer's own example: Allianz states €276.79 a month for a child aged 0–15 in its tariff “MeinGesundheitsschutz Plus 90” (retrieved 10 October 2026).
- Care insurance: children are insured in private long-term care insurance without a premium (§ 110 SGB XI).
These premiums run until adulthood and continue to rise with medical costs. A child who later studies or trains often stays privately insured – and from 18 pays an adult-style tariff.
The numbers: a family of four in 2027
Take an employee aged 35 earning €90,000, married, the spouse without income, two children. In public insurance only the employee pays – the family is covered. In private insurance four policies are due, and the employer pays half – but health and long-term care parts are capped separately, in 2027 at about €557.81 and €114.75 a month (scenario).
Family of four on one salary (€90,000) – own share per month in 2027, in €
Spouse without income, two children · public: family insured free of charge · private: two adults at €649 plus two children at €120, employer pays up to €557.81 for health and €114.75 for long-term care, assuming about €60 long-term care per adult (high end of the range: about €2,156)
Own calculation, as of 10 October 2026 (§ 10 and § 257 SGB V; Finanztest 3/2025; children's tariffs typically €120–250, transparent-beraten.de 04.09.2026). From 2028 a 2.5-point surcharge applies to family-insured spouses unless, for example, a child is under 12.
| Per month in 2027 | Public | Private, low end | Private, high end |
|---|---|---|---|
| Total premiums / contributions | – | €1,538 | €2,774 |
| Employer pays | about half | about €617.81 | about €617.81 |
| The family pays | €656.63 | €920.19 | €2,156.19 |
How the public figure comes about: €6,375 × 8.75% = €557.81 for health insurance plus €6,375 × 1.55% = €98.81 for long-term care (the care rate is lower with two children) – €656.63 in total. Even at the cheapest end, private costs the family about €264 more a month; at the high end about €1,500 more. Your own numbers: public vs private cost calculator.
One parent private, one public: the children rule
Mixed couples are common among newcomers – for example when one partner earns above the threshold and goes private while the other stays public. For the children, § 10 (3) SGB V decides. They can't be family-insured with the publicly insured parent if the other parent:
- is married to (or in a civil partnership with) the publicly insured parent,
- is not publicly insured,
- earns more than €6,450 a month in 2026 (€7,012.50 in 2027, draft), and
- earns more than the publicly insured parent.
If all four apply, the children need private policies or a voluntary public membership of their own. Unmarried parents are not affected by this rule. So before the higher earner goes private, the couple should check what it means for current and future children – it can turn a cheap private premium into an expensive family decision.
Your employer's contribution for family members
If you are a privately insured employee, your employer also contributes towards the premiums of family members who would be family-insured in public insurance (§ 257 SGB V). But there is only one overall maximum: €613.22 a month in 2026 and about €672.56 in 2027 (scenario). In the example above, half of €1,538 would be €769 – more than the cap. The employer pays at most €672.56, and usually somewhat less, because the health and care parts are capped separately. Every euro above the cap is yours alone. Details: employer contribution to private health insurance.
From 2028: the surcharge for family-insured spouses
Public insurance will become less generous for some couples. From 1 January 2028, a surcharge of 2.5 percentage points applies to members whose spouse is family-insured; the member pays it (GKV-Beitragssatzstabilisierungsgesetz, BGBl. 2026 I No. 228). There are exceptions – for example if a child under 12 lives in the household, in certain care situations or after reaching the standard retirement age.
For a family with young children nothing changes. For a couple without children under 12, public insurance gets more expensive – but one surcharge is usually still far cheaper than a second private adult policy. Keep this in mind if your spouse plans to work again anyway.
When private health insurance can still work for a family
Private can make sense if …
- both partners earn well and would each be privately insured anyway
- you plan to stay in Germany long term and value contract benefits
- you are a civil servant – the state allowance (Beihilfe) pays a large part for your family
Public is usually better if …
- one partner has no or little own income
- you have children or plan them soon
- you may leave Germany within a few years – see short stays
One more point for privately insured parents: newborns are covered without health questions and without waiting periods if you register them within two months of the birth, with cover not higher than your own (§ 198 VVG). Miss that window and the insurer may ask health questions for the child.
Your family joins you later: what to plan
Many international professionals come first and bring their spouse and children a few months later. Health insurance follows two different logics here:
- If you are publicly insured: family insurance requires that your family members live in Germany. While they still live abroad, they are not covered. Once they have moved here and meet the conditions above, they can be family-insured through you – ask your fund which documents it needs, such as marriage and birth certificates.
- If you are privately insured: each family member needs an own private policy from the day they arrive. The insurer asks its health questions at that point, for every person – a surcharge or an exclusion for one family member can change the whole calculation.
For the visa of joining family members, adequate health insurance has to be proven. Whether a policy is sufficient is decided by the German mission abroad or the local immigration office (Ausländerbehörde) – this page is not immigration or legal advice.
Five questions for families before choosing
- Will my spouse earn an own income in Germany? If not, family insurance is worth hundreds of euros a month.
- How many children do we have or plan? Each child is an extra private premium, often for 18 years or longer.
- Are we married, and who earns more? The children rule in § 10 (3) SGB V can apply to mixed couples.
- How long will we stay? A move outside the EU/EEA usually ends a German private policy – for every family member.
- Can we afford private premiums for all of us if income falls? Private premiums don't follow income; public contributions do.
Family on the way? Decide before you switch
Many newcomers decide on their health insurance in the first weeks in Germany – often before the family has joined or before children are planned. Private insurance is hard to undo: under 55 the way back usually requires a job below the threshold, and from 55 it is usually closed (§ 6 (3a) SGB V). If your partner and children are likely to join you, or you want children in the next years, calculate the family scenario now.
The 60-second decider asks about your partner and children (planned ones too) and tells you honestly when public insurance fits better. All other downsides are summarised in disadvantages of private health insurance; the overall comparison is in public vs private health insurance. In German: PKV mit Kindern (source in German).
Frequently asked questions
Is private health insurance worth it for a family in Germany?
Usually not if one partner has no or little income: in public insurance the spouse and children are insured free of charge, in private insurance each person pays. It can make sense if both partners earn well, are privately insured themselves and plan to stay long term. Compare the total for all family members, not just your own premium.
Can I add my spouse to my private health insurance in Germany?
Not for free. In private insurance your spouse needs an own policy with an own premium and own health questions. Your employer contributes for dependants who would be family-insured in public insurance – but only up to the same overall maximum of €613.22 a month (2026).
How much does private health insurance cost for children in Germany?
Children's tariffs typically cost €120 to €250 a month per child (broker analysis, 4 September 2026); Allianz, for example, states €276.79 for a child aged 0–15 in one tariff (insurer's own example, October 2026). Children are not charged for private long-term care insurance (§ 110 SGB XI).
Are children automatically covered in public health insurance in Germany?
Usually yes, if they live in Germany and a parent is publicly insured: they are family-insured free of charge up to 18, up to 23 if not working and up to 25 in education (§ 10 SGB V). Exception: if the parent they are related to is not publicly insured, is married to the member, earns more than the member and more than €7,012.50 a month (2027).
What happens with a newborn if I am privately insured?
The insurer must cover your newborn without health questions and waiting periods if you register the child within two months of the birth, with cover not higher than your own (§ 198 VVG). The child then pays its own premium.
Sources
- § 10 SGB V – family insurance
- § 257 SGB V – employer contribution, including dependants
- § 198 VVG – insurance of newborns
- § 110 SGB XI – private long-term care insurance (children without premium)
- BGBl. 2026 I No. 228 – GKV-Beitragssatzstabilisierungsgesetz (spouse surcharge from 2028)
- Stiftung Warentest: private health insurance compared (Finanztest 3/2025) – 19 February 2025
- transparent-beraten.de: cost of private health insurance for children – broker analysis, 4 September 2026 (secondary source)
- Allianz: Private Krankenversicherung für Ausländer – insurer's own example, retrieved 10 October 2026
This article provides general information on health insurance in Germany (as of 10 October 2026). It does not replace individual advice. Which solution suits you depends on your personal situation, e.g. age, health, income, family and length of stay. Despite careful review we cannot guarantee completeness and accuracy; laws and tariffs change. It is not immigration advice: whether your insurance is sufficient for a visa or residence permit is decided by the German mission abroad or your immigration office. Publisher: German-PKV.de. German-PKV.de is not an insurance broker and does not provide insurance, legal or tax advice; individual advice is provided exclusively by specialised cooperation partners licensed under § 34d GewO.