Contents (14 sections)
- Public vs private health insurance in Germany: the two systems in a nutshell
- Who may choose private health insurance?
- What public and private health insurance cost in 2027
- Family: where public health insurance wins
- Benefits and everyday life: what changes for you
- Sick pay: the difference that matters for freelancers
- The long run: price increases, old age and the way back
- Leaving Germany: the exit plan decides
- Public vs private for typical newcomer profiles
- Five myths about health insurance for expats in Germany
- What changes in 2027 – in one place
- How the switch from public to private works in practice
- Public or private? Seven questions that decide
- Next steps
- Employees may only choose private health insurance above €77,400 (2026) or €84,150 (2027, draft); freelancers and civil servants can choose regardless of income.
- In 2027 an employee above the contribution ceiling pays up to €729.94 a month for public health and care insurance; full-cover private tariffs cost €649–1,137 at age 35, half paid by the employer.
- Public insurance covers a spouse without income and children free of charge; in private insurance every person pays.
- From 55 the way back to public insurance is usually closed (§ 6 (3a) SGB V) – and outside the EU/EEA a German private policy usually ends when you move.
- Rule of thumb: young, single, long stay and high income → private can make sense; family on one income, short stay or over 50 → usually public.
In Germany you can choose private health insurance only as an employee earning above €77,400 (2026) or €84,150 (2027, draft), or as a freelancer, self-employed person or civil servant. Private is often cheaper at first for young, single high earners who stay long. Public insurance is usually better for families on one income, short stays and people over about 50 – because contributions follow income and family members are insured free of charge (as of October 2026).
Public vs private health insurance in Germany: the two systems in a nutshell
Germany runs two full health insurance systems side by side. Most residents are in public insurance (gesetzliche Krankenversicherung, GKV), run by around 90 health insurance funds (Krankenkassen) such as TK, AOK or Barmer; 8.79 million people had full private cover at the end of 2025 (PKV association). Private insurance (private Krankenversicherung, PKV) is offered by private insurers and replaces public insurance completely – it is not a top-up. You are always in one of the two, never in both.
| Question | Public (GKV) | Private (PKV) |
|---|---|---|
| What does the price depend on? | Your income, up to a ceiling | Entry age, tariff, health at entry |
| Spouse without income, children | Insured free of charge | Each person pays a premium |
| Employer contribution | About half | Half of the premium, up to a maximum |
| Health questions | None | Yes – surcharge, exclusion or rejection possible |
| Bills | Insurance card, direct billing | You usually pay first and claim back |
| Benefits | Set by law, same for everyone | Set by your contract – can be more or less |
| Way back | – | Restricted; from 55 usually closed |
| Leaving Germany | Membership usually ends | Continues in the EU/EEA; elsewhere usually ends |
Who may choose private health insurance?
Whether you may choose at all depends on your status – not on your nationality.
Employees
Only with a regular gross annual salary above the income threshold (Jahresarbeitsentgeltgrenze): €77,400 in 2026, €84,150 in 2027 (draft). Already privately insured on 31 December 2026? Then €80,550 applies in 2027. Below the threshold, public insurance is compulsory.
Freelancers & self-employed
Free choice, whatever you earn. But public insurance needs prior insurance periods – newcomers from outside the EU often have no way in and must take out private insurance.
Civil servants
Usually private: the state's allowance (Beihilfe) pays part of the bills, a private tariff covers the rest.
PhD and students over 30
Employed doctoral researchers below the threshold are publicly insured. On a scholarship or as a student over 30, special rules apply – see health insurance for PhD candidates over 30.
New job vs existing job: If you start a new job with a regular salary above the threshold, you are exempt from day one. In an existing job you can only leave public insurance at the end of a calendar year – and only if your salary also exceeds the next year's threshold (§ 6 (4) SGB V). Your exact date: income threshold checker.
Public stays open for newcomers.If this is your first job in Germany and you earn above the threshold, you can still join public insurance voluntarily within three months of starting – without prior insurance (§ 9 (1) no. 3 SGB V). After that window it usually closes.
What public and private health insurance cost in 2027
In public insurance you pay a percentage of your income up to the contribution ceiling (Beitragsbemessungsgrenze) of €6,375 a month in 2027 (draft): the general rate of 14.6%, your fund's additional contribution (Zusatzbeitrag; 2.9% assumed for 2027) and long-term care insurance (Pflegeversicherung; 3.6%, childless people over 23 pay more). Employees pay about half. Anyone allowed to go private as an employee earns above the ceiling – so they pay the maximum.
| Per month in 2027 | Total | Your share |
|---|---|---|
| Public, employee above the ceiling, childless | €1,402.50 | €729.94 |
| Public, employee above the ceiling, one child | €1,345.13 | €672.56 |
| Public, self-employed at the ceiling, childless | €1,402.50 | €1,402.50 |
| Private full cover, age 35, employee | €649–1,137 | €324.50–568.50 |
| Private full cover, age 35, self-employed | €649–1,137 | €649–1,137 |
What an employee pays per month in 2027 – own share in €
Single, no children, salary above €84,150 · public: scenario with 2.9% additional contribution · private: Stiftung Warentest full-cover range for age 35, employer pays half
Own calculation, as of 10 October 2026: contribution ceiling €6,375 a month (Federal Cabinet decision of 7 October 2026, Bundesrat approval pending), long-term care per draft reform (childless 4.5%). Private: Finanztest 3/2025 (€649–1,137 total premium). Guide values, not an offer.
Two warnings about the private column. First, it is a benchmark for one age: older entrants pay more, and health questions can add a surcharge. Second, cheap is not the same as good: only 384 of 1,245 tariff combinations met Stiftung Warentest's full-cover criteria. Compare benefits such as psychotherapy, dental cover and the deductible (Selbstbehalt) – not just the price. Our page on private health insurance costs shows more published price examples.
Family: where public health insurance wins
This is the point most newcomers underestimate. In public insurance your spouse or registered partner and your children are family-insured (Familienversicherung) free of charge if they live in Germany, are not insured themselves and earn at most €565 a month (2026; €590 in 2027, draft). In private insurance every person needs a policy – children's tariffs typically cost €120 to €250 a month each (broker analysis, September 2026).
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.
- Mixed couples: If you are married, one of you is private and earns more than the other and above €7,012.50 a month (2027), your children can't be family-insured with the publicly insured parent (§ 10 (3) SGB V). Unmarried parents are not affected by this rule.
- From 2028: public insurance will charge a surcharge of 2.5 percentage points for a family-insured spouse – unless, for example, a child under 12 lives in the household. Even then, one surcharge is usually far cheaper than a second private policy.
- Your employer helps in private, too: the employer contribution also covers dependants – but only up to the overall maximum of €672.56 a month in 2027 (scenario).
More examples and the newborn rules in private health insurance with a family.
Benefits and everyday life: what changes for you
Public insurance benefits are set by law and are largely the same at every fund – funds differ mainly in their additional contribution, extra services and service quality. In private insurance your contract decides: a good tariff can pay more than public insurance (for example a single or double room in hospital, treatment by the chief physician), a cheap one can pay less.
Typical strengths of private insurance
- Benefits defined by your contract rather than by health legislation
- Options such as hospital comfort, higher dental cover, no-claims bonus (Beitragsrückerstattung)
- Some insurers and digital brokers serve expats in English
Typical downsides of private insurance
- You usually pay bills first and claim them back
- Health questions – surcharge, exclusion or rejection possible
- Contract documents may be binding only in German – check before you sign
English service exists on both sides: TK, for example, advertises English-speaking assistants around the clock and English apps; some private insurers and digital brokers serve expats in English. What to check is listed in private health insurance in English and in our fair TK vs private comparison.
Sick pay: the difference that matters for freelancers
Employees in public insurance receive sick pay (Krankengeld) from their fund once their employer's continued pay ends. Freelancers in public insurance only get it if they opt in with a declaration of choice and pay the general rate of 14.6% instead of 14.0%; it then starts from the seventh week of illness. In private insurance, sick pay is a separate policy (Krankentagegeld) that you choose and pay for yourself – as an employee it usually starts after your employer's continued pay, as a freelancer from a waiting day you pick. When you compare prices, compare like with like: a private premium without sick pay against a public contribution with sick pay is not a fair comparison. More for the self-employed in health insurance for freelancers.
The long run: price increases, old age and the way back
Both systems get more expensive. From 2006 to 2026, contributions per insured person rose by 3.9% a year in public and 3.4% a year in private insurance on average, according to the PKV association's research institute – averages that hide jumps in single tariffs. On 1 January 2026 about 60% of privately insured people had an increase, by about 13% on average (PKV association).
- Old age: In private insurance the premium does not follow your income – also not in retirement, when your employer's contribution ends. A legal 10% surcharge – paid from the year after you turn 21 until the year you turn 60 – is saved to dampen later increases (§ 149 VAG). In public insurance your contribution follows your (lower) pension income.
- The way back: Under 55 you can usually only return through a new compulsory insurance – for example a job below the threshold – or through family insurance. From 55 the way back is usually closed if you were not publicly insured in the previous five years (§ 6 (3a) SGB V). Details: switching back to public.
- Income risk: If your salary falls below the threshold later, you become compulsorily insured again as an employee – which some see as a safety net and others as a disruption.
Leaving Germany: the exit plan decides
For many newcomers this is the deciding factor. If you move to another EU/EEA country, a German private policy continues and pays up to German levels (§ 207 (3) VVG). If you move elsewhere – Switzerland, the UK, the USA, India – it usually ends unless you agree otherwise; a temporary move can be bridged with a dormant policy (Anwartschaft, § 15 (3) MB/KK 2009). Your ageing reserves (Alterungsrückstellungen) stay behind. Public insurance usually just ends when you move away.
So the shorter or more uncertain your stay, the stronger the case for public insurance. Read what happens to your health insurance when you leave Germany and plan your options with the leaving-Germany planner.
Public vs private for typical newcomer profiles
Most international professionals fall into one of these situations. The answers are a first orientation for 2027 – your own numbers come from the cost calculator.
| Profile | May choose private? | Usually the better fit |
|---|---|---|
| Blue Card IT specialist, €65,000, single | No – below €84,150 | Public by law |
| Senior engineer, €95,000, single, plans to stay | Yes | Private can make sense – with an exit plan |
| Manager, €110,000, spouse without income, two children | Yes | Public – family insured free of charge |
| Freelance designer from outside the EU, new in Germany | Yes – often the only option | Private, unless prior public periods open the door |
| Researcher on a two-year contract, €58,000 | No | Public by law |
| Consultant, €90,000, likely to leave within two years | Yes | Public – private is built for the long term |
| Job seeker with an Opportunity Card | No (no income yet) | Incoming cover now, public with the first job |
Five myths about health insurance for expats in Germany
“As an expat I need private insurance.”
No. Your nationality doesn't matter. Most employees in Germany, including most Blue Card holders, are publicly insured by law.
“Public insurance doesn't speak English.”
Not necessarily. TK, for example, advertises English-speaking assistants around the clock and English apps. Ask your fund.
“I can switch back whenever I want.”
No. Under 55 you usually need a job below the threshold or family insurance; from 55 the way back is usually closed.
“My incoming policy is enough.”
Only as a bridge. German missions point out that travel and incoming policies can exclude long stays – and once you live here you need German health insurance.
“Private is the cheap option.”
Only at the start and only for some. With a family, after a pay cut or in old age the picture can turn – and cheap tariffs often cover less.
“Both systems are good.”
True. Germany has two full systems with good care. The question is not which is better, but which fits your life for the next decades.
What changes in 2027 – in one place
- Income threshold: €77,400 → €84,150 (draft), including a one-off increase of €300 a month; €80,550 for people already privately insured on 31 December 2026.
- Contribution ceiling: €5,812.50 → €6,375 a month (draft) – public insurance gets more expensive for higher earners.
- Additional contribution: the official average for 2027 will be announced by 1 November 2026; the Ministry of Health aims for 2.9%.
- Long-term care: the draft care reform raises the surcharge for childless people from 0.6 to 0.9 points (4.5% in total).
- From 2028: a surcharge of 2.5 percentage points for family-insured spouses, with exceptions.
We update all values as soon as they are final – the date at the top of each page shows the last review.
How the switch from public to private works in practice
If you decide to go private, the order of steps matters – mistakes here are expensive and sometimes irreversible.
1. Check eligibility and timing
New job above the threshold: you may choose from day one. Existing job: the switch is possible at the turn of the year at the earliest – see the threshold checker.
2. Get offers – with care
Compare full-cover tariffs, not entry prices. If you have health issues, an anonymous pre-check through a broker comes before any application.
3. Apply and answer completely
Answer every health question the insurer asks (§ 19 VVG). Incomplete answers can cost you your cover years later.
4. Leave public insurance correctly
When compulsory insurance ends, your fund continues it as voluntary membership unless you declare your exit within two weeks of its notice and prove your private cover (§ 188 (4) SGB V). Tell your employer which insurer you chose.
Freelancers follow the same logic: get the private acceptance first, then end the public membership. The step-by-step guide with deadlines is in switching from public to private.
Public or private? Seven questions that decide
- May I choose? Employee above €84,150 (2027, draft), freelancer or civil servant?
- How long will I stay? Under two years usually means public.
- Who else needs cover? A spouse without income or children shift the balance towards public.
- How old am I? The later the entry, the higher the private premium – and from 55 there is usually no way back.
- How secure is my income? Private premiums don't fall when income does.
- Which benefits matter to me? Compare full-cover tariffs, not the cheapest offer.
- What is my exit plan? EU/EEA or elsewhere, return likely or not?
The 60-second decider runs through exactly these questions and gives you one of three honest answers: stay public, private with an exit plan, or the date you cross the threshold. A source in German with the same logic: GKV oder PKV im ehrlichen Vergleich (source in German).
Next steps
- Your own numbers, including family and ten years: public vs private cost calculator.
- From when you may switch: income threshold 2027.
- Honest downsides of private insurance: disadvantages of private health insurance.
- German terms explained: glossary.
Frequently asked questions
Is public or private health insurance better in Germany?
Neither is better for everyone. Private insurance can be cheaper and offer more for young, single high earners who stay long term. Public insurance is usually the better deal for families on one income, for short stays and for people over about 50, because contributions follow income and family members are insured free of charge.
Can foreigners get private health insurance in Germany?
Yes – under the same rules as Germans: employees above the income threshold (€77,400 in 2026, €84,150 in 2027, draft), freelancers, the self-employed and civil servants. Insurers check your health in the application. Your nationality does not decide, but your status and income do.
Why do most expats in Germany have public health insurance?
Because most employees earn below the income threshold and are insured by law. The EU Blue Card minimum salary – €50,700 in 2026 – is far below the threshold, so many Blue Card holders have no choice. Above it, public insurance remains a valid option.
Should I get private health insurance if I only stay a few years?
Usually not. Private contracts can bind you for up to two years under the model terms, your ageing reserves stay in Germany when you leave, and outside the EU/EEA the policy usually ends. Public insurance simply stops when you move away – and is easy to rejoin through a job.
What happens with public vs private health insurance in old age?
In public insurance your contribution follows your income, also in retirement. In private insurance the premium does not depend on income; a legal 10% surcharge, paid from the year after you turn 21 until the year you turn 60, helps to dampen increases later (§ 149 VAG), but premiums can still rise. Your employer's contribution ends when you retire.
Sources
- § 6 SGB V – exemption from compulsory insurance (income threshold, age 55)
- § 9 SGB V – voluntary insurance
- § 10 SGB V – family insurance
- § 257 SGB V – employer contribution
- Federal Government: contribution ceilings 2027 (Cabinet decision) – 7 October 2026, Bundesrat pending
- Stiftung Warentest: private health insurance compared (Finanztest 3/2025) – 19 February 2025
- PKV association: why premiums rise
- BGBl. 2026 I No. 228 – GKV-Beitragssatzstabilisierungsgesetz – spouse surcharge from 2028, § 6 (8) SGB V
- PKV association: model terms MB/KK 2009 – as of June 2024
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.