Skip to main content

Health Insurance (Krankenversicherung)

In Germany, health insurance is mandatory for everyone.

Two Types of Insurance​

GKV (public)PKV (private)
Full nameGesetzliche KrankenversicherungPrivate Krankenversicherung
Contribution~17.5% of income (14.6% base + ~2.9% average Zusatzbeitrag, 2026; half paid by employer)Fixed, depends on age and health
CoverageStandard for allIndividual, often broader
FamilyFree (Familienversicherung) if family member earns under €565/month (2026)Each member pays separately

Who Can Choose PKV​

  • Employees with income above €77,400/year (2026)
  • Self-employed and freelancers
  • Civil servants (Beamte)

GKV — Public Insurance​

Advantages​

  • Contribution depends on income
  • Free family coverage (Familienversicherung — if family member earns under €565/month, 2026)
  • Easy to return to

Disadvantages​

  • Limited choice of doctors
  • Longer waits for specialists
  • Less coverage (e.g., dental)

TK (Techniker), Barmer, DAK, AOK

PKV — Private Insurance​

Advantages​

  • Faster access to doctors
  • Broader coverage
  • Better hospital conditions

Disadvantages​

  • Premiums increase with age
  • Return to GKV after 55 is virtually impossible (tightened from 2026)
  • Family not included
Important for Self-Employed

If you're a freelancer and chose PKV, returning to GKV will be difficult. Think carefully, especially if planning a family.

How to Choose​

SituationRecommendation
Young, healthy, high income, no familyPKV may be beneficial
Planning a familyLikely GKV
Self-employed with unstable incomeLikely GKV
BeamtePKV (state covers part)

FAQ​

The PKV trap: premiums keep rising, but switching back to GKV is blocked. What now?​

Returning from PKV to GKV is legally restricted and nearly impossible after age 55 (§ 6 Abs. 3a SGB V, tightened in 2026). Before 55, main paths: (1) salaried employment below Versicherungspflichtgrenze (€77,400/year in 2026); (2) register as unemployed with Arbeitsagentur; (3) employment in an EU country with mandatory public insurance, then return. Within PKV: there is a legal right to an internal tariff switch under § 204 VVG — no health check, Altersrückstellungen (age reserves) are preserved. Example: a tariff switch reduced premiums from €810 to €690/month (saving €4,680/year) with no coverage loss.

The average PKV premium increase in 2026 is 13%, with some individual tariffs rising 60%+ (2025 average was 18%). Increases are legal if the insurer follows VVG formal requirements. However, not every increase is lawful — if the notification letter has formal errors, you can challenge it and recover overpayments for up to 3 years. Available instruments: (1) internal tariff switch under § 204 VVG; (2) increase your Selbstbehalt (deductible); (3) use your Sonderkündigungsrecht (special cancellation right) within 2 months of receiving the increase notice.

What happens if I live in Germany without health insurance?​

Health insurance has been mandatory for all German residents since 2009. Consequences of gaps: (1) when you eventually join GKV, retroactive premiums (Nachzahlung) at ~50% of owed contributions for the entire uninsured period; (2) interest and late fees on top; (3) without insurance, you cannot renew a residence permit, register at a university, or complete various bureaucratic processes; (4) doctors may refuse non-emergency treatment. Example: 6 months uninsured at €450/month policy = ~€1,350 back payment. Getting insured from day one in Germany avoids these consequences.

Health insurance for freelancers: why 800+ €/month and how to reduce it?​

Freelancers in GKV pay the full rate (~17.5% in 2026) with no employer subsidy. Minimum monthly contribution: ~€220 (even with zero income); maximum: over €1,000/month. Factors affecting the amount: (1) switch Krankenkasse — Zusatzbeitrag varies, saving €100+/year; (2) ensure contributions are calculated on actual profit (Gewinn), not revenue; (3) for creative professions — apply to Künstlersozialkasse (KSK), which covers 50% of contributions; (4) deduct 100% of basic health and Pflegeversicherung on your tax return.

Familienversicherung: who qualifies for free coverage?​

Familienversicherung is free co-insurance for family members in GKV. Covers a spouse with no income or income below the threshold (~€505/month) and children up to 18 (up to 25 if studying). PKV has no equivalent — each family member pays separately. This is the key argument for GKV when planning a family: two children and a non-working spouse in GKV cost nothing extra; in PKV, that means 3 additional policies.

Sources​