Public vs Private Health Insurance (GKV/PKV)

Germany has a dual health insurance system: public statutory insurance (GKV - Gesetzliche Krankenversicherung) and private insurance (PKV - Private Krankenversicherung). About 90% of residents are in GKV, but high earners and self-employed people have a choice.

Public insurance (GKV) charges a percentage of your income, about 17.5% total, split between you and your employer. The maximum contribution is capped because there is an income ceiling (Beitragsbemessungsgrenze) of €5,812.50/month in 2026. A major advantage is free family coverage: your spouse and children are included at no extra cost if they earn below €565/month.

Private insurance (PKV) sets premiums based on your age, health status, and chosen coverage level when you first enrol. Premiums do not depend on income. Young, healthy people often pay less than in GKV, sometimes with better coverage (single rooms, faster appointments). However, each family member needs their own policy, and premiums rise with age.

The biggest risk of PKV is the difficulty of returning to GKV. Once in PKV, switching back requires meeting strict conditions (e.g., earning below €77,400 as an employee). After age 55, it becomes nearly impossible. Many people in PKV face rapidly rising premiums in retirement when they can least afford them.

Civil servants (Beamte) are a special case. The government covers about 50-80% of their medical costs through Beihilfe, so they only need PKV for the remainder, making it much cheaper. For civil servants, PKV is almost always the better choice.

As an employee, your GKV contribution comes straight off your salary: the salary calculator shows it in your net pay. Self-employed? Start with the Freiberufler or Gewerbe check.

Sources: §6 Abs. 1 Nr. 1 and §10 SGB V, §18 SGB IV and the yearly Sozialversicherungs-Rechengrößenverordnung (gesetze-im-internet.de); the Familienversicherung income limit cross-checked against two independent tax guides.