Health insurance in Germany: public and private, and how to actually decide

Health insurance is the one policy nobody living in Germany can skip. The difficult part is not whether you need it, but which of the two systems you belong in — and that choice is harder to undo than most newcomers expect.

What German health insurance actually is

Germany runs two parallel systems. Around nine in ten residents are in the public system, gesetzliche Krankenversicherung (GKV), run by non-profit funds called Krankenkassen. Your contribution is a percentage of your salary, your employer pays roughly half, and your spouse and children can often be covered at no extra cost. The rest are in private health insurance, private Krankenversicherung (PKV), where the price depends on your age and health when you join, not on your income.

This topic needs more than a one-line summary because the two systems follow completely different logic. Public insurance is a solidarity system: everyone gets the same legally defined benefits. Private insurance is a contract: you get exactly what your tariff says — often more than the public system, sometimes less — and the premium is calculated for you personally.

Why health insurance works differently in Germany

Health insurance is compulsory for everyone who lives in Germany, from the first day of residence. Most employees are automatically members of the public system. Only if your gross salary is above the compulsory insurance threshold (Versicherungspflichtgrenze, €77,400 a year in 2026) can you choose private cover instead. Self-employed people, freelancers and civil servants may choose regardless of income.

Two things surprise many expats. First, you cannot simply switch back and forth: once you are private, a return to the public system is only possible under narrow conditions, and after 55 it is almost impossible. Second, a travel or expat policy from home usually does not count as valid health insurance for a German residence permit.

What health insurance costs in Germany

Public (GKV): 14.6% of your gross salary plus a fund-specific additional contribution (on average 2.9% in 2026, many funds charge more), plus long-term care insurance of 3.6% (4.2% if you are 23 or older and have no children). Employers pay about half. Contributions stop rising at €5,812.50 gross a month — at that level an employee pays roughly €610–650 a month for health and care together, and the employer pays about the same again.

Private (PKV): For a healthy employee in their early thirties, full cover typically starts around €400–700 a month in total, of which the employer contributes half up to a legal maximum. Children and non-working partners each need their own policy.

Self-employed in the public system: a minimum contribution of roughly €270–300 a month applies, even with low income.

What it does not cover

Public insurance covers what is medically necessary — reliably and generously — but not comfort or extras. For adults, glasses and contact lenses are usually not paid for, dental crowns and implants are only partly covered, and a single hospital room or treatment by the head physician costs extra. Many of these gaps can be closed with inexpensive supplementary policies (Zusatzversicherung).

Private insurance covers what your tariff lists and nothing beyond it. Pre-existing conditions may be excluded or cost a surcharge, deductibles are common, and cheap tariffs can have lower limits for things like psychotherapy or medical aids than the public system.

What expats should watch out for

• Gaps are billed retroactively. If you should have been publicly insured and were not, the fund can charge the missing contributions later.
• Health questions are binding. In private insurance, every treatment in recent years must be declared — including those abroad. Omissions can void the policy when you need it.
• Waiting periods. Private tariffs can have a general waiting period of three months and eight months for pregnancy, dental work and psychotherapy. These are often waived when switching directly from other cover — ask before you sign.
• Sick pay. From week seven of illness, public insurance pays sick pay (Krankengeld). In private insurance, this only exists if you add daily sickness benefit (Krankentagegeld).
• Think about the long term. Private cover can be excellent value when you are young, single and high-earning. With a family, a career break or a plan to stay into retirement, the maths often changes.

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