Health insurance is mandatory in Germany — every resident must be covered under either the public system (GKV — gesetzliche Krankenversicherung, statutory health insurance) or the private system (PKV — private Krankenversicherung). This is one of the most significant financial decisions for expats arriving in Germany, and the choice between GKV and PKV has implications that compound over years and decades.
The GKV (Public Health Insurance)
How it works: GKV is a social insurance system — contributions are income-based (approximately 14.6% of gross salary, split equally between employer and employee; there are additional supplementary contributions that vary by insurer, currently averaging about 1.7%). The contribution is capped at a monthly maximum (the Beitragsbemessungsgrenze, or contribution assessment ceiling — €5,512.50/month gross in 2025; contributions are not calculated on income above this). Coverage: all GKV members in Germany receive the same basic coverage regardless of insurer — hospital care (including semi-private rooms), GP care, specialist referrals, prescription drugs (with co-payments), dental (basic), mental health, maternity. Family co-insurance: spouses or partners without income and children can be co-insured on the same policy at no additional cost — this is one of the major advantages of GKV for families. The major GKV insurers: TK (Techniker Krankenkasse), AOK, Barmer, DAK — the differences between them are minor; compare their Zusatzbeiträge (supplementary contributions) and additional services. For English-speaking expats, TK has the best English-language services.
The PKV (Private Health Insurance)
How PKV works: private insurance — premiums are calculated individually based on age at entry, health status, and chosen coverage level. Not income-based — a 30-year-old with excellent health pays significantly less than a 50-year-old with pre-existing conditions. Coverage: PKV typically covers more than GKV — private hospital rooms, specialist access without referrals, dental (typically better), faster appointment access, some alternative treatments. The catch: the premium advantage at age 30 reverses over time — private insurance premiums increase significantly with age, and the premium at age 60-70 can become very burdensome. Additionally, switching back to GKV from PKV becomes very difficult (generally only possible if your income drops below the Versicherungspflichtgrenze, the mandatory insurance threshold). Family implications: unlike GKV, in PKV each family member needs their own separate policy — a family of four means four separate premiums. This is frequently not adequately factored in when younger single people choose PKV and then later have families. Who can choose PKV: employees earning above the Versicherungspflichtgrenze (in 2025: €69,300 gross/year or €5,775/month) can opt out of GKV and choose PKV. The self-employed and civil servants (Beamte) can use PKV regardless of income. The recommendation for most expats: unless you are young, healthy, have no intention of having a family in Germany, and are confident about long-term earnings above the threshold, GKV is the lower-risk choice. The PKV choice becomes attractive specifically for high-earning single people who plan to leave Germany before their 50s, or civil servants who get substantial employer contributions to PKV.
