Germany splits health insurance into two systems: GKV (gesetzliche Krankenversicherung, statutory public insurance) and PKV (private Krankenversicherung). The right choice depends on your income, employment type, and family situation — and switching from one to the other is difficult once you’re enrolled.
GKV: Public Insurance
Employees earning below €69,300 gross per year (2024 threshold) are mandatory GKV members. The contribution is 14.6% of gross salary, split equally between employee and employer, plus a provider-specific surcharge averaging around 1.7%. For a €3,500/month salary, you’d pay roughly €290/month.
GKV covers spouses and children without extra cost if they don’t have their own income. Pre-existing conditions don’t affect your rate. The coverage is comprehensive but some services (dental crowns, prescription glasses, certain specialist treatments) require co-payment.
PKV: Private Insurance
Employees earning above €69,300 can choose PKV. Freelancers, civil servants (Beamte), and self-employed people can access PKV regardless of income. Premiums depend on age, health status, and coverage level — a healthy 28-year-old might pay €250–400/month for a good plan, while a 45-year-old with health history pays significantly more.
PKV offers shorter waiting times, better specialist access, senior doctor treatment, private hospital rooms, and direct reimbursement (you pay, submit receipt, get refunded). Your family members each need their own PKV policy at additional cost — this is where PKV becomes expensive for families.
Who Should Choose PKV
PKV makes financial sense for: single high earners (salary above €6,000/month), civil servants (Beamte, who get 50–70% refunded by their employer), and young healthy freelancers with no children. For families with one income, GKV usually costs far less because spouses and children ride free.
Switching Back to GKV
Once in PKV, returning to GKV is very difficult. You can switch only if your income drops below the threshold (very unlikely for established workers) or if you become unemployed. Private insurance can become extremely expensive in your 50s and 60s. Factor this into a 30-year calculation, not just today’s premium.
