Your HR department sends you a form on your first week. It asks which health insurance you have. If you are new to Germany and earning below a certain salary, the answer is already decided for you. If you earn above it, or if you are self-employed, you have a choice. It is one of the most consequential financial decisions you will make in Germany, and it is much harder to reverse than it is to make.
This guide explains what each option means, what it costs in 2026, and which one fits your situation.
Not sure where to start? Here's a quick look at how GKV and PKV compare in practice.
What Is GKV and What Is PKV?
GKV (Gesetzliche Krankenversicherung, or statutory health insurance) is Germany's public system. Around 90% of people in Germany are covered by GKV. Your premium is calculated as a percentage of your income, your employer pays half of it, and your family members are covered at no extra cost. It is a solidarity system: everyone contributes according to income and everyone receives the same standard of care.
PKV (Private Krankenversicherung, or private health insurance) is an entirely separate system. Your premium is not based on your income. It is based on your age when you sign up, your health at that point, and the level of coverage you choose. You pay medical bills upfront and submit receipts to claim reimbursement later. Both systems provide solid medical care. The differences are in how you pay, what you pay over time, and how much flexibility you have if your life changes.
Who Can Choose Between GKV and PKV?
Most expats starting employment in Germany do not get a choice. If your gross salary is below the JAEG (Jahresarbeitsentgeltgrenze, or annual income threshold), GKV is mandatory by law.
The threshold in 2026 is €77,400 per year (€6,450 per month gross). If you earn below this as an employee, you are in GKV. If you earn above it, or if you fall into one of the following groups, you can consider PKV: employed people earning more than €77,400/year, self-employed people and freelancers at any income level, civil servants (Beamte) who typically receive a state subsidy for PKV, and students under certain age limits. If you are unemployed and receiving Bürgergeld (citizens' income), GKV is automatic. Most expats arriving for a first professional role in Germany land in GKV without any decision to make.
How Much Does Each Cost in 2026?
GKV Costs
GKV premiums are calculated as a percentage of your gross income. The standard base rate is 14.6%, and each GKV provider adds its own Zusatzbeitrag (additional contribution), which averages around 3.4% across providers in 2026. Combined, you pay approximately 18% total, split equally between you and your employer. On a €60,000/year salary, your monthly share is around €225, and your employer pays the same.
GKV contributions are capped at the Beitragsbemessungsgrenze (contribution ceiling), which is €5,512.50/month gross in 2026. Earn above this and your contribution stays fixed at around €496/month on the employee side, regardless of how much more you earn. If you are self-employed, you pay 100% of the contribution yourself with no employer covering half, which means on a €60,000/year income your GKV cost as a freelancer is around €900/month. This is a major difference that many self-employed people underestimate when comparing the two systems.
PKV Costs
PKV premiums are not based on your income. They depend on your age at sign-up, your health status, and the plan you choose. A 30-year-old in good health might pay around €250 to €400/month for solid coverage, which can look attractive compared to GKV at the same income. The same person at 60 might pay €600 to €900/month on a comparable plan, and in retirement, when your employer no longer contributes, that full premium comes out of your pension income alone.
| Your situation | GKV per month (approx) | PKV per month (approx) |
|---|---|---|
| Employed, €60,000/year | ~€225 (you pay half) | €250–400 (age 30, healthy) |
| Employed, €90,000+/year | ~€496 (capped) | €300–500 (age 30, healthy) |
| Self-employed, €60,000/year | ~€900 (no employer split) | €250–400 (age 30, healthy) |
| Family of 3, employed €90,000/year | ~€496 (family free on GKV) | €700–1,200+ (per-person premiums) |
| Age 60, in PKV since age 30 | — | €600–900+ (rising with age) |
GKV figures vary by provider's Zusatzbeitrag. PKV figures are illustrative estimates and vary significantly based on health and chosen plan.
What Does Each System Cover?
| Service | GKV | PKV |
|---|---|---|
| GP and specialist access | Standard wait times | Faster appointments; broader choice of doctors |
| Hospital | Shared room; doctor on duty | Private or single room; chief physician |
| Dental | Basic care fully covered; advanced treatment partly subsidised | Customisable; up to 100% dental coverage possible |
| Psychotherapy | Up to 300 sessions via approved providers | Typically 20–30 sessions per year |
| Prescription drugs | 10% co-pay (€5–€10 per item) | Full reimbursement; deductible may apply |
| Pre-existing conditions | Covered automatically; provider cannot reject you | Health check required; exclusions possible |
| Sick pay (from day 43) | Included: 70% of gross income, capped | Requires a separate sick-pay clause in your plan |
| Maternity leave (Elternzeit) | Contributions paused during leave | Premiums continue during leave |
Two gaps in particular are often missed in comparisons. On psychotherapy: GKV covers up to 300 sessions through approved therapists, while PKV typically caps this at 20 to 30 sessions per year depending on your tariff. If mental health support matters to you, GKV has a clear and significant advantage here. On maternity leave: PKV holders continue paying full premiums during Elternzeit (parental leave), at a time when income is often reduced, while GKV contributions are paused.
Family Coverage: The Cost That Changes Everything
GKV includes free family coverage for your spouse and children, as long as they have no significant income of their own. A family of four on GKV pays the same monthly rate as a single person. There are no extra policies, no extra forms, no extra cost.
PKV works differently. Each family member needs a separate policy with its own premium. A child's plan costs around €100 to €200/month. A non-working partner's plan costs around €200 to €400/month. A family of four on PKV could easily pay €700 to €1,200/month more per month than the same family on GKV at the same income level. This single difference is why GKV almost always wins on total cost for families, even at high incomes.
How Costs Change Over Time
GKV costs are tied to your income, so they move with your life. If you earn less, you pay less. If Germany raises the contribution rate, it applies to everyone equally and your employer still absorbs half. In retirement, your GKV contribution is calculated on your pension income, which is lower than your working income, so your monthly cost drops accordingly.
PKV premiums rise with age by design. Providers build Altersrückstellungen (age reserves) into your premiums to slow future increases, but premiums still climb substantially over decades. The retirement problem is especially serious for self-employed people on PKV: as a freelancer, no employer has ever contributed to your premiums. When you retire, your pension replaces your working income, but your PKV premium does not drop to match. You pay a high premium out of reduced pension income: a trap that many self-employed people do not plan for until it is too late to change course.
Can You Switch Back to GKV After Choosing PKV?
Switching from GKV to PKV is simple. Switching back is not. Germany's rules are deliberately designed to prevent people from using cheaper PKV while young and healthy, then returning to GKV when older and more likely to need care.
You can return to GKV only in specific circumstances: if your salary drops below the €77,400 threshold and you are under 55, or if you become unemployed and claim social benefits. After age 55, switching back is practically impossible unless you have been continuously voluntarily insured in GKV throughout your working life. This is the most important thing to understand about PKV: you are not just deciding about this year's premium, you are deciding where you will be in 20 or 30 years. Once you are past 55, the door back to GKV closes.
GKV or PKV: Which Is Right for You?
Answer four quick questions and get a personalised recommendation based on your employment status, income, family situation, and plans for Germany.
If you prefer the text version:
Choose GKV if your income is below €77,400/year (it is mandatory), you have children or a non-working partner, you plan to stay in Germany long-term or retire here, you have any pre-existing conditions, or you are self-employed and want predictable costs in retirement.
Choose PKV if you earn above the threshold as an employee or are self-employed, you are young and healthy with no dependants, you plan to leave Germany within a few years, and you have carefully modelled the long-term costs including what happens in retirement. If you are self-employed and considering PKV, get advice from a fee-based Versicherungsberater (insurance adviser) before deciding. A commission-based broker earns more when you choose PKV. A fee-based adviser does not.
How to Sign Up for GKV
Frequently Asked Questions
The health insurance decision feels bigger than it is for most people. If you are employed and earning below €77,400/year, GKV is your answer, and it is a solid one. If you are self-employed or above the threshold, take the time to model the numbers across your lifetime, not just this year's premium, and consider what the costs look like when you are 60 rather than 30.
If you want a clear answer based on your specific income, employment status, and family situation, XpatAI can walk you through the decision in a few minutes.