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Public, private or expat cover: which one fits you
Written by
Janine El-Saghir
Janine El Saghir is an editor at How-to-Germany.com, where she specializes in the practical aspects of daily life and integration for expatriates. With years of...
Reviewed by
Erkan Boga
Erkan Boga is the founder and CEO of qmedia GmbH, the publishing house behind How-to-Germany.com. He established the platform with the clear vision of creating...
Edited by
Sadie Voss
Content Lead & Editor
Sadie Voss is the Lead Editor for How-to-Germany.com. As an expat who carved her own way into Berlin from the United States, Sadie is deeply...
- Everyone who lives here must be insured — in public health insurance or with a private plan from an insurer authorized in Germany. Without cover you pay the missed months later.
- Employees earning up to €77,400 a year (2026) have no choice: they belong to public insurance and only pick the fund.
- Above that salary, the self-employed and civil servants may choose private cover. It pays off for some and becomes a trap for others — family plans, income swings and age decide.
- Students under 30 are in public student insurance unless they opt out within three months; that decision cannot be undone.
- Before your first job, a temporary incoming policy usually covers the visa and the first months. It is a bridge, not a long-term solution.
Three kinds of cover — and the legal duty behind them
Germany runs two full systems side by side, and newcomers often meet a third kind of policy before either of them applies.
Public health insurance (gesetzliche Krankenversicherung, GKV) is run by non-profit funds called Krankenkassen. The contribution is a share of your income, not of your risk: age, gender and health play no part. The benefits are set by law and are largely the same at every fund. Spouses and children without their own income are insured free of charge, and doctors bill the fund directly when you show your card.
Private health insurance (private Krankenversicherung, PKV) is a contract with a company. The premium depends on your age and health when you join and on the plan you pick; every family member needs a policy of their own. You usually pay the doctor’s bill and claim it back. In return, the plan can cover more than the public catalog — single rooms, chief physicians, higher dental or vision allowances — and private patients tend to get specialist appointments sooner.
Incoming or expat health insurance is a temporary policy for people who come from abroad. It is built for the visa and the weeks before a job or university place starts, excludes pre-existing conditions and usually runs for a few years at most. Once you work in Germany, it no longer meets the requirements for your situation.
Behind all three sits one rule: everyone who lives in Germany must have health insurance. That means public insurance, or a private plan from an insurer authorized in Germany that pays at least for outpatient and hospital treatment.1 If you were last insured in the public system and have no other cover, you are placed back into it — and owe contributions from the first day.2 On the private side, a late start costs a surcharge: one monthly premium for every month without cover, and one sixth of a premium for every further month from the sixth.1
Which insurance you can choose: the decision path
The choice is less open than comparison sites suggest. German law looks at what you do here — work for an employer, run a business, study — and at your salary. Answer these questions in order; the first one that fits decides.
- Are you a student at a state or state-recognized university and under 30? You must be in public student insurance.2 Private cover is possible only if you apply for an exemption within three months of enrolling. The exemption then holds for your whole course of studies.3 Health insurance for students
- Are you a civil servant (Beamter)? You do not have to join public insurance.4 The state’s allowance (Beihilfe) pays a share of your medical bills; a private plan covers the rest.
- Do you work for an employer? Compare your regular annual pay with the limit of €77,400 (or €6,450 a month).
- Up to the limit: public insurance from your first working day.2 You choose the fund; a private plan can only top it up.
- Above the limit: you are free to choose between voluntary membership in public insurance and a private plan.4 If this is your first job in Germany, a public fund must take you as a voluntary member — as long as you apply within three months of starting.5
- Are you self-employed or a freelancer as your main occupation? Public insurance is not compulsory for you.2 A fund accepts you as a voluntary member only if you were publicly insured for at least 24 months in the last five years, or for twelve months without a break right before.5 Newcomers without that record usually insure privately. Health insurance for freelancers
- Is your spouse or parent publicly insured, and do you earn little or nothing? You may be covered free of charge through their family insurance (details below).
- None of these yet — you are applying for a visa or looking for work? You need cover for the visa and your stay until a job or course begins, usually an incoming policy. Expat health insurance
| Your situation | Public (GKV) | Private (PKV) |
|---|---|---|
| Employee earning up to €77,400 a year | Compulsory | Only as a top-up |
| Employee earning more | Voluntary membership | Yes, your choice |
| Self-employed, freelancer | Voluntary, only with earlier public cover | Yes |
| Student under 30 | Compulsory student insurance | Only after an exemption within three months |
| Student over 30, language course, Studienkolleg | Voluntary, only with earlier public cover | Yes, often the only option |
| Civil servant | Voluntary, rarely sensible | Yes, alongside Beihilfe |
| Spouse or child of a public member with little or no income | Free family insurance | Own policy only if family insurance is ruled out |
| Visa applicant, job seeker before the first job | From the first job | Incoming policy until then |
| Aged 55 or older and not publicly insured in the last five years | Usually closed, even with a low salary | Stays private |
| Sources: Social Code Book V and Residence Act as of 19 October 2026 (gesetze-im-internet.de); the exact provisions are listed in the sources at the end of the page. Simplified; special groups such as apprentices, pensioners and people on benefits follow their own rules. | ||
The income limit: when an employee may go private
The limit that decides whether you may leave public insurance is the compulsory insurance threshold (Versicherungspflichtgrenze or Jahresarbeitsentgeltgrenze): €77,400 a year in 2026. What counts is your regular annual pay from employment. Allowances paid because of your family status are left out.4 Whether a bonus counts depends on whether it is regular and agreed — payroll can tell you how your contract is assessed.
Starting a job above the limit: you are free from compulsory insurance from the first day and decide between a private plan and voluntary public membership.
Already employed and your pay rises above it: compulsory insurance ends only at the end of the calendar year — and only if your pay also exceeds next year’s limit, which applies from 1 January.4 That second condition matters now. On 7 October 2026 the federal government adopted the values for 2027: an income limit of €84,150 a year and a contribution ceiling of €76,500. They are still a draft: the Bundesrat, the chamber of the federal states, has to approve them (status 19 October 2026).6 Someone earning €80,000 is above the 2026 limit but below the 2027 one, and so stays in public insurance next year.
Do not confuse the threshold with the contribution ceiling (Beitragsbemessungsgrenze) of €69,750 a year. The ceiling caps the income on which public contributions are charged; it has nothing to do with whether you may go private.
More on the rules for private cover: eligibility for private health insurance.
What health insurance costs in 2026
Public insurance charges a general rate of 14.6% of your income plus the additional contribution (Zusatzbeitrag) of your fund. The Federal Ministry of Health publishes an average additional rate for each year — 2.9% for 2026 — but every fund sets its own.7 Long-term care insurance comes on top: 3.6%, plus a surcharge of 0.6% for members aged 23 or older without children.8 Income above €5,812.50 a month is not charged.
| Who pays | How it is calculated | Per month |
|---|---|---|
| Employee | Half of the health rate and half of the care rate on your salary; the employer pays the other half. The childless surcharge is yours alone. | Up to about €613, or €648 if childless (at the ceiling; in Saxony about €29 more) |
| Self-employed, voluntary member | Full rate on your income, at least on a minimum of €1,318.33 a month; with sick pay from the 43rd day | About €278 to €1,226 (€286 to €1,261 if childless) |
| Student under 30 | Reduced student rate on a fixed amount of €855 a month (2026/27 winter semester) | €142.96, or €148.09 if childless and 23 or older |
| Spouse or child in family insurance | No contribution of their own | €0 |
| Sources: Federal Ministry of Health, contribution rates 2026 (minimum and maximum contributions); Social Code Books V and XI and the long-term care contribution ordinance 2025. Calculated by us on 19 October 2026; your fund’s own additional contribution changes the result. | ||
Private premiums have no table of this kind: they depend on your age at entry, your health, the plan and the deductible. Employees above the limit get an employer subsidy of half the premium, capped at the amount the employer would pay toward public insurance.9 The self-employed pay everything themselves — in either system. What drives private premiums and how they develop with age: private health insurance costs.
Public or private: how to decide when you have the choice
If the law leaves the decision to you, five questions settle most cases.
- Who else needs cover? A spouse without income and children are free in public insurance. In private insurance each of them pays a premium — and children may even be shut out of free public cover if the parent with the higher income is private (see families below).
- How stable is your income? Public contributions fall when your income falls. A private premium stays the same during parental leave, a weak business year or unemployment.
- How healthy are you today? Private insurers ask health questions before they accept you.10 Pre-existing conditions can lead to surcharges, exclusions or a refusal. Public insurance takes everyone at the same rate.
- How long will you stay, and how old are you? Private plans build reserves for old age, so joining young keeps premiums lower. The way back is narrow. From 55, you stay private even if your salary drops — if you were not publicly insured in the previous five years and were free of compulsory insurance or self-employed for at least half of that time.4
- What do you want from your doctor? Private patients typically get specialist appointments sooner and can choose extended benefits; public patients avoid paying bills upfront and the paperwork of claiming them back.
Private cover usually suits single employees well above the limit, the self-employed with a steady income and civil servants. Public cover usually suits families with one earner or several children, anyone with a pre-existing condition, people whose income is uncertain and those who expect to cross back below the limit. A side-by-side table of benefits, billing and contributions is on our page GKV vs. PKV.
Private health insurance plans you can sign up for in English
Advertising notice: provider links in this overview are affiliate links — we receive a commission from the provider for sign-ups made through them.
These plans are open to employees above the income limit, the self-employed and civil servants; the insurer checks your health before accepting you. ottonova is a private health insurer; Feather is a licensed insurance agent that sells plans of partner insurers. If your salary is below the limit, the next section is the one that applies to you. All insurers in comparison: private health insurance companies in Germany.
Choosing a public health insurance fund
Choosing a Krankenkasse is simpler than it looks, and you cannot pick wrong in a way that is hard to fix.
- You choose freely among the funds open in your state. A fund may not turn you down.11
- Tell your employer within two weeks of starting. If you do not, the employer registers you with your last fund — or, if you have never been insured in Germany, with a fund it picks.11
- You are bound for twelve months. After that, you can switch with two months’ notice to the end of a month.11 If your fund raises its additional contribution, you may leave earlier.
- Compare three things: the fund’s additional contribution, service in English, and the extras each fund may add to the standard benefits.12 Many funds, for example, pay €20 to €100 toward professional teeth cleaning, according to the consumer advice centers (Verbraucherzentrale).13
Step by step, with the documents you need: how to choose and register with a public fund. Funds side by side: public health insurance providers compared.
Moving to Germany: visa, first job and EU citizens
For a visa or residence permit, you must be able to support yourself including adequate health insurance. Membership of a public fund always counts as adequate.14 For a private or incoming policy, the embassy or immigration office checks the terms. Before a job starts — as a job seeker, with an Opportunity Card or on a language course — most newcomers take an incoming policy. What these plans cover and which ones are sold in English: expat health insurance in Germany; for short visits, see travel insurance for visiting Germany.
With your first German employment contract, the decision path above applies from day one: public insurance below the limit, a free choice above it. Cancel the incoming policy for the day your new cover starts.
EU citizens can use the European Health Insurance Card for treatment that cannot wait during a temporary stay, such as a holiday, a business trip or a study period.15 It does not replace German insurance once you move here and take up work.
Families: who is covered for free
Public family insurance (Familienversicherung) covers a member’s spouse or registered partner and children at no extra cost. The conditions: they live in Germany, are not insured in their own right, are not self-employed as their main occupation and earn no more than €565 a month — €603 with a mini-job. Children are covered up to 18, up to 23 if they do not work and up to 25 while in school or training.16
One exception surprises many couples: if the parent who is not publicly insured earns more than one twelfth of the income limit a month and more than the publicly insured parent, the children are not covered for free.16 They then need their own voluntary or private policy. Plan this before one partner goes private. Families compared in detail: health insurance for families.
When your situation changes
- Your salary falls below the limit: public insurance becomes compulsory again — unless you are 55 or older and meet the five-year rule above.4 Switching back from private to public
- You want to leave public for private: as a voluntary member, cancel after twelve months with two months’ notice to the end of a month and prove your new cover.11 Switching from public to private
- Your student insurance ends: it continues as voluntary membership, at a much higher contribution. To avoid that, leave within two weeks of the fund’s notice and prove other cover.17
- You become self-employed: compulsory insurance through the job ends. Your earlier public cover usually entitles you to stay as a voluntary member — decide before you leave.
Top-up cover worth considering
Public insurance pays for what is medically necessary. The largest gap is dental work: for crowns, bridges and dentures, the fund pays a fixed subsidy based on the standard treatment. You pay the rest.18 Dental insurance is therefore the most common private add-on for publicly insured people.
Advertising notice: provider links in this overview are affiliate links — we receive a commission from the provider for sign-ups made through them.
What the plans pay, waiting periods and how to choose: dental insurance in Germany. Other add-ons — hospital extras, glasses, alternative medicine — are on our page on supplementary health insurance, and cover for trips abroad on travel health insurance.
Frequently asked questions
Yes. Everyone living in Germany must be insured — in public health insurance or with a private plan from an insurer authorized in Germany that pays at least for outpatient and hospital treatment. If you take out private cover late, the insurer charges a surcharge of one monthly premium for every month you were uninsured. If you were last insured in the public system, you are placed back into it and owe contributions from the first day without cover.
Only in certain situations. Employees earning more than €77,400 a year (2026), the self-employed and civil servants may choose private cover. Employees below that salary are compulsorily insured in the public system, and students under 30 are in public student insurance unless they apply for an exemption within three months of enrolling.
The income limit (Versicherungspflichtgrenze, €77,400 a year in 2026) decides whether an employee may leave public insurance. The contribution ceiling (Beitragsbemessungsgrenze, €69,750 a year in 2026) only caps the income on which public contributions are charged. For 2027, the federal government adopted €84,150 and €76,500 on 7 October 2026; the Bundesrat still has to approve them.
Yes, for employees in both systems. In public insurance, the employer pays half of the general rate and of the fund’s additional contribution, and half of the long-term care contribution. Privately insured employees get a subsidy of half their premium, capped at the amount the employer would pay toward public insurance. The self-employed pay their full contribution or premium themselves.
In public insurance, usually yes: a spouse or registered partner and children are covered at no extra cost if they live in Germany, are not insured in their own right and earn no more than €565 a month, or €603 with a mini-job (2026). Children are covered up to 18, up to 23 if they do not work and up to 25 in school or training. In private insurance every family member needs a policy of their own.
Yes. Private insurers ask about your health before they accept you and can charge a surcharge, exclude a condition or refuse the application. Public funds must accept every person who is entitled to join, at the same rate regardless of health.
Only if you become compulsorily insured again, for example because your salary as an employee falls below the income limit. From the age of 55, even that does not work if you were not publicly insured in the previous five years and were free of compulsory insurance, exempt from it or self-employed for at least half of that time. Treat private cover as a long-term decision.
Only during a temporary stay, such as a holiday, a business trip or a study period, and only for treatment that cannot wait. Once you move to Germany and take up work, you need German health insurance under the same rules as everyone else.
Sources and legal basis (as of 19 October 2026)
Footnotes (laws: gesetze-im-internet.de, retrieved on 19 October 2026)
- Insurance Contract Act (VVG) § 193: duty to have health insurance, surcharge for a late start
- Social Code Book V (SGB V) § 5: compulsory insurance, students, self-employed, fall-back insurance
- Social Code Book V § 8: exemption of students
- Social Code Book V § 6: income limit, civil servants, end of compulsory insurance at year end, age 55
- Social Code Book V § 9: voluntary membership
- Federal Ministry of Labour and Social Affairs, Social Insurance Calculation Values Ordinance 2027 and the government draft of 7 October 2026 (2027 values, Bundesrat approval pending)
- Social Code Book V § 242 and § 242a: additional contribution and average additional contribution
- Social Code Book XI (SGB XI) § 55: long-term care rate, childless surcharge
- Social Code Book V § 257: employer subsidy for private insurance
- Insurance Contract Act § 19: health questions
- Social Code Book V § 173 and § 175: choice of fund, registration, twelve-month commitment, switching
- Social Code Book V § 11: benefits, extras of the funds
- Verbraucherzentrale, subsidies of the health insurance funds for professional teeth cleaning (retrieved on 7 September 2026)
- Residence Act (AufenthG) § 2: adequate health insurance cover
- European Union, Your Europe, health cover for temporary stays (European Health Insurance Card)
- Social Code Book V § 10: family insurance
- Social Code Book V § 188: end of compulsory insurance, continued voluntary membership
- Social Code Book V § 55: dental subsidies
Further sources (retrieved on 19 October 2026): Social Code Book V § 236 (student contribution base), § 240 (contributions of voluntary members), § 241 (general rate), § 245 (student rate), § 249 (contribution shares of employees); Social Code Book XI § 58 (contribution shares, Saxony); Federal Training Assistance Act § 13 (student needs rate); Social Insurance Calculation Values Ordinance 2026 (income limit, contribution ceiling, reference value); Long-Term Care Contribution Rate Ordinance 2025 (3.6 % from 1 January 2025); Federal Ministry of Health, contributions to public health insurance (rates, average additional contribution 2026, minimum and maximum contributions).
Calculations: the monthly costs in the table are our own calculation from the rates and amounts above (19 October 2026), at the average additional contribution; your fund’s own rate changes the result.