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Private health insurance: narrow way in, hard way back
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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...
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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...
Compare private health insurance in Germany
Advertising notice: provider links in this overview are affiliate links — we receive a commission from the provider for sign-ups made through them.
Full private health plans from ottonova, a licensed private health insurer, and Feather, a licensed insurance agent; both serve customers in English. The monthly prices come from our own product database and are starting prices, because every premium depends on age at entry, health and the options chosen.
The decision has a deadline built into it. Employees choose when they start their first job in Germany or when their salary crosses the line, students within three months of enrolling, and each choice is hard to undo: an exemption from public insurance cannot be withdrawn, and from 55 the public system stays shut for most people who left it. The threshold for employees also moves every 1 January, so a salary that clears it today may fall short of it next year.
- Who may join: employees whose regular pay exceeds €77,400 a year (threshold for 2026), the self-employed in their main occupation, civil servants, and students who apply for an exemption within three months of enrolling.
- What sets the price: age and health when you join, the tariff and the deductible. For a 32-year-old, ottonova publishes example premiums of €284 to €358 a month as the employee’s own share and €579 to €726 for the self-employed (as of 4 October 2026).
- What the employer pays: half of the premium, but never more than it would pay towards public health insurance: €508.59 a month at most in 2026, with a separate subsidy for long-term care insurance.
- Who usually stays public: employees below the threshold have no choice, and a family with one earner keeps a spouse without income and the children insured free of charge in the public scheme. Private cover charges every person separately.
- Who sells it in English: ottonova (a licensed private health insurer), Feather (a licensed insurance agent) and, for advice across several insurers, Getsafe.
Who may take private health insurance
Public insurance is the default in Germany. Private full cover is only possible for people the law places outside compulsory public insurance, and the routes out are narrow. Your employment status decides first, your income second.
| Your situation | Public or private | The rule that decides |
|---|---|---|
| Employee, regular annual pay above the threshold | Your choice: a private policy, or voluntary membership of a public fund | § 6(1) no. 1 SGB V. On a first job in Germany you have three months to join a public fund voluntarily (§ 9(1) no. 3 and (2) no. 3). |
| Employee at or below the threshold | Public insurance is compulsory; private policies only as a top-up | § 5(1) no. 1 SGB V |
| Self-employed or freelance as main occupation | Not compulsorily insured; public membership only with enough previous public insurance | § 5(5) and § 9(1) no. 1 SGB V: 24 months in the last five years or 12 months without a break immediately before |
| Civil servant (Beamter) | Private cover for the share the state’s Beihilfe does not pay | § 6(1) no. 2 SGB V |
| Student under 30 | Public student insurance, unless you apply for an exemption within three months | § 5(1) no. 9 and § 8(1) no. 5 SGB V; the exemption cannot be withdrawn (§ 8(2)) |
| Job seeker, language student, newcomer before the first contract | A temporary incoming or expat policy that satisfies the visa | § 2(3) of the Residence Act counts sufficient health insurance as part of the means of subsistence; the regular choice follows once you work or study |
| Source: Book V of the Social Code (SGB V), §§ 5, 6, 8 and 9, as published on gesetze-im-internet.de. The threshold for employees is set each year by the Social Insurance Reference Values Ordinance. | ||
Two details catch employees out. First, crossing the threshold in the middle of a year does not free you at once: compulsory insurance ends at the end of the calendar year in which your pay exceeded the line, and only if it also exceeds the threshold that applies from 1 January (§ 6(4) SGB V). A newcomer whose first German contract pays above the threshold, by contrast, is free from the first working day. Second, that newcomer has only three months to join a public fund voluntarily instead; whoever lets the deadline pass cannot use this route into public insurance later.
The self-employed face the opposite problem. They are free of compulsory insurance, but a public fund can only take them on with the previous insurance periods listed in § 9 SGB V, and most newcomers from outside the EU do not have them. For them private cover is often the only way to meet the duty that applies to everyone living in Germany (§ 193(3) of the Insurance Contract Act). Insurers add requirements of their own: Feather, for example, asks freelancers who are new to Germany for an income of at least €36,000 a year if they are under 51 and €51,000 from 51 (as of 4 October 2026).
Students have their own page, because the exemption is final for the whole degree: private health insurance for students explains the student tariffs and when the public student rate is the safer choice. Newcomers who need cover for a visa before the first contract start on our page on health insurance for expats.
The Federal Ministry of Labour has proposed €84,150 a year (€7,012.50 a month) for 2027: the wage-linked adjustment of 4.38% plus an extra €300 a month that the law requires. The ordinance still has to be adopted by the Federal Government and approved by the Bundesrat. If your pay rises above today’s threshold but stays below the new one, compulsory public insurance does not end on 31 December. If you are already privately insured and the new threshold overtakes your salary, you become compulsorily insured again. The law has so far allowed an exemption on application within three months when a change of the threshold causes this (§ 8(1) no. 1 SGB V), and such an exemption cannot be withdrawn; whether it also covers the extra 2027 increase depends on the final rules, so ask the public fund before you rely on it.
Which cover fits which situation
Being allowed to go private is not the same as being better off with it. Each row describes a group of readers who move to Germany, not your individual case, and the last word belongs to the offer you receive after the health questions.
| Situation | Cover that usually fits | What to settle first |
|---|---|---|
| Employee above the threshold, single or with a working partner | Private full cover, or voluntary public insurance if you value the way back | Daily sickness benefit from day 43, the employer subsidy, and whether your pay will stay above the threshold |
| Self-employed newcomer | Private full cover; a temporary expat tariff only as a bridge | The full premium without subsidy, a daily sickness benefit from an early day, the insurer’s income requirement |
| Employee above the threshold with a partner at home and children | Usually public insurance with free family cover | Compare the household total: in private cover each person pays a premium |
| Employee below the threshold | Public insurance plus private top-ups, for example dental insurance | Which public fund, and which gaps a top-up should close |
| Student | Public student insurance or a private student tariff | The exemption is final for the whole degree |
| Free family insurance for a spouse and children without own income: § 10 SGB V. Children of a privately insured parent who earns more than the publicly insured parent and more than one twelfth of the threshold a month cannot be insured free of charge (§ 10(3) SGB V). | ||
The family row is the one that most often turns the calculation. A child of two publicly insured parents costs nothing extra, and so does a spouse without income. In private cover a child tariff costs a premium of its own, and if the parent with the higher income is privately insured and earns more than the threshold, the child cannot join the other parent’s public insurance for free either. Our page on statutory health insurance covers the public side of the comparison, and the GKV and PKV comparison sets the two systems side by side.
What private health insurance costs
A private premium is fixed when you join, from four inputs: your age at entry, your state of health, the tariff and the deductible. Income plays no part, which is the main difference from the public scheme, where you pay a percentage of your pay up to a ceiling.
| Monthly cost | Employee, own share | Self-employed, full premium |
|---|---|---|
| ottonova, five tariffs from Premium Economy to First Class Pro+ | €284 to €358 | €579 to €726 |
| Public health insurance at the contribution ceiling | €508.59 | €1,017.19 |
| ottonova: example calculations on the insurer’s tariff pages for a 32-year-old with €150 daily sickness benefit from day 43 and €200 premium relief from 67, without risk surcharge, retrieved 4 October 2026; these are not quotes. Public scheme: general rate of 14.6% plus the average supplementary rate of 2.9% on the 2026 ceiling of €5,812.50 a month (Federal Ministry of Health). Long-term care insurance is compulsory in both systems and comes on top. | ||
At 32 the comparison favours the private side; the price that matters, though, is the one you pay at 50 and at 70. Three mechanisms decide it.
- Adjustments in steps. Insurers may only raise premiums when a basis of their calculation, such as the claims they pay, changes more than temporarily, and an independent trustee has to agree (§ 203 of the Insurance Contract Act). Increases therefore tend to come as larger steps after calmer years. The association of private health insurers reported increases for around 60% of privately insured people on 1 January 2026, averaging about 13% for those affected, and expects an average premium of about €617 a month across all its members’ customers in 2026. The association speaks for the industry; the figures are its own.
- The statutory surcharge. From the calendar year after you turn 21 until the year you turn 60, a full private policy carries a surcharge of 10% that goes straight into your ageing reserve and is used to hold premiums down in old age (§ 149 of the Insurance Supervision Act).
- Every person pays. A partner without income and each child need a policy of their own, which is why private cover gets more expensive with every family member.
Employees keep their employer’s contribution. It equals half of the general public rate plus half of the average supplementary rate, applied to their pay up to the ceiling, and never more than half of the actual premium (§ 257(2) SGB V): in 2026 at most €508.59 a month for health insurance, plus a separate subsidy for private long-term care insurance (§ 61 SGB XI). The self-employed pay everything themselves. The details by age and tariff are on our page on private health insurance costs.
What to check in a tariff
Private cover is a contract, not a catalogue: two tariffs that look alike in a brochure can pay very differently. Six points decide most of the difference.
- Daily sickness benefit. An employer continues your pay for six weeks of illness (§ 3 of the Continued Remuneration Act); after that a privately insured employee gets nothing unless the policy includes a daily sickness benefit (Krankentagegeld). Employees usually let it start on day 43, the self-employed much earlier.
- Doctors’ fees. Doctors bill private patients under the official fee scale, normally up to 2.3 times the base rate and up to 3.5 times where the case justifies it (§ 5 GOÄ). A tariff that reimburses only up to 2.3 times leaves you with the rest.
- Deductible and refund. ottonova offers deductibles of €500, €1,000 or €1,250 depending on the tariff, and two tariffs without deductible that refund part of the premium after a year without claims; Feather offers €0, €1,200 or €3,000 in each of its three plans.
- Dentures and medical aids. Dental benefits are often capped in the first years of a contract; ottonova’s tariff conditions, for example, set staged limits for the first three or four years. For medical aids such as hearing aids, check whether the tariff pays by medical necessity or only from a closed list. Read the tariff conditions, not the summary.
- Cover abroad. Feather’s plans cover the EU and EEA and up to one month outside Europe; anyone who travels for longer needs a tariff or a top-up that says so.
- Changing tariff later. You have a right to move to another tariff of your insurer with comparable cover and keep your ageing reserve; only for additional benefits may the insurer ask health questions again (§ 204 of the Insurance Contract Act). Changing insurer is a different matter, because most of the reserve stays behind.
How to apply: health questions, documents, waiting periods
The application is where private cover is won or lost. You must disclose every circumstance the insurer asks about in text form, and if an answer is wrong, the insurer may withdraw from the contract or end it (§ 19 of the Insurance Contract Act). On the answers it decides whether to accept you at the normal premium, with a surcharge, with an exclusion, or not at all.
If your medical history is complicated, do not send formal applications to several insurers to see what happens. An insurance broker (Versicherungsmakler) or a fee-based insurance adviser (Versicherungsberater, paid by you and not by insurers, § 34d(2) of the Trade Regulation Act) can ask insurers how they would assess you before you apply. If no normal tariff is available, every insurer based in Germany that sells full cover must offer the basic tariff, whose benefits are comparable to public insurance and whose premium may not exceed the maximum public contribution (§ 152 of the Insurance Supervision Act).
Expats should have these ready: passport and residence permit or visa, the employment contract or proof of self-employment and income, a confirmation of previous health insurance, and a German or SEPA bank account for the premium. Previous cover matters for the waiting periods, which may not exceed three months in general and eight months for childbirth, psychotherapy, dental treatment, dentures and orthodontics: time in a public fund or under another health insurance contract must be credited if you apply no later than two months after it ended, for cover that follows on directly (§ 197 of the Insurance Contract Act). Once you are accepted, the insurer issues a confirmation for your employer, which the employer needs to pay the subsidy; Feather, for example, puts it in your online account together with the confirmations for the visa and the tax office.
Who sells private health insurance in English
The German market has 42 health insurers under federal supervision (BaFin company database, as of 3 October 2026), and the list of private health insurance companies names them all. Three providers serve expats in English, and each plays a different legal role.
ottonova: a licensed private health insurer
ottonova Krankenversicherung AG in Munich has held a licence as a health insurer since June 2017 and carries the risk of its policies itself. It sells five full tariffs, from Premium Economy to First Class Pro+, manages them in an app and offers English-speaking support by phone and chat, which also helps to find English-speaking doctors. For stays of limited length it has a separate expat tariff that ends after 60 months at the latest.
Advertising notice: provider links in this overview are affiliate links — we receive a commission from the provider for sign-ups made through them.
Feather: a licensed insurance agent
Feather is the brand of Popsure Deutschland GmbH in Berlin, registered as an insurance agent (Versicherungsvertreter) under § 34d(1) of the Trade Regulation Act, register number D-E6HJ-UVL9S-62. It sells three plans, Standard, Plus and Premium, entirely online and in English; a quote takes a few minutes. Feather does not carry the medical risk itself: the insurer that underwrites your plan is named in your policy documents.
Advertising notice: provider links in this overview are affiliate links — we receive a commission from the provider for sign-ups made through them.
Getsafe: advice across insurers
Getsafe compares more than 150 private health offers and names Hallesche, ARAG and Allianz among its partners; its plans start at €200 a month, and a first consultation of 15 minutes is free and in English (as of 4 October 2026). Two companies stand behind the brand: Getsafe Digital GmbH is registered as an insurance agent, Getsafe Broker GmbH as an insurance broker (§ 34d(1) no. 1 and no. 2 of the Trade Regulation Act). Getsafe no longer runs an insurer of its own.
Leaving again: the way back to public insurance
The way back is not a choice but a consequence. You return when the law makes you compulsorily insured again, typically because an employee’s pay falls below the threshold, and you can then cancel the private policy with effect from that date if you do so within three months (§ 205(2) of the Insurance Contract Act). From the age of 55 this route closes for most people: anyone who was not publicly insured in the five years before and was privately insured, exempt or self-employed for at least half of that time stays outside even with a job below the threshold (§ 6(3a) SGB V). The exceptions and the right order of steps are on our page on switching back to public health insurance.
Frequently asked questions
Only if your regular annual pay exceeds the compulsory insurance threshold, which is €77,400 a year in 2026. If you already work in Germany, compulsory public insurance ends at the end of the calendar year in which your pay crossed the line, and only if it also exceeds the threshold of the following year. If your first job in Germany pays above the threshold from the start, you can choose at once; to stay in the public system instead, you must join a public fund voluntarily within three months of starting work.
For some people, at least at the start. Public insurance costs a share of your pay, at most €1,017.19 a month for health cover in 2026, half of it paid by an employer. A private premium follows age, health and tariff instead: ottonova’s example for a 32-year-old ranges from €579 to €726 a month before any employer subsidy (as of 4 October 2026). Young, healthy single earners often pay less privately; a family with one income usually pays less publicly, because a spouse without income and the children are insured free of charge there.
Possibly, but on the insurer’s terms. The application asks about your health in writing, and you must answer every question completely; a wrong answer allows the insurer to withdraw from the contract later. On your answers it can accept you, add a surcharge, exclude the condition or refuse. If no normal tariff is available, every insurer based in Germany that sells full cover must offer the basic tariff, which pays benefits comparable to public insurance and may not cost more than the maximum public contribution.
No. Every person needs a contract and a premium of their own; the private system has no free family insurance. Whether the children can join a publicly insured parent’s cover for free instead depends on the parents’ incomes: it is excluded when the privately insured parent earns more than the publicly insured one and more than €6,450 a month. Work out the household total before you decide, not only your own premium.
Only when the law makes you compulsorily insured again, for example because your pay as an employee falls below the threshold. You then have three months to cancel the private policy with effect from that date. From the age of 55 the route is closed for most people who were not publicly insured in the five years before. The exceptions are explained on our page on switching back to public health insurance.
If you are privately insured as an employee and the new threshold on 1 January exceeds your regular pay, you become compulsorily insured in the public system. For this case the law provides an exemption on application to the public fund within three months, which lets you keep your private policy but cannot be withdrawn later; ask the fund how it applies to your situation before you rely on it. If you are still publicly insured, crossing the old threshold is not enough: your pay must also exceed the new one.
Sources and legal basis (as of 4 October 2026)
Statutes (Federal Ministry of Justice, gesetze-im-internet.de): § 5 SGB V (compulsory insurance), § 6 SGB V (exemption above the threshold, rule from 55), § 8 SGB V (exemption on application), § 9 SGB V (voluntary membership), § 10 SGB V (family insurance), § 257 SGB V (employer subsidy), § 61 SGB XI (subsidy for long-term care insurance), § 3 EFZG (continued pay during illness), § 19, § 193, § 197, § 203, § 204 and § 205 VVG (Insurance Contract Act), § 149 and § 152 VAG (statutory surcharge, basic tariff), § 34d GewO (agents, brokers, advisers), § 5 GOÄ (doctors’ fee scale), § 2 AufenthG (means of subsistence).
Thresholds and contribution rates: Social Insurance Reference Values Ordinance 2026 (compulsory insurance threshold and contribution ceiling); Federal Ministry of Labour and Social Affairs, draft ordinance for 2027 and draft text with explanatory notes (21 September 2026); Federal Ministry of Health, contributions in statutory health insurance 2026 (average supplementary rate 2.9%).
Supervision and market figures: BaFin company database, health insurers under federal supervision (data as of 3 October 2026) and entry for ottonova Krankenversicherung AG; withdrawal of the Getsafe Insurance AG licence; Association of Private Health Insurers, figures for 2025 and premium increases in 2026 (read on 7 September 2026).
Providers (read on 4 October 2026 unless stated): ottonova tariff pages for employees and the self-employed, ottonova expat health insurance (7 September 2026), ottonova tariff conditions Business Class Pro, First Class Pro+ and First Class Expats; Feather, private health insurance, Feather imprint and Feather licensing information 2026; Getsafe, private health insurance and Getsafe imprint (7 September 2026).
Prices and card details in the comparison come from our own product database and are refreshed automatically; example premiums in the text are the providers’ published calculations as of the date given, not quotes.