Health insurance is one of the most important financial decisions of all. The key question: statutory (GKV, gesetzliche Krankenversicherung) or private (PKV, private Krankenversicherung)? Both systems have clear pros and cons – depending on your occupation, income, age and family situation. We give you an overview.
Note: PKV contributions are strictly individual (age, health, plan). A reliable figure for the contribution is only possible after personal advice. This page does not replace individual insurance advice.
GKV or PKV – which suits me?
In Germany, health insurance is compulsory in principle. Most employees are in statutory health insurance (GKV) – the contribution depends on income (2026: general contribution rate 14.6% plus an additional contribution set by each fund; the average additional contribution set by the Federal Ministry of Health for 2026 is 2.9%). Contributions are charged on income up to the contribution assessment ceiling of €69,750 a year (€5,812.50 a month). The following can switch to private health insurance (PKV): employees earning above the compulsory insurance threshold (Versicherungspflichtgrenze, 2026: €77,400 gross a year), the self-employed, freelancers and civil servants (Beamte). Here the contribution is not based on income but on age, state of health and the chosen level of cover.
Advantages & risks of PKV
Advantages of PKV:
- Often more extensive benefits (treatment by the head physician, single room, free choice of doctor)
- Contribution independent of income – inexpensive if you are in good health and join at a young age
- Plans can be put together individually
Risks of PKV:
- Contributions can rise significantly in old age
- Children and non-working partners must be insured separately (no family insurance as in the GKV)
- Returning to the GKV later is only possible with difficulty
Switching to PKV should therefore be carefully considered – ideally with independent advice.
Tip: the plan is what counts
What matters is not the cheapest starting contribution but long-term contribution stability and the level of cover. Look at the ageing reserves (Alterungsrückstellungen), the option to switch plans (§ 204 VVG, the German Insurance Contract Act) and the insurer's solid balance-sheet figures. A cheap teaser plan can become expensive in old age.
What statutory health insurance covers and costs
The GKV (statutory health insurance) works on the solidarity principle: your contribution depends on your income subject to contributions, while the core benefits are the same for all insured people and are set out in Book V of the German Social Code (SGB V). They include medical treatment, hospital care, medicines, preventive care and sick pay. Under § 10 SGB V spouses and children without significant income of their own are covered free of charge through family insurance, which is a considerable financial advantage for families with a single earner.
A worked example using freely chosen sample values: an employee earns €4,000 gross a month. With the general contribution rate of 14.6% and the average additional contribution of 2.9%, the total rate is 17.5%, or €700 a month. Employer and employee each pay €350. Long-term care insurance comes on top. The additional contribution your fund actually charges is shown on its website and can change every year.
If your fund raises its additional contribution, § 175(4) SGB V gives you a special right of cancellation, so you can change fund by the end of the month for which the increase applies. Otherwise you are normally tied to your fund for twelve months. Switching is straightforward: the new fund handles the cancellation and the core benefits stay the same. Differences mainly concern statutory-plan extras such as bonus programmes, vaccination subsidies or alternative medicine.
How private health insurance works
The PKV (private health insurance) works on the equivalence principle: your premium depends on the risk you bring at the start of the contract and on the agreed benefits. You answer health questions and the insurer decides whether to accept you and whether to demand risk surcharges or exclusions. Wrong or incomplete answers can later lead the insurer to withdraw from or terminate the contract (§ 19 VVG, the German Insurance Contract Act), so answer the questions carefully and completely.
From your premium the insurer builds up an ageing reserve (§ 146 VAG, the Insurance Supervision Act) to cushion the rising healthcare costs of old age. For insured people aged 21 to 60 the insurer also charges a statutory premium surcharge of 10 percent (§ 149 VAG), which is later used to limit premium increases in old age. Premiums can still rise, for example when treatment costs grow. Adjustments are tied to statutory thresholds and must be reviewed by an independent trustee.
Employees receive an employer subsidy based on the amount the employer would pay if you were a GKV member (§ 257 SGB V). The self-employed receive no such subsidy. Civil servants receive state assistance (Beihilfe) from their employer and insure only the remaining share privately. An excess lowers your ongoing premium, but you pay medical bills up to the agreed amount yourself. Check whether you could really afford that sum in an emergency.
Switching, changing tariffs and the basic tariff
If you are privately insured, you can switch to another tariff with the same insurer and have a legal right to do so under § 204 VVG. The ageing reserves you have built up are credited. This is often the most effective way to contain rising premiums, for instance by moving to a tariff with a higher excess or a reduced scope of cover. Have the consequences of a tariff change explained in writing, because giving up benefits lowers the premium but can become expensive when you fall ill.
Switching to a different insurer is harder. Since 2009 you can take only part of your ageing reserve with you, namely the amount corresponding to the benefits of the basic tariff (§ 204(1) VVG). The new insurer also reviews your health again. The older and sicker you are, the smaller your choice. Changing insurer at an older age is therefore rarely financially sensible.
For people who cannot find a contract or are in financial difficulty there is the basic tariff (§ 152 VAG). It offers benefits at GKV level, cannot be refused and its premium is capped at the maximum GKV contribution. If you need financial assistance, the premium is halved. The basic tariff is not an ideal solution, but it is an important statutory safety net. Since 2009 § 193 VVG has also imposed a general obligation to hold health insurance.
Checklist before you decide
Before choosing between GKV and PKV, assess your income, family plans and health realistically. Factor in family planning: in the PKV every child costs a separate premium, in the GKV it does not. Remember also that your income may fall in retirement, whereas PKV premiums do not fall automatically. Anyone who stays in the PKV in retirement must be able to pay the premiums from their pension and other income.
Do not compare only the starting premium. Ask about premium adjustments over the last ten years, benefits for dentures, aids and psychotherapy, any premium refund and the size of the excess. Before you sign, the insurer must give you the product information sheet and the contract documents. Use the chance to read them in peace and, if necessary, get independent advice, for example from a consumer advice centre.
Private health insurers are supervised by the Federal Financial Supervisory Authority (BaFin). If you have a dispute with your insurer, you can contact the Ombudsman for private health and long-term care insurance free of charge. Statutorily insured people can complain to the fund, then to its objections committee and finally to the social court. Keep all notices and correspondence, because deadlines and evidence are decisive in these proceedings.