Health insurance in Germany: public or private?
Facts as of 07/2026 · reviewed every 6 months · by Benjamin Farmer
The short answer
Health insurance is mandatory in Germany from day one of your employment. As an employee earning up to €77,400 gross per year (2026), you are automatically insured in the public system (GKV) — your employer registers you, the contribution of roughly 17.5% of gross salary is split between you and your employer, and non-working spouses and children are covered free of charge. Only above that threshold can you choose private insurance (PKV) instead, which can be cheaper for young, healthy, high-earning singles but is a long-term decision that is hard to reverse. For most international hires the honest answer is: start public, decide about private later, deliberately.
- Mandatory
- yes — from your first day of employment (no waiting period)
- Public threshold 2026 (JAEG)
- PKV possible only above €77,400/year gross (€6,450/month)
- Public cost 2026
- 14.6% + insurer supplement (avg. 2.9%, range ~2.2–4.3%) ≈ 17.5% of gross — half paid by employer, capped at €69,750 income
- Family (GKV)
- non-working spouse & children covered free (Familienversicherung)
- Family (PKV)
- every family member pays their own premium
- Choosing a public insurer
- free choice among ~90 Krankenkassen; supplements differ
How the public system (GKV) works
Public insurance is income-based, not risk-based: you pay a percentage of your salary, and everyone gets the same core coverage — doctors, hospital, medication, sick pay after six weeks. The general rate is 14.6% of gross salary plus an insurer-specific supplement (2.9% on average in 2026, ranging from about 2.2% to over 4.3%). Your employer pays half of the total, and contributions are only charged on income up to €69,750 (2026). Above that, your effective rate falls.
You can pick any public insurer (Krankenkasse) — the coverage core is identical by law, so the differences are the supplement rate, English-language service, and extras like dental cleaning or health apps. For internationals, an insurer with solid English support is usually worth more than 0.2 percentage points of supplement.
When private insurance (PKV) becomes an option
Employees may only switch to private insurance when their regular salary exceeds the Versicherungspflichtgrenze — €77,400 in 2026. Private premiums are calculated from your age, health and chosen tariff, not your income. That's why PKV can look dramatically cheaper for a healthy 30-year-old earning €90,000 — and become expensive later:
- Premiums rise with age, and switching back to public insurance is deliberately difficult — above 55 it is practically impossible.
- Every family member costs extra. The free family coverage of the GKV does not exist in PKV — a partner who pauses work and two children can triple your household premium.
- Better access, better rooms: PKV typically buys faster specialist appointments, private hospital rooms and broader dental cover. Those benefits are real.
- Rule of thumb: PKV suits high earners who stay high-earning, plan no larger family in Germany, and decide with a long horizon. If your family plans are open, GKV's family insurance is one of the best deals in the German system.
What internationals specifically need to know
- Your visa depends on it: proof of health insurance is required for residence permits. Travel insurance does NOT count for employment.
- Day one, automatically: your employer registers you for GKV with your start date — you only choose *which* Krankenkasse. Tell HR your choice in the first days, otherwise they pick one for you.
- EHIC/expat policies from home don't replace German insurance once you are employed here.
- Waiting for the Anmeldung? You can already be insured — the Krankenkasse needs your address later, but employment triggers cover immediately.
Common mistakes
- Signing a private tariff in week one because it's cheaper this year — reverse gears barely exist; decide deliberately, not under time pressure.
- Comparing GKV insurers only by supplement rate and ignoring English service quality.
- Assuming a foreign travel or expat policy satisfies German requirements once employed — it doesn't.
- Forgetting that the JAEG threshold changes every January — a salary that allowed PKV last year may not this year.
- Not naming a Krankenkasse to HR and being defaulted into one that has no English support.
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Benjamin Farmer
Executive German coach and licensed § 34d broker in Bavaria. I place international professionals with German employers — free for candidates — and walk them through exactly these steps every week.
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This guide is general information for orientation — not legal, tax or insurance advice. Rules, fees and thresholds change; the facts above were last verified 07/2026 against the sources listed below and are reviewed every six months. For decisions about your specific case, rely on the responsible authority or on qualified professionals — legal questions are handled by our partner immigration lawyers, tax questions by cooperating tax advisors.
Sources: AOK — Jahresarbeitsentgeltgrenze (employer guidance) · Finanztip — GKV-Zusatzbeiträge 2026 · Make it in Germany — Health insurance