German Health Insurance Explained: Public vs Private

Health insurance in Germany isn't optional. It's the law. Every resident must have coverage, and you'll need to prove it during your Anmeldung and for your residence permit. The system is actually quite good once you understand it, but choosing between public (gesetzliche Krankenversicherung, or GKV) and private (private Krankenversicherung, or PKV) is one of the biggest financial decisions you'll make as an expat.

How the German System Works

Germany has a dual healthcare system that's been running since the 1880s. About 87% of residents are on public insurance, and 13% on private. Both systems provide excellent care. The difference is in how they work, what they cost, and who can access them.

If you earn under 73,800 EUR per year (2026 threshold), you must join public insurance. No choice. Above that salary, or if you're self-employed, you can choose between public and private.

Public Health Insurance (GKV)

Public insurance costs roughly 14.6% of your gross salary, split 50/50 between you and your employer. So your actual contribution is about 7.3% plus a small supplementary rate (Zusatzbeitrag) that varies by provider, typically 1.2-1.7%. On a 50,000 EUR salary, that works out to around 350-370 EUR per month from your paycheck.

Pros of Public Insurance

• Family coverage included - your non-working spouse and children are covered for free (Familienversicherung)
• Income-based pricing - if you earn less, you pay less
• No health screening - pre-existing conditions don't matter
• Contributions stay predictable - they scale with your salary, not your age

Cons of Public Insurance

• Longer wait times - especially for specialist appointments (weeks to months)
• No private rooms in hospitals unless you pay extra
• Limited dental coverage - basic only, crowns and implants are mostly out of pocket

Private Health Insurance (PKV)

Private insurance works completely differently. Your premium is based on your age, health status, and the coverage you choose, not your income. A healthy 30-year-old might pay 300-400 EUR per month for excellent coverage. The same plan at 50 could cost 700-900 EUR.

Pros of Private Insurance

• Faster appointments - doctors prioritize privately insured patients (controversial but true)
• Better coverage - private rooms, chief physician treatment, alternative medicine
• Potentially cheaper when young - if you're healthy and under 35, premiums can beat public rates

Cons of Private Insurance

• Premiums increase with age - and they increase faster than most people expect
• No family coverage - each family member needs their own policy
• Hard to switch back - returning to public insurance is difficult after 55
• You pay upfront - then submit claims for reimbursement

Which Should You Choose?

For most employed expats, public insurance is the safer choice. It's simpler, family-friendly, and predictable. Go with TK or one of the other large public insurers.

Private insurance makes sense if you're young, single, healthy, earn well above the threshold, and either plan to leave Germany eventually or are very financially disciplined about saving for rising premiums.

If you're freelancing, the decision is trickier. Public insurance for freelancers starts at about 210 EUR per month (minimum) but can jump to 900+ EUR at higher income levels. Private might be cheaper initially, but the long-term math often favors public.

How to Sign Up

For public insurance, contact TK, AOK, Barmer, or another GKV provider directly. Most have English applications online. For private insurance, use an English-speaking broker like Feather or ottonova. A broker costs you nothing extra since they're paid by the insurer, and they'll help you compare plans properly.

Our Honest Take

If we had to give one recommendation for expats who aren't sure how long they'll stay: go public. You can always switch to private later if your situation changes. Switching the other direction is much harder. And with a good public insurer like TK, the quality of care is genuinely excellent.