GKV or PKV — what would you actually pay?

Public or private health insurance in Germany: the questions people actually ask

Can I choose private health insurance?

Not everyone can. As an employee you need a gross salary above the compulsory insurance threshold (Versicherungspflichtgrenze), which is €77,400 in 2026 — and you generally need to have been above it in two consecutive years before you are free to leave the public system. Self-employed people, freelancers and civil servants may choose at any income. Students and people on short-term contracts have their own rules.

Is private insurance cheaper?

Often yes on the day you sign, and that is exactly what makes the decision hard. Public contributions are a percentage of income and stop rising at the ceiling, so a high earner pays the same as anyone else above it. A private premium is calculated from your age at entry, your health at entry and the cover you choose — nothing to do with your income. A healthy 32-year-old will usually pay less privately. The same person at 60 may not, because premiums rise over a lifetime as medical costs and life expectancy rise, and the employer's contribution is capped.

Can I go back to the public system later?

Under 55, yes, but only through a specific door: as an employee your gross salary has to fall back below the threshold, which makes public insurance compulsory again, or you become employed under it after being self-employed. From 55 onwards it is largely closed. The law blocks a return if you were not covered by public insurance for at least one day in the previous five years, and if you were exempt or outside compulsory cover for more than half of that period. Family cover through a publicly insured spouse remains a narrow exception with strict income limits. Treat the switch as close to permanent.

What happens to my family?

This is the single largest structural difference and it does not appear in a monthly premium comparison. In the public system, a spouse without their own income and your children are covered at no extra cost. In the private system every person is a separate policy with a separate premium, including newborns. For a single high earner private cover can be markedly cheaper; for the same person with a non-working partner and two children the arithmetic often reverses entirely.

What happens to my premium when I retire?

Private premiums do not fall at 67. Insurers build ageing provisions (Alterungsrückstellungen) to dampen the rise, and you can pay into an optional supplement to reduce the premium in old age, but the trend is upward across a lifetime. In the public system, pensioners pay a percentage of their pension, with the pension insurer covering roughly half of the health contribution. Anyone weighing up the two should look at the projection to 67 and beyond, not just the figure for next month.

What if I leave Germany?

Public cover normally ends when your employment and residence in Germany end, and cover continues elsewhere in the EU only under coordination rules. A private policy is a contract you can sometimes keep, which is occasionally an advantage — but German policies are built around German treatment costs and may be poor value abroad. If you expect to leave within a few years, that belongs in the decision from the start.

What does my employer pay?

Roughly half, either way. In the public system your employer pays the same share as you. If you go private, your employer contributes half the premium but no more than a statutory maximum — €508.59 a month for health plus €104.63 for long-term care in 2026. Once your premium passes about €1,017 a month, every further euro is yours alone. Self-employed people have no employer share at all, which is why the comparison looks so different for them.