Private Health Insurance in Germany
The complete guide for expats navigating Germany's dual healthcare system. Learn who qualifies for PKV, what it costs, and how to make the switch — all in plain English.
What Is Private Health Insurance (PKV)?
The German healthcare system works differently from most countries. All residents must carry health insurance (Krankenversicherungspflicht), but depending on your income and employment status, you can choose between two fundamentally different systems:
- GKV (Gesetzliche Krankenversicherung) — the public, statutory system. Premiums are a percentage of your gross income (~14.6% plus supplements), and coverage is standardised across all providers.
- PKV (Private Krankenversicherung) — the private system. Premiums are based on your age, health profile, and chosen plan — not your earnings. Coverage is typically more comprehensive with faster access to specialists.
Over 8.7 million people in Germany are privately insured — roughly 11% of the population. PKV is particularly popular among high-earning professionals, self-employed individuals, civil servants, and international professionals relocating to Germany.
The dual structure traces back to Germany's 1883 Health Insurance Act (Krankenversicherungsgesetz), one of the world's first social insurance programmes. The private option evolved alongside the public system, creating the unique two-tier model that still defines healthcare in Germany today.
Eligibility: Who Qualifies for PKV?
Not everyone can opt out of the public system. PKV eligibility depends on your employment type and whether your salary exceeds the annual insurance threshold (Versicherungspflichtgrenze):
Employed Professionals
Earning above €77,400 gross/year (2026 threshold). Income must exceed this for at least one calendar year.
Self-Employed & Freelancers
No income threshold. You can join PKV regardless of how much you earn — especially attractive for the self-employed.
Civil Servants (Beamte)
Receive government aid (Beihilfe) covering 50–80% of costs, so they only need PKV for the remainder.
New Arrivals & Expats
Arriving in Germany with a job above the threshold or as self-employed? You can go directly into PKV.
GKV vs PKV: Key Differences
Choosing between GKV and PKV is one of the most important financial decisions for anyone moving to or working in Germany. Here's how the two systems compare across the categories that matter most:
| Feature | GKV (Public) | PKV (Private) |
|---|---|---|
| Monthly cost | ~14.6% of gross income (+ supplements) | Fixed premium based on age, health & plan |
| Doctor access | Standard panel doctors | All doctors including private specialists |
| Wait times | Weeks to months for specialists | Days — priority appointments |
| Hospital | Shared rooms, senior physician | Private room, chief physician treatment |
| Dental coverage | Basic (50–65% for standard treatments) | Comprehensive (80–100% including implants) |
| Family | Free co-insurance for dependants | Each member needs own policy |
PKV Costs: What Expats Can Expect to Pay
Unlike the income-based GKV model, PKV premiums are determined by individual risk factors. The main drivers of your monthly contribution are:
- Age at entry — the younger you join, the lower your base premium
- Health status — pre-existing conditions may lead to surcharges
- Coverage level — basic vs. comprehensive plans
- Deductible (Selbstbeteiligung) — a higher deductible lowers your premium
As a rough guide, expats in their early 30s in good health can expect premiums of €250–600 per month depending on the level of coverage chosen.
Employer contribution: If you're employed, your employer pays 50% of your PKV premium, up to a maximum of approximately €403 per month (2026). This effectively halves your out-of-pocket cost.
Premiums are also tax-deductible — basic health coverage contributions count as special expenses (Sonderausgaben), which can meaningfully reduce your tax bill.
Switching from Public to Private Coverage
Whether you're leaving the public system or choosing PKV as a new arrival in Germany, the process involves three key steps:
Verify Your Eligibility
Confirm that your income exceeds the threshold or that you qualify as self-employed, freelancer, or civil servant.
Compare Plans with a Broker
A licensed broker (Versicherungsmakler) compares 50+ insurers to find the plan that fits your health profile, budget, and coverage needs. Their service is free for you.
Apply & Complete Health Assessment
Answer health questions (Gesundheitsfragen), submit your application, and once accepted — cancel your GKV membership and notify your employer.
The entire process typically takes 4–8 weeks. Working with an English-speaking broker makes it straightforward, even without German.
PKV for Freelancers & Self-Employed
PKV is especially attractive for freelancers and self-employed professionals in Germany. Unlike salaried employees, there is no income threshold — you can opt for private coverage regardless of how much you earn.
The financial case is compelling: freelancers in GKV pay the full contribution rate themselves (no employer share), which can easily exceed €1,000 per month at higher incomes. A comparable PKV plan might cost €400–600 per month with better coverage.
The key trade-off: as a freelancer in PKV, you pay 100% of the premium yourself with no employer subsidy. However, premiums are fixed (not income-based), so as your income grows, your insurance cost stays the same — an advantage that compounds over time.
Top PKV Providers in Germany
Germany has over 50 PKV providers, ranging from established names like Allianz and DKV to specialists like HanseMerkur and Signal Iduna. Each insurer offers multiple tariff levels (Tarifoptionen), and premiums can vary significantly for the same person depending on the provider.
This is exactly why working with an independent broker matters — they have access to all providers and can match your health profile and priorities to the right plan, including insurers you might not find on your own.
Frequently Asked Questions
Answers to the most common questions from expats navigating the German healthcare system.
Yes. Expats who earn above the income threshold (€77,400 gross per year in 2026), are self-employed, or are civil servants can opt into the private system. Many international professionals choose PKV for its superior coverage and shorter wait times. The application process is the same as for German citizens — and English-speaking brokers handle the paperwork.
Yes, Krankenversicherungspflicht (compulsory health insurance) applies to all residents. However, you can choose between the public system (GKV) and the private system (PKV) if you meet the eligibility criteria. Employees earning above €77,400, self-employed individuals, and civil servants have the right to choose PKV.
Yes, but it becomes harder with age. If your income drops below the threshold or you become unemployed, you can return to GKV. After age 55, switching back is very difficult. Self-employed individuals can switch back by taking up salaried employment below the threshold.
Your PKV policy continues into retirement. Premiums may be lower because the statutory surcharge (Gesetzlicher Zuschlag) of 10% that you pay during working years builds a reserve specifically to stabilise premiums in old age. Additionally, your employer's contribution is replaced by a subsidy from your pension fund (up to half your premium).
Insurers evaluate your health history when you apply. Pre-existing conditions may lead to risk surcharges (Risikozuschläge), exclusions for specific conditions, or in rare cases, rejection. However, every insurer must offer a Basistarif (basic tariff) that cannot reject applicants. Working with an independent broker helps you find providers with the most favourable assessment for your situation.
Unlike the public system, there is no free co-insurance (Familienversicherung) in PKV. Each family member — spouse and children — needs their own policy. Children's premiums are relatively low (€100–200/month), but the total family cost can be higher than GKV. If your spouse works and earns below the GKV threshold, they can stay in the public system.
Yes. Contributions for basic healthcare coverage (Basiskrankenversicherung) are fully tax-deductible as special expenses (Sonderausgaben). Supplementary coverage like single-room hospital or dental extras are deductible up to certain limits. This can reduce your effective cost significantly, especially in higher tax brackets.
The Basistarif is a legally mandated basic tariff that every PKV insurer must offer. It provides coverage equivalent to GKV at a premium capped at the GKV maximum contribution. It matters as a safety net: if you can no longer afford your regular PKV premium, you can switch to Basistarif without a new health check. Insurers cannot reject Basistarif applications.
Ready to Explore Your Options?
We connect expats with licensed insurance brokers (Versicherungsmakler under §34d GewO) who provide free, personalised PKV consultations in English.