| Profile | Monthly cost (employee share) |
|---|---|
| Employee, any salary | ~8.75% of gross, capped at €508.60/mo |
| Freelancer, voluntary, minimum | €260–€278/mo |
| Freelancer, ~€4,000/mo income | €620–€700/mo |
| Student tariff (under 30) | €120–€140/mo |
Sources: BMG, vdek
Health Insurance12 May 20269 min read
Health Insurance in Germany 2026: The Complete Guide for Expats
GKV vs PKV explained in plain English with verified 2026 figures: €77,400 threshold, real costs by profile, switching rules, and coverage compared.
The short version
- Every resident of Germany must hold health insurance. The rule sits in §5 SGB V and §193(3) VVG.
- Employees earning over €77,400 gross in 2026 can pick between public (GKV) and private (PKV). Freelancers, civil servants, and students have their own paths.
- GKV costs roughly 8.75% of your salary up to a cap. PKV starts around €236/mo for a healthy 30-year-old employee and is priced on age and health, not income.
Sources: BMG, pkv.de
Why 2026 matters
The 2026 PKV eligibility threshold is €77,400
Most expat sites still quote €73,800 (2025) or €69,300 (2024). The €77,400 figure took effect on 1 January, once the Bundesregierung published the Sozialversicherungs-Rechengrößenverordnung on 26 November 2025. If a comparison site shows a lower number, it's out of date.
Source: bundesregierung.de
Which type can I get?
Your employment status and income decide which options are actually open to you. The table below covers the cases we see most often.
| Your status | Your options |
|---|---|
| Employee earning ≤ €77,400/yr | GKV (mandatory) |
| Employee earning > €77,400/yr | GKV or PKV (your choice) |
| Freelancer or self-employed | Voluntary GKV or PKV |
| Civil servant (Beamte) | PKV with Beihilfe state subsidy |
| Student under 30 | GKV student tariff or PKV |
| Visa applicant or newcomer | Expat short-term, then upgrade |
Source: §5 SGB V, §6 SGB V
What health insurance costs in Germany in 2026
Real numbers for the four buyer profiles that come through our inbox most often. All figures are 2026, sourced and dated.
| Profile | Monthly cost |
|---|---|
| Employee, age 30, healthy | €236–€500/mo (after 50% employer subsidy) |
| Freelancer, age 35 | €350–€800/mo (no employer share) |
| Freelancer, age 45+ | €500–€1,000/mo |
| Basistarif (statutory maximum) | Capped at €1,017.18/mo |
Sources: pkv.de, broker market data
| Plan | Monthly cost |
|---|---|
| Newcomer or visa plans | from €72/mo |
| Student visa packages | €120–€140/mo (published market rates) |
Sources: published market rates, January 2026
PKV premiums are individually underwritten on age and health. Your final number depends on your profile, so the only way to know your real price is a personalised quote.
What you actually get
GKV and PKV cover the same core medical care. The real differences are waiting times, hospital comfort, dental work, and how family members are handled.
| Service | Public (GKV) | Private (PKV) |
|---|---|---|
| GP visits | Direct billing, no upfront cost | Pay first, reimbursed in about 3 weeks |
| Specialist access | Often via GP referral, longer waits | Direct booking, priority appointments |
| Hospital room | Shared ward, 3 to 4 beds | Single or twin room, chief-physician option |
| Dental basic and crowns | Cleanings limited, crowns ~60% of fixed catalogue | 80–100% with the right tariff |
| Vision aids | Only on medical necessity | €150–€450 every 2 years (tariff-dependent) |
| Mental health | Covered, 3 to 6 month waits typical | Faster access |
| Prescription copays | ~10%, capped €5–€10 per item | Pay full, reimburse per tariff |
| Family members | Free Familienversicherung if income ≤ €565/mo | Each member insured separately |
Long-term care insurance (Pflegeversicherung) is mandatory and sits on top of either system, typically around 3.6% extra. It has its own contribution rules and caps.
Sources: BMG, vdek, §10 SGB V
Can I switch later?
Yes, but the rules tighten with age. Under 55, several routes back to public stay open. From 55, the door is mostly one-way. It's the single biggest reason we tell clients to think long-term before choosing PKV.
| Going | When you can | Source |
|---|---|---|
| GKV → PKV | Salary crossed €77,400 in the current year and is projected to stay above next year | §6 SGB V |
| PKV → GKV (under 55) | Salary dropped below €77,400, you became unemployed, or your new job pays under the threshold | §5 SGB V |
| PKV → GKV (age 55+) | Almost never. Narrow §6(3b) SGB V exceptions for returnees and spouse Familienversicherung only | §6(3b) SGB V |
Under 55, you can usually move back to public if your situation changes. Over 55, the door is effectively closed. Pick carefully.
Common questions about health insurance in Germany
Who is eligible for private health insurance in Germany in 2026?
Employees earning more than €77,400/yr gross, anyone freelance or self-employed, civil servants with Beihilfe, and certain students. Everyone else stays in mandatory GKV.
Source: §6 SGB V, BMG
How much does private health insurance cost in Germany?
Healthy 30-year-old employee: €236–€500/mo after the 50% employer subsidy. Freelancer aged 35: €350–€800/mo full premium. Older applicants pay more, and pre-existing conditions push the price up further. The statutory Basistarif is capped at €1,017.18/mo.
Source: pkv.de
How much does public health insurance cost?
A 14.6% base contribution plus a 2.9% average Zusatzbeitrag in 2026, which works out to around 17.5% of gross income total. Capped at the BBG of €5,812.50/mo. Employees pay half (around 8.75%) and the employer pays the rest.
Source: BMG
Should I pick public or private?
If you plan to stay in Germany long term, want predictable premiums, and may have a family, GKV usually wins. If you're young, healthy, high-earning, and want shorter waits, PKV can be cheaper for years before age-driven adjustments catch up. In our experience this is where new arrivals get stuck, so we'll model both for your case before you commit.
Source: DigiCare broker assessment
Can I switch back from private to public?
Under 55, yes. The usual routes are a salary drop below €77,400, becoming unemployed, or taking a job under the threshold. From age 55, it's effectively impossible outside the narrow §6(3b) SGB V exceptions for returnees and spouses on Familienversicherung.
Source: §5 SGB V, §6(3b) SGB V
Do I need health insurance for my visa or residence permit?
Yes. §5 AufenthG requires proof of adequate cover for every residence permit, including the Blue Card and freelance visa. A Schengen short-stay visa needs €30,000 minimum medical cover. Worth knowing before you book your visa appointment.
Source: §5 AufenthG
Does my employer pay for my health insurance?
Yes. With GKV, your employer pays half of the total contribution. With PKV, the employer covers 50% of the premium up to about €508.60/mo for health and around €105/mo for long-term care. Above those caps you pay the rest yourself.
Source: §257 SGB V
Can freelancers get public health insurance?
Yes, voluntarily (freiwillig versichert). The minimum monthly contribution sits at €260–€278/mo in 2026, calculated from the Mindestbemessungsgrundlage of €1,318.33/mo. Above that, contributions scale with declared income.
Source: krankenkassen.de
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