German Health Insurance: GKV vs. PKV (Public vs. Private)
January 2026 · 9 min read
When you start working in Germany, one of your first decisions is choosing health insurance. You have two options: GKV (public) or PKV (private). This choice directly affects your take-home pay.
Most employees use GKV, but higher earners might benefit from PKV. Here's how they compare.
GKV: Gesetzliche Krankenversicherung (Public insurance)
GKV is Germany's statutory public health insurance system. It's the default for most employees and mandatory for anyone earning below a certain threshold.
GKV basics (2026)
- Employee contribution: Average 8.55% of gross salary
- Employer contribution: ~8.55% on top
- Additional surcharge: 1.0% (varies by fund, passed to employee)
- Total cost: ~17.1% of gross salary
GKV advantages
- ✓ Lower contributions for lower earners
- ✓ Comprehensive coverage (dental, vision, maternity have limits)
- ✓ No medical underwriting; you can't be rejected
- ✓ Family members can be covered at no additional cost (spouse, children)
- ✓ Contributions frozen if unemployed (ALG I)
GKV disadvantages
- ✗ Higher contributions for high earners (on income above ~€52,000)
- ✗ Limited coverage for dental (only €50/year for cleaning)
- ✗ Vision care not covered (you pay full price)
- ✗ Maternity benefits are capped
PKV: Private Krankenversicherung (Private insurance)
PKV is private health insurance sold by private insurers. Not everyone can switch to PKV; you must meet income or occupational thresholds.
PKV eligibility
You can choose PKV if:
- ✓ Your gross annual income exceeds the versicherungspflichtgrenze (mandatory insurance threshold) of €66,600 (2026)
- ✓ You're self-employed or a freelancer
- ✓ You're a civil servant (Beamter)
Once you switch to PKV, you generally can't return to GKV unless you drop below the threshold or become unemployed.
PKV cost structure
PKV premiums vary widely by insurer and coverage level. For a 30-year-old:
- Basic coverage: €250–350/month
- Standard coverage: €350–500/month
- Premium coverage: €500–700+/month
Unlike GKV's percentage-based contribution, PKV is a flat monthly premium that doesn't scale with your salary.
PKV advantages
- ✓ Lower premiums for younger, healthier employees
- ✓ Better dental coverage (often 70–100%)
- ✓ Vision care covered
- ✓ Shorter waiting times for specialist appointments
- ✓ Choice of doctors and hospitals
PKV disadvantages
- ✗ Premiums increase with age (much higher in old age)
- ✗ Medical underwriting; you can be rejected or have exclusions
- ✗ Family members need separate policies (expensive)
- ✗ Pre-existing conditions may be excluded
- ✗ Premiums don't include unemployed coverage
GKV vs. PKV: Financial comparison
For a single 30-year-old earning €60,000 gross:
| GKV | PKV (basic) | PKV (standard) | |
|---|---|---|---|
| Gross salary | €60,000 | €60,000 | €60,000 |
| Health insurance | €5,130/yr | €3,600/yr | €5,400/yr |
| Other deductions* | €15,000 | €15,000 | €15,000 |
| Net annual | €39,870 | €41,400 | €39,600 |
*Includes income tax, pension (9.3%), unemployment (1.3%), long-term care (1.8%), but excludes church tax and solidarity surcharge.
At €60,000, PKV basic saves about €1,530/year vs. GKV. But consider age and family status.
What happens at retirement?
This is critical: PKV premiums typically double or triple by age 60–65. Many retirees find PKV premiums unaffordable and regret switching.
GKV premiums, by contrast, are capped at a percentage of your pension income.
Family considerations
GKV: Spouse and children are covered at no additional cost (if the spouse doesn't work or earns below thresholds).
PKV: Each family member needs a separate policy:
- Spouse: €250–400/month additional
- Each child: €150–300/month additional
For a family of 4, PKV could cost €1,500–2,000/month, far more than GKV's family coverage.
Who should choose PKV?
PKV makes sense if:
- ✓ You're young (under 35), healthy, and single
- ✓ Your income is high enough to absorb premiums
- ✓ You plan to stay in Germany short-term (5–10 years)
- ✓ You value choice and shorter wait times
PKV is risky if:
- ✗ You have a family or plan one
- ✗ You have pre-existing conditions
- ✗ You plan to retire in Germany (premiums skyrocket)
- ✗ You might need to return to GKV
Key takeaways
- GKV is percentage-based (~8.55%) and mandatory for most employees below €66,600 income.
- PKV is flat-premium and available to higher earners, but premiums increase significantly with age.
- PKV saves money for young, single earners but costs more for families.
- Switching back from PKV to GKV is difficult and often impossible.
- Plan for retirement; PKV premiums can become unaffordable in old age.
Use our German salary calculator to model your net salary with different health insurance options.