Health Insurance Companies in Germany: GKV, PKV, and Krankenkasse

In Germany, health insurance is mandatory, and the choice usually comes down to two systems: the public GKV through a Krankenkasse and the private PKV through a private insurance company. For most employees, students, and families with average earned income, the GKV remains the standard option; the PKV is more commonly considered by high-income employees, the self-employed, civil servants, and some students.

What is a Krankenkasse

A Krankenkasse is a health insurance fund through which the public health insurance system operates. It collects premiums, issues proof of insurance, covers medical treatment as required by law, and offers additional services such as bonus programs, expanded preventive care, digital apps, English-language support, or regional services.

In the GKV, the package of mandatory services is largely the same because it is regulated by SGB V. The differences between health insurance funds usually lie not in the basic entitlement to treatment, but in the amount of the Zusatzbeitrag, the convenience of service, and additional programs.

GKV and PKV: The Main Difference

Criterion	GKV	PKV
Contribution principle	Percentage of income up to the Beitragsbemessungsgrenze	Individual rate based on age, health, and coverage
Family	Non-working spouses and children can be covered free of charge if certain conditions are met	Usually a separate contract and premium for each person
Availability for Employees	Usually mandatory for those with income below the Jahresarbeitsentgeltgrenze	Available to employees with income above the threshold, as well as to certain groups
Re-enrollment	Generally easier as long as you’re still subject to mandatory GKV coverage	After switching to PKV, re-enrollment can be complicated, especially as you approach age 55
Services	Statutory minimum plus additional benefits offered by the health insurance fund	Coverage depends on the selected plan

Premiums and Limits in 2026

In 2026, the total contribution to the GKV is 14.6% of income for insured individuals entitled to sick pay (Krankengeld); the reduced rate for those without this entitlement is 14.0%. In addition, each Krankenkasse sets its own Zusatzbeitrag. The estimated average Zusatzbeitrag for 2026 is 2.9%, but the actual percentage varies from one insurance provider to another.

The employer usually pays half of the total premium and half of the individual Zusatzbeitrag. Premiums are calculated only up to the Beitragsbemessungsgrenze: in 2026, this is 5,812.50 euros per month or 69,750 euros per year.

For employees, another threshold is important—the Jahresarbeitsentgeltgrenze. In 2026, it amounts to 77,400 euros per year. If an employee’s salary is below this limit, they are generally required to remain insured under the GKV. If their income exceeds the threshold and certain conditions are met, they can remain a voluntary participant in the GKV or switch to the PKV.

Types of Public Krankenkassen

In Germany, there are several historically established groups of public health insurance funds. Today, for most insured individuals, what matters more than the name of the group is whether the fund is available in your region or through your employer, what its Zusatzbeitrag is, and what additional services it offers.

Alternative Health Insurance Funds

This group includes large, open health insurance funds, such as TK – Techniker Krankenkasse, Barmer, DAK-Gesundheit, hkk, HEK, and KKH. The name is historical: today, these health insurance funds are open to more than just specific professional groups.

AOK

AOK is a regional network of Allgemeine Ortskrankenkassen. It is not a single federal health insurance fund, but rather several independent organizations organized by state and region. Each AOK may have different additional premiums (Zusatzbeitrag), benefits, and local services.

BKK

Betriebskrankenkassen (BKKs) historically originated within companies. Some BKKs are open to everyone, while others remain tied to specific employers or groups of employees. Therefore, before making a choice, you should check whether you are eligible to join that particular BKK.

IKK

Innungskrankenkassen (IKKs) evolved from craft and professional associations. Today, some IKKs are open to a wide range of insured individuals, but the terms and availability depend on the specific health insurance fund.

Knappschaft

Knappschaft has historical ties to the mining industry but now operates as an open public health insurance fund.

Agricultural Health Insurance Fund

The LKK serves agricultural entrepreneurs, farmers, and their family members. Special rules apply to this group, so the process for choosing a health insurance fund is different here than it is for regular employees.

Private Health Insurance Companies

PKV offers comprehensive private health insurance and supplementary coverage, such as for dental care, eyeglasses, or extended inpatient care. The cost of a comprehensive PKV plan depends on age, health status at the time of enrollment, the selected coverage, and the terms of the contract.

Private insurance may be attractive to young, healthy people with high incomes, but the decision shouldn’t be based solely on savings in the early years. It’s important to assess future premiums, your family situation, plans for children, self-employment, potential drops in income, and the rules for re-enrolling in the GKV in advance.

Major private insurers in Germany include Debeka, AXA, DKV, Allianz, HUK-Coburg, Signal Iduna, and other companies. Their rates cannot be accurately compared based solely on brand name: the specific terms of the contract, deductibles, coverage, and how premiums increase are the deciding factors.

How to Choose a Krankenkasse as an Immigrant

For most new residents of Germany, the practical choice starts with GKV, unless the law requires or permits another option. When comparing health insurance funds, consider:

• current Zusatzbeitrag;
• the option to enroll before arrival or immediately upon arrival;
• English or Russian-language support if your German is still limited;
• a digital app and the speed at which the Mitgliedsbescheinigung is issued;
• coverage for additional preventive care programs;
• Convenient communication with doctors, employers, and universities;
• Terms of family insurance through Familienversicherung.

While the differences between health insurance providers are minor, for a newcomer, reliable communication and quick confirmation of coverage are often more important than saving a few euros.

Can you switch health insurance providers?

Switching between public health insurance funds is possible, but depends on minimum membership periods, notice periods, and special rights in the event of an increase in the Zusatzbeitrag (supplementary premium). If a health insurance fund increases the supplementary premium, the insured person usually gains a Sonderkündigungsrecht—the right to special termination.

Before switching, check to make sure you won’t lose any necessary bonus programs, current treatment agreements, or convenient regional services. For people with chronic conditions and regular therapy, this may be more important than a small difference in premiums.

Common Mistakes

• Choosing PKV just because the initial premium is cheaper than GKV.
• Do not include separate premiums for children and spouses in private insurance.
• Don’t compare Krankenkassen based solely on advertising ratings; instead, consider the Zusatzbeitrag and the services you need.
• Don’t forget to check whether the BKK or regional AOK you’ve chosen is available in your place of work and residence.
• It’s easy to forget that public health insurance and private insurance operate differently in cases of job loss, the birth of children, and a reduction in income.

Brief Conclusion

If you’re moving to Germany as an employee, student, or family member, first check whether you’re required to enroll in the GKV. If you have a choice between GKV and PKV, compare not only the current cost but also the long-term implications: family situation, age, income, eligibility for reimbursement, and scope of coverage.