Health Insurance in Germany: How GKV, PKV, and Pflegeversicherung Work
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Health insurance is mandatory in Germany: you cannot live, work, or study in the country without valid insurance coverage. For most newcomers, the choice comes down to two systems: the public statutory health insurance (GKV) and private health insurance (PKV). In addition to these, there is mandatory long-term care insurance (Pflegeversicherung).
What Is Covered by the German Health Insurance System
In Germany, health insurance usually consists of two mandatory components:
- Health Insurance — basic health insurance that covers doctor visits, hospitalization, medical tests, some medications, and other necessary medical services.
- Long-Term Care Insurance — insurance that covers long-term care if a person needs regular assistance due to illness, age, or a serious medical condition.
You can also purchase voluntary insurance policies: for example, for comprehensive dental care, a private hospital room, treatment by a specialist, or more extensive coverage abroad. Such policies do not replace mandatory health insurance.
GKV and PKV: What’s the Difference?
| Criterion | GKV | PKV |
|---|---|---|
| How premiums are calculated | Primarily based on income up to the Beitragsbemessungsgrenze | Based on the rate, age, health status, and selected services |
| Who is typically insured | Employees earning less than the annual income threshold (Jahresarbeitsentgeltgrenze), many students, retirees, and recipients of social benefits | Self-employed individuals, civil servants, some employees earning above the threshold, certain students, and participants in language courses |
| Family | Free family insurance (Familienversicherung) may be available for a spouse or children if certain conditions are met | Typically, each person is insured under a separate policy |
| Doctors and Services | Standard Access to the Healthcare System | Sometimes faster appointments and a wider selection of additional services, but conditions depend on the plan |
| Re-enrolling in GKV | Can be complicated, especially as you get older or if your status changes | It’s important to check the long-term consequences before switching |
GKV is suitable for most employees and families because premiums are based on income rather than individual health risk. PKV may be advantageous for some self-employed individuals, civil servants, and high-income earners, but it should be considered a long-term commitment: premiums may rise, and family coverage is often arranged separately.
Who Is Required to Be Enrolled in the GKV
In 2026, employees with a regular gross income below the annual income threshold (Jahresarbeitsentgeltgrenze) will generally remain mandatory members (Pflichtmitglieder) of the GKV. For 2026, the general threshold is 77,400 euros per year, or 6,450 euros per month. For certain cases where an individual was already privately insured as of December 31, 2002, a special threshold of 69,750 euros per year applies.
The GKV also often includes:
- Apprentices and many students, provided they meet the requirements for student insurance;
- recipients of Arbeitslosengeld or Bürgergeld who meet the legal requirements;
- retirees with the required insurance history;
- People without other coverage, provided they are legally eligible for GKV.
If an employee is starting work in Germany for the first time and already earns an income above the annual income threshold (Jahresarbeitsentgeltgrenze), they may be exempt from mandatory GKV, but under certain conditions, they may still choose to enroll in GKV on a voluntary basis.
How Much Does Public Health Insurance Cost?
In the GKV, the basic general premium is 14.6% of income. Added to this is the Zusatzbeitrag—an additional premium charged by a specific health insurance provider. The amount varies by provider, so before choosing TK, Barmer, AOK, DAK, or another health insurance provider, it’s worth checking the current rate.
Premiums are not calculated based on any infinitely high income, but rather up to the Beitragsbemessungsgrenze. In 2026, this limit for health insurance and long-term care insurance is 69,750 euros per year, or 5,812.50 euros per month.
For employees, the premium is usually split between the employee and the employer. For self-employed individuals who are voluntarily insured under the GKV, the calculation is different: they pay the premium themselves, and the minimum contribution base and other details depend on their status and income.
Long-Term Care Insurance: Mandatory Long-Term Care Insurance
Long-term care insurance is arranged together with health insurance: if a person is enrolled in the GKV, their long-term care fund (Pflegekasse) is usually affiliated with the same health insurance fund (Krankenkasse); if a person is enrolled in the PKV, they need private mandatory long-term care insurance.
In 2026, the total long-term care insurance contribution is 3.6% of income. A surcharge applies to people without children; for parents, the contribution amount may depend on the number of children under the age of 25. Because of these rules, it’s best to check the exact amount with your health insurance provider or employer.
Family Insurance
Under the GKV, a spouse, registered partner, and children can be included in family coverage (Familienversicherung) free of charge if they live in Germany and do not exceed the established income limit. This is not an automatic right for every family: the health insurance provider (Krankenkasse) checks their status, income, place of residence, and whether they have other insurance.
For families, this is one of the main advantages of GKV over PKV. In the private system, spouses and children usually require separate policies, so the total cost can be significantly higher.
How to Get Health Insurance After Moving
The process usually goes like this:
- Determine your status. Employees, students, the self-employed, civil servants (Beamte), language course participants, spouses, and family members may be subject to different rules.
- Check whether GKV is available to you. For most employees earning less than the annual income threshold (Jahresarbeitsentgeltgrenze), this is the standard option.
- Compare health insurance providers. Look at the additional premium (Zusatzbeitrag), English-language support, online services, bonus programs, and the ease of handling paperwork.
- Submit an application to the health insurance provider (Krankenkasse) or private health insurance provider (PKV) of your choice. You will usually need your passport, your address in Germany (if you have one), an employment contract or proof of enrollment in school, as well as your employer’s information.
- Submit the confirmation to your employer or university. Once you’ve completed the registration, you’ll receive your membership and, later, your Gesundheitskarte.
- Check the coverage start date. For work and study, it’s especially important that your insurance coverage begins on the first day of your contract or semester.
If you’re coming on a work contract, your employer usually handles the enrollment process through the health insurance provider (Krankenkasse) of your choice. If you’re a student, your university often requires electronic confirmation of your insurance status. If you’re self-employed, it’s best to compare GKV and PKV in advance, because a mistake at the start can end up costing you dearly later on.
What the Insurance Covers
GKV covers medically necessary services: doctor’s visits, hospital treatment, many diagnostic tests, preventive care, basic dental care, prescription medications, and some rehabilitation services. However, there may be copayments, restrictions, and services that are only partially covered or not covered at all.
PKV covers what is specified in the contract. A good plan may offer broader coverage than GKV, but a basic or low-cost plan may have restrictions that could become a problem if you get sick. Before signing up, it’s important to read the terms regarding deductibles, dental care, psychotherapy, pregnancy, chronic illnesses, treatment abroad, and premium increases.
Common Mistakes
- Don’t choose PKV just because the initial premium is lower, without considering your family and the long-term costs;
- Don’t forget about Pflegeversicherung;
- Do not check the Zusatzbeitrag for a specific health insurance provider;
- assuming that a spouse is automatically covered by the GKV without an income check;
- taking out travel insurance instead of full-fledged Krankenversicherung for work or a long-term stay;
- It’s too late to start the application process once your employment contract, studies, or visa application has already begun.
In Brief
For most expats and their families, GKV is the most straightforward and stable option. It makes sense to consider PKV if your status actually allows for private insurance and you understand the long-term costs. In 2026, the key figures to check are the annual income limit (Jahresarbeitsentgeltgrenze) of 77,400 euros and the contribution assessment ceiling (Beitragsbemessungsgrenze) of 69,750 euros, but you should verify the supplementary contribution rates and the specific terms of your health insurance provider before enrolling.
