The German Health Insurance System Explained

Health insurance has been mandatory for every resident in Germany since 2009. Most people are insured through the statutory system, known as GKV. A smaller group can choose private health insurance, known as PKV. The decision is not simply a question of comfort or price: eligibility, income, age, family status and long-term planning all matter.

Instead, Germany runs two parallel insurance systems. Statutory health insurance is based on solidarity: contributions are calculated from income, not from individual health risk, and the core benefits catalogue is defined by law. Private health insurance is based on individual risk: premiums are calculated when the contract starts, using age, health status and the selected level of cover.

The legal foundation is split as well. Section 5 SGB V defines who is compulsorily insured in the statutory system. Section 193 para. 3 VVG obliges everyone not covered by GKV to hold at least basic private cover. In practice, long-term residents fall into one of these two systems, with only narrow exceptions.

Employees are generally subject to compulsory GKV membership as long as their regular gross salary stays below the compulsory insurance threshold, the Jahresarbeitsentgeltgrenze (JAEG). In 2026, this threshold is €77,400 per year, or €6,450 per month. Students, pensioners with statutory pension entitlement, recipients of unemployment benefits and several other groups are also typically covered by GKV.

What GKV covers

The statutory benefits catalogue includes outpatient and inpatient treatment, prescription medication, hospital stays, maternity care, preventive check-ups and a broad range of therapies. Individual Krankenkassen may offer extras, but the core medical benefits are standardised.

• Contributions depend on income up to a ceiling
• Core medical benefits are largely identical across statutory funds
• Family members may be co-insured for free if legal conditions are met
• Members can usually switch Krankenkassen after a minimum membership period

PKV is open only to specific groups. Employees need regular income above the JAEG on a sustained basis. Self-employed people and freelancers can generally choose PKV regardless of income. Civil servants usually combine private insurance with Beihilfe, Germany's special public-sector reimbursement system.

Basistarif and Notlagentarif

German law requires private insurers to provide safety nets. The Basistarif offers benefits comparable to the statutory catalogue and is capped around the maximum GKV contribution. The Notlagentarif applies when a policyholder falls significantly behind on premiums and provides only minimal emergency cover until arrears are resolved.

Everyone with health insurance in Germany must also hold long-term care insurance. For GKV members, the care contribution is collected alongside the health insurance contribution. Privately insured people hold a separate private mandatory long-term care policy.

The base care contribution is usually split between employer and employee. The childless surcharge is borne by the employee.

GKV can include free family co-insurance under Section 10 SGB V. A spouse, registered partner or child with little or no income of their own may be covered at no additional contribution if the legal conditions are met.

A child generally cannot be co-insured for free if the other parent is privately insured, earns above the JAEG and earns more than the GKV-insured parent. All three conditions must apply at the same time, and the rule usually does not apply to unmarried parents.

Students and retirees

Students under 30, or within their 14th semester, are usually subject to statutory student insurance. Older students may need voluntary GKV or PKV. Pensioners drawing a statutory pension may be covered through Krankenversicherung der Rentner if they meet the prior-insurance requirements.

Expats and internationals

Newcomers are rarely completely free to choose. Employees registered by a German employer are usually enrolled in GKV if their income is below the JAEG. High earners, self-employed people and some visa categories face the same statutory eligibility rules as German nationals. Short-term incoming or travel cover is usually not a long-term substitute for full German health insurance.

Switching from GKV to PKV is possible only when the legal requirements are met: income above the JAEG, self-employment, civil servant status or another qualifying route. Switching back from PKV to GKV is much more restricted.

Cancellation and proof deadlines

When compulsory GKV cover starts again, cancelling a PKV contract involves separate cancellation and proof deadlines. Missing formal proof after the insurer requests it can keep the private contract legally active, even if a cancellation letter was sent.

GKV finances are under sustained pressure. The GKV-Beitragssatzstabilisierungsgesetz completed the legislative process in July 2026 and introduces several changes that affect the GKV/PKV calculation over the next years.

• From 2027, both the contribution assessment ceiling and the JAEG receive a special one-off increase of €300 per month, on top of the regular annual adjustment.
• From 2028, GKV members with a co-insured spouse or registered partner pay an additional 2.5 percent surcharge on contributory income.
• Children remain protected under free family co-insurance according to the reform logic.
• Further changes to long-term care insurance are under discussion and may add another family-related surcharge from 2028.

Final social security thresholds are normally confirmed each autumn. The special €300 supplement is already fixed by law; the regular annual component is not.

• Bundesministerium fuer Gesundheit: GKV-Beitragssatzstabilisierungsgesetz
• Bundesministerium fuer Gesundheit: Mitglieder und Versicherte der GKV
• Gesetze im Internet: Sections 5 and 10 SGB V, Sections 193 and 205 VVG
• vdek: data on insured persons and family insurance
• PKV and Beihilfe information from PKV industry and public-service resources