Public vs private insurance in Germany: what is the difference? What’s best for me?
One of the first big questions you’ll face when settling in Germany is which type of health insurance to get: public or private. Both systems have their own rules, costs, benefits and depending on your job, income, or personal situation, you might not even have a choice.
This guide breaks down the key differences between public and private health insurance in Germany so you can understand what each option really means. No complicated jargon, just the essentials to help you figure out what works best for your life here.
If something is still unclear, feel free to ask questions in the comments too. I gladly answer them.
Public vs private insurance in Germany: TL;DR
Choosing between public and private health insurance in Germany depends on your income, job status, health, and long-term plans. Here’s what you need to know at a glance:
- Public insurance (GKV) is mandatory for most employees earning under 73,800€/year (as of 2025) and is based on your income.
- It covers dependents at no extra cost, includes broad medical coverage, and is ideal for families or long-term residents.
- Private insurance (PKV) is available to the self-employed, civil servants, and employees above the income threshold.
- It may offer better services (shorter wait times, private rooms) and lower premiums if you’re young, healthy, and child-free.
- However, private premiums are risk-based, can rise with age, and switching back to public is difficult later on.
- General rule: Go public if you want security and simplicity. Go private if you’re eligible and plan carefully around the long-term financial impact. Full comparison in the guide below.
- Find trusted & popular public providers here.
- Here is a guide on how to pick the best private provider for your life situation.
What is the difference between private and public in Germany?
Here is a quick overview:
| Feature | Public (GKV) | Private (PKV) |
|---|---|---|
| Cost | Income-based (~14.6%) with caps; employer pays half | Risk-based (age, health, plan); employer pays capped share |
| Eligibility | Mandatory for income under €73,800/year; students, unemployed included | Optional if income > €73,800 ; self-employed, students |
| Family coverage | Spouse & kids included at no extra cost | Separate policy & premium per person |
| Billing | Direct billing, no upfront expenses | Pay first, submit receipts for reimbursement |
| Service level | Standard care; longer wait times | Faster appointments; private/single rooms |
| Dental, glasses, alternative medicine | Limited or co-pay only | Can be customized and comprehensive |
| Pre-existing conditions | No impact on eligibility or premiums | Health checks; excess premiums; exclusions possible |
| Switching | Easy and allowed anytime | Difficult to return after age 55; permanent decision in many cases |
Private health insurance will has undeniable benefits: it frequently allows for shorter wait times for a specialist appointment as well as treatment by highly paid specialists and using cutting-edge medical treatments. However, these advantages are only available through high tariffs. The basic reality in private health insurance is that exceptionally low-cost contracts frequently provide minimal protection. They even provide less than the statutory health insurers for some services.
In contrast, statutory health insurance is a solidarity system in which all insured persons are treated similarly and receive the same protection, regardless of how much they contribute. Those who seek additional benefits than what the law requires can get private supplementary insurance.
Who is the public system for?
Everyone gets the same advantages under statutory health insurance, regardless of age, wealth or health. This best for most people, families, people with unstable or lower income.
- Income based: the contribution is completely based on income. People who have statutory health insurance pay 14.6 percent of their income for health insurance. The employer pays half of the health insurance contribution for employees. However, income is only counted up to the so-called income threshold of 5.512,50 euros per month (gross, as of 2025).
- Family is covered for free: Children and spouses with no source of income are likewise covered for free, so it’s usually preferred by families
- Pre-existing conditions are covered: a provider cannot turn you away if you have chronic conditions, diagnosed or undiagnosed.
- Longer wait to some doctors & specialists: doctors earn more with private patients, so they tend to bump public patients down the waiting list.
- Students, self-employed individuals, and other low-income voluntarily insured individuals must make a limited payment.
Who is the private system for?
Private health insurance is only relevant to civil servants, self-employed individuals, students, and employees whose annual income exceeds a certain threshold. In general, this is best for people without kids with a large income and enough assets for the future too.
- Most people are not eligible: This threshold is 77,400€ gross per year in in 2026. Employers also pay half of the payment for employees, but only up to the maximum rate for a person with statutory insurance.
- The premium is risk-based: after a health assessment and based on some factors.
- Family members are not covered: spouses and children must make a separate contribution. A good tariff will cost you between 500 and 700 euros each month.
- Pre-conditions aren’t covered by default: Private as opposed to statutory health insurance companies, are allowed to reject applications if they have a pre-conditions.
- Limited last resort: In the case you have no other option than private, those companies will only offer you basic and pretty limited contracts.
- More admin work: you pay upfront and get a reimbursement later. That is a hassle and a strain on cashflow.
The decision to get private health insurance is life-altering, because returning to the statutory system is difficult. As a result, you should budget a change ahead of time, for the rest of your life.
How benefits & costs evolve over time in both systems
Costs
- Statutory health insurance contributions are always set by your level of income, regardless of your life situations. If you earn less at a later stage, your contributions will automatically drop too. It’s unlikely not to afford them. However, contributions rate (in %) may be increase over time.
- Private health insurance premiums are determined by age, health, and insurance benefits rather than income.
While young, healthy people often pay lower premiums than those in statutory health insurance, private insurance premiums sometimes increase many times over in old age. Even with old-age reserves (Altersrückstellungen), expenditures accrue over time as a result of greater insured expenses and medical developments. That’s true even during retirement.
Many private health insurers provide deductible to lower premiums. In this situation, insured individuals carry their own health-care costs up to the agreed-upon level in exchange for lower rates. However, because you cannormally only lower the deductible following a new health check, the size of the deductible should be carefully examined.
If you have become unwell in the meanwhile (heart issues, back problems, etc), you will no longer be able to reduce the deductible. Salaried employees gain less from deductible savings than self-employed individuals since they split premiums with their employer.
Benefits
- The statutory health insurance benefits catalog is frequently updated or restricted as part of healthcare system reforms. As a result, it is unclear which benefits the SHI will cover in the future. In recent years, coverage for dental care, sight care or medications have been reduced in Germany.
- In the private system, contractually agreed-upon benefits cannot be revoked retroactively, nor can they be easily adjusted.
While statutory health insurers can adjust rates in response to medical innovations, some rates in private health insurance are limited to contract (for example, a list of medical aids like prostheses). In other words: future innovations might not be covered with private.
More benefits are only possible by changing to a different but that’s usually not financially recommended.
Which services are covered by public vs private insurance in Germany?
It is very difficult to compare benefits covered by public and private health insurance. That’s because individual pick and choose in the private system.
We can give it a try in broads terms. That’s what we do in this table. But remember you cannot based your choice on those elements alone.
| Service type | Service | Public health insurance | Private health insurance |
|---|---|---|---|
| Doctors & specialists | Payment | Sorted between the provider and the practice directly. | Pay the bill first, get refund from your provider later. |
| Choice of practice | Only doctors accepting public patients. | Free choice (when option is booked) | |
| Medication | 10% co-payment for prescriptions (5-10€). Must pay other medication yourself. | Full refund. Deductible may apply. | |
| Psychotherapy | Only approved therapies. Max 300 sessions possible. | Depends on contracts, usually limited to a few sessions only (20 – 30 per year) | |
| Medical aids (wheelchairs, prostheses, etc.) | Variable coverage, 10% additional payment (5-10€) | Tied to contract list, cannot change with time, limited refunds often. | |
| ———— | ——————– | ———————————- | ———————– |
| Hospital stays | Doctor | Doctor on duty | Chief physician, doctor on duty in a few tariffs |
| Room | Shared rooms usually | Mostly single or double rooms | |
| Choice of hospital | Limited choice of hospitals | Free choice of hospital, private clinic, depending on contract | |
| Additional payment | €10 per day for a maximum of 28 days a year | no | |
| ————– | —————- | ———————————- | ————————– |
| Dental care | Treatment | Full coverage for basic care, limited for more expensive treatments | No restriction to basic service, pays 50% to 100% depending on the contract. |
| Crowns, dentures | 60-75% of costs for standard service but some additional costs may apply | No restriction to basic service, pays 50% to 100% depending on the contract. | |
| ———— | —————— | ———————————- | ———————— |
| Sick pay | Sick pay | 70% of the gross earnings or max. 90% net, also in the case of a sick child (from the 43rd day).* | Beginning and amount of payment by clause, no money if the child is sick |
| Maternity benefits (prenatal) | max. 13 €/day maternity allowance + employer top-up to match net salary.* | Max. 210€ public maternity benefit depending on the contract. | |
| Maternity/paternity leave (post natal) | No contributions paid during leave. * | Pay premiums during your leave also. |
How difficult it is to switch in both systems
People on statutory health insurance can change providers (even to private ones) at any moment & does not bare immediate profound consequences.
It rarely make sense to switch providers when being privately insured:
- Privately insured people can select another provider, but they will lose a significant portion of their old-age savings. As a result, it is critical to select a tariff with favorable terms from the start.
- Returning to statutory health insurance is only conceivable in extraordinary circumstances (unemployment or return to employee status before 55). That is because Germany want to avoid that healthy, high-income people stay with private health insurance when they are young and then switching to statutory health insurance when they are old.
Should I go for public or private insurance in Germany?
Your situation always require close inspection but here is a good rule of thumb:
Should you go with public or private health insurance?
- Choose public insurance (GKV) if:
- You earn less than 77,400€/year (as of 2026) – it’s mandatory for employees below this threshold.
- You prefer stable monthly premiums based on your income.
- You have pre-existing conditions and want guaranteed coverage.
- You plan to stay in Germany long-term or retire here.
- You have children and want free coverage for dependents.
- Choose private insurance (PKV) if:
- You are self-employed, a freelancer, or earn more than 77,400€/year and prefer flexible options.
- You’re young, healthy, and want lower premiums with more benefits (like private rooms or faster appointments).
- You don’t have dependents, or are okay with paying extra to insure them.
- You value more personalized care and faster access to specialists.
- You’re planning to stay in Germany short-term and want to reduce costs.
Where to sign up for a public provider?
Most benefits are the same for all providers in the case of statutory health insurance. The additional contribution, service, and additional benefits vary only slightly. These extra benefits include travel vaccines, alternative medicine methods, preventive exams, and family benefits. You can turn to providers with the highest level of satisfaction:
- Digital signup with Techniker Krankenkasse (leading provider, also supports English-speakers)
- Digital signup with AOK
- Digital signup with DAK
- Digital signup with Barmer
How to find the right private provider?
Private health insurance is far more complicated to chose, and picking the incorrect provider/contract can be costly in the long run. If you begin with a low-cost entry-level tariff, you can usually only expand the benefits later at an additional expense. Entry-level rates can lack critical services.
Finding the right private provider takes time. You can read how to pick the right policy in this dedicated guide: Picking the right private health insurance in Germany
You can also turn to reputable brokers catering to foreigners in Germany like Feather Insurance. They are not incentivized the same way as the rest of the industry. They will tell you if you should go with public instead.
Private vs public insurance in Germany – conclusion
Private health insurance is not always superior to statutory health insurance. A private health insurance plan with extensive benefits is also quite expensive. Anyone considering purchasing private health insurance should ensure that they can afford the increasing premiums in the long run.
For most people, going public and signing for additional supplementary insurance (e.g: dental) is a good winning combo.
Sources and references
- Wikipedia contributors. Krankenversicherung in Deutschland. Last modified May 28, 2025. https://de.wikipedia.org/wiki/Krankenversicherung_in_Deutschland
- Bundesministerium für Gesundheit. “Online-Ratgeber Krankenversicherung.” Accessed June 20, 2025. https://www.bundesgesundheitsministerium.de/themen/krankenversicherung/online-ratgeber-krankenversicherung.html
- Finanztip. “Krankenversicherung: Gesetzliche und Private im Vergleich.” Accessed June 20, 2025. https://www.finanztip.de/krankenversicherung/
- GKV-Spitzenverband. “Statutory Health Insurance.” Accessed June 20, 2025. https://www.gkv-spitzenverband.de/english/statutory_health_insurance/statutory_health_insurance.jsp