# Private health insurance in Germany: the choice most expats get only once > Germany runs two parallel systems: statutory health insurance (GKV) for about nine in ten residents and private health insurance (PKV) for the self-employed, civil servants and employees above an income threshold. If you are new to the country, the choice you make in your first months can shape your costs for decades, because switching back is restricted by law. Quelle/Source: https://www.nammert.com/en/insurance-broker-private-health-insurance.php Updated: 2026-09-18 ## Should I choose public or private health insurance in Germany? It depends mainly on your income, your family and how long you plan to stay. As an employee you may only choose private cover if your gross salary is above 77,400 euros a year in 2026. Private cover usually pays off for single, healthy people with high and stable income who expect to stay long term. Public cover is usually better for families with one earner, because a non-working spouse and children are insured there at no extra cost. ## At a glance - **Income threshold for employees 2026:** €77,400 gross a year (€6,450 a month) - **Self-employed and freelancers:** free to choose regardless of income - **Employer contribution 2026:** up to €508.59 a month for health plus €104.63 for long-term care, never more than half the premium - **Family:** every person needs their own private policy and premium - **Going back to public cover:** only if you become compulsorily insured again; from age 55 generally ruled out ## How the two systems differ, in plain terms Public insurance charges a percentage of your income: 14.6 percent plus a fund-specific additional rate, which averages 2.9 percent in 2026, split between you and your employer and capped at a monthly income of €5,812.50. Your spouse without income and your children are covered free of charge through family insurance. Private insurance ignores your income. The premium depends on your age when you join, your health and the level of cover you pick. You pay doctors' bills yourself and claim them back, much like a reimbursement plan in the US. In return, benefits are fixed in your contract and cannot be cut by legislation. ## Visas, Blue Cards and proof of insurance Every residence permit requires adequate health insurance. For employees the question is simple: below the income threshold you are automatically in public insurance from your first working day, above it you choose. Blue Card holders are treated like any other employee. Self-employed people from outside the EU often have no choice at all. Voluntary membership in a public fund requires prior periods of public insurance, and periods in another EU country usually count, but years in the US, UK or India do not. Many freelancers therefore end up in private insurance by necessity. A travel or incoming policy may cover your first weeks, but immigration offices typically do not accept it as long-term proof for a residence permit. ## Why leaving private insurance is harder than joining Before 55, you can return to public insurance only if you become compulsorily insured again, for example by taking a job with a salary below the threshold. After 55 the door is generally closed if you were not publicly insured in the previous five years (Section 6 (3a) of Book V of the Social Code). Moving abroad and coming back does not reset this automatically. Private insurers build up an ageing reserve from your premiums. If you leave Germany, most of that reserve stays with the insurer. If you might return, ask about a dormant policy (Anwartschaft): a small monthly fee keeps your age and health status so you can resume without new health questions. ## The health questionnaire The application asks about treatments, medication and diagnoses from recent years, typically three to five for outpatient care and up to ten for hospital stays and psychotherapy. Answer from records, not from memory, including treatment abroad. If something is left out, the insurer can withdraw from the contract or change it retroactively within five years, or ten if the omission was deliberate. If you have pre-existing conditions, a broker can send an anonymous risk inquiry to several insurers first. You learn whether they accept, add a surcharge or exclude a condition, without a formal rejection on file. ## What is covered - Outpatient treatment with any doctor, including specialists without referral in most plans - Hospital treatment, in good plans with a private or semi-private room and senior consultant - Prescription drugs, therapies and medical aids such as hearing aids - Dental treatment and dentures at fixed reimbursement rates - Psychotherapy, depending on the plan with or without session limits - Treatment abroad, usually unlimited within Europe and for a limited time worldwide - Sick pay (daily benefit) as a separate module - Statutory long-term care insurance, which private members must take out ## What is not covered - Conditions explicitly excluded after the health check - Treatment that is not medically necessary, such as cosmetic surgery - Anything you did not disclose in the health questionnaire - Costs above the plan's maximum rates, for example for dentures in early years - Medical aids outside a closed catalogue in basic plans - Treatment during agreed waiting periods ## Who needs it - Employees earning above the threshold who are single or whose partner has their own income - Self-employed people from outside the EU who cannot join a public fund - Civil servants and professors with state allowance (Beihilfe) - Expats who plan to stay long term and want contractually guaranteed benefits ## Who can do without - Families with one earner and children, who are insured for free in public insurance - Anyone planning to stay only two or three years and then leave - People over 50 with health issues, where premiums rise sharply and the way back is closed ## What it costs There is no fixed price. The same plan can cost very different amounts for a 30-year-old and a 50-year-old, or for someone with a chronic condition. Compare benefits first and premiums second, and include what the premium will look like at 65. **What drives the premium:** - Age when you join - Health status and any surcharges or exclusions - Level of cover for outpatient, hospital and dental care - Annual deductible - Daily sick pay and from which day it starts - Number of family members, each with their own premium _We do not show example premiums because age and health move them too much for a guide value to be useful. Your premium is fixed in the quote, after the health questions have been reviewed._ ## The policy levels on the market - **Entry plan:** Benefits close to public insurance, often with a gatekeeper GP and a closed list of medical aids. Cheap to start, but upgrading later requires a new health check. - **Standard plan:** Free choice of doctor, semi-private room, reimbursement above the standard fee scale, dentures at around 75 to 80 percent. The usual choice for employees and freelancers. - **Premium plan:** Private room and senior consultant, open list of medical aids, dentures up to 90 percent, longer cover worldwide. Worth it if you can still afford the premium in retirement. ## How to recognise a good policy | Criterion | Minimum standard | Strong policy | Why it matters | | --- | --- | --- | --- | | Medical aids | closed catalogue | open catalogue including future technology | Wheelchairs, hearing aids or prostheses quickly cost five figures. | | Fee scale | reimbursement up to 2.3 times the standard rate | up to 3.5 times and beyond with fee agreements | Specialists regularly bill private patients above the standard rate. | | Worldwide cover | one month outside Europe | several months or unlimited | Long visits to your home country should not need extra insurance. | | Psychotherapy | limited sessions per year | no session limit | Mental health treatment often lasts longer than a year. | | English service | German only | English app, claims and hotline | You will deal with your insurer every time you submit a bill. | | Dormant policy option | not offered | affordable Anwartschaft when moving abroad | Keeps your entry age and health status if you might return to Germany. | | Sick pay adjustment | fixed amount | increase without a new health check when salary rises | Otherwise your income protection falls behind your salary. | ## Insurers on the German market Private health insurance in Germany is run by dedicated health insurance companies. The list below is a market overview of well-known insurers. Some sell only through their own agents and do not work with brokers. - **ottonova**: digital insurer, app and service available in English - **Allianz**: sold through agents and brokers - **AXA**: sold through agents and brokers - **DKV**: health insurer of ERGO Group, part of Munich Re - **HanseMerkur**: Hamburg-based group, strong broker distribution - **Barmenia**: part of Barmenia Gothaer group - **Signal Iduna**: mutual insurer, agents and brokers - **Hallesche**: mutual insurer in the ALH group, broker distribution - **Debeka**: mutual insurer with its own sales force, focus on civil servants, does not work with brokers - **Continentale**: mutual insurer, agents and brokers 42 insurers supervised by BaFin, the German regulator, are licensed for this class of insurance. (Krankenversicherer). Source: BaFin company database, retrieved 2026-09-18. Insurers from other EU countries selling through a branch or without a German office are not included. ## Typical claims and who pays - **Hospital stay on a long US visit** (tens of thousands of euros for a few days): Entry-level tariffs often cover trips outside Europe for only one month. Strong tariffs cover several months or have no limit. - **Therapy after a burnout** (roughly 8,000 to 12,000 € over two years): Basic tariffs cap the number of sessions per year. Strong tariffs pay for as long as treatment is medically needed. - **Specialist without a GP referral** (roughly 100 to 300 € per visit): Tariffs with a gatekeeper rule cut the refund if you skip your GP. Tariffs with free choice of doctor pay in full. - **Private room after surgery** (often 100 € or more per night): Entry-level tariffs pay for a shared room. Premium tariffs include a single room and the senior consultant. - **Nose job after a lost bet** (roughly 5,000 to 10,000 €): German private insurance pays for medically necessary treatment only. Purely cosmetic surgery is excluded everywhere. - **Broken wrist while skiing in Austria** (roughly 2,000 to 6,000 € with surgery): Every tariff covers stays within Europe without a time limit. The differences start with longer trips further away. ## Myth or truth - „German private insurance works like US insurance, with networks you must stay in." ✘ False. You can usually choose any licensed doctor or hospital in Germany. Only some cheaper tariffs ask you to see your GP first. - „Private policyholders pay an extra 10 percent until age 60 to keep premiums stable later." ✔ True. German law adds a 10 percent surcharge from age 21 to 60 (§ 149 VAG). The money is used from 65 to soften increases and from 80 to lower the premium. - „If I change private insurer, my savings for old age move with me." ✘ Only partly. For contracts since 2009, only the share matching the basic tariff transfers. The rest stays with the old insurer, which makes late switching expensive. - „Every private insurer must offer a basic tariff to eligible people, whatever their health." ✔ True. The basic tariff matches public benefits and its premium is capped at the maximum public contribution. Insurers cannot refuse eligible applicants, but it is a safety net, not a bargain. - „My premium goes up because I made a lot of claims last year." ✘ False. Premiums are adjusted for everyone in a tariff when that group's costs rise. Your own claims affect only premium refunds, not your price. ## Common mistakes - Choosing private cover in your first year without considering a future partner and children - Filling in the health questionnaire without mentioning treatment received abroad - Relying on a travel policy as proof of insurance for a residence permit - Comparing only the starting premium and ignoring premiums at 65 - Cancelling private cover when leaving Germany without asking about a dormant policy - Switching to private cover after 50 without planning for the closed way back ## FAQ ### Can I switch from public to private insurance as an employee? Yes, if your regular gross salary exceeds the threshold, which is €77,400 a year in 2026. If you move to Germany and start a job above the threshold, you can choose private cover from day one. If you are already publicly insured, you can leave at the end of the year in which you cross the threshold. ### Do I have to pay doctors' bills upfront with private insurance? For outpatient care, yes. You receive an invoice, pay it and upload it to your insurer, usually through an app. Hospitals normally bill the insurer directly, and many insurers pay pharmacies directly for expensive drugs. ### Is my family covered with private insurance? No. Each family member needs their own policy and pays their own premium. In public insurance, a spouse without income and children are covered for free, which is often the deciding factor for families. ### What if I leave Germany? You can cancel private cover when you move your residence abroad. Most of the ageing reserve is lost. If you may return, a dormant policy keeps your status for a small monthly fee. ### Can I go back to public insurance later? Before 55, only if you become compulsorily insured again, for example through a job below the income threshold. From 55 it is generally excluded if you were not publicly insured in the previous five years. ### Is private health insurance cheaper than public? At the start, often yes, for young and healthy single people with high income. Over a lifetime it depends on premium increases and family size. Public contributions rise with salary, private premiums rise with healthcare costs. ### Do I need German to deal with a private insurer? Contracts and legal documents are in German. Some insurers offer English apps, claims handling and phone support. A broker can explain the terms and handle correspondence with the insurer for you. ### What is the employer contribution for private insurance? Your employer pays half of your premium, up to the amount they would pay for public insurance. In 2026 that is at most €508.59 a month for health and €104.63 for long-term care, a lower care amount applies in Saxony. ### Can a private insurer cancel my policy if I get sick? No. For comprehensive health insurance the insurer cannot terminate the contract. It can only raise premiums for all members of a plan when costs rise, not for you individually because of your claims. ## Legal basis and sources - [Social Code Book V (statutory health insurance)](https://www.gesetze-im-internet.de/sgb_5/) - [Insurance Contract Act (VVG, German)](https://www.gesetze-im-internet.de/vvg_2008/) - [BaFin company database (licensed insurers)](https://portal.mvp.bafin.de/database/InstInfo/) ## Request quotes We obtain quotes and come back with a comparison. Free of charge and without obligation: the insurer pays our commission. You can write in English. https://www.nammert.com/en/insurance-broker-private-health-insurance.php#anfrage --- NAMMERT Assekuradeur GmbH, insurance broker licensed under section 34d(1) of the German Trade Regulation Act, broker register no. D-C08Q-TOSD4-37. For boat and yacht insurance we act as underwriting agency, not as broker. NAMMERT Assekuradeur GmbH, Karl-Marx-Straße 4, 15711 Königs Wusterhausen, +49 3375 29 12 77, info@nammert.com. Wikidata: Q141141479.