Public vs. private health insurance in Germany

In Germany, every resident must have health insurance, and you'll usually choose between two systems: public health insurance (gesetzliche Krankenversicherung, GKV) and private health insurance (private Krankenversicherung, PKV).

Public insurance costs about 14.6% of your gross salary, plus an average 2.9% surcharge (roughly 17.5% in 2026), split with your employer, and covers you and low-income dependents (mainly family members) regardless of health status.

Private insurance is priced based on your age and health and is mainly open to employees earning over €77,400 a year (2026), civil servants, the self-employed, and students.

Feather is a licensed insurance broker that helps expats and internationals in Germany choose and sign up for health cover: Online, in English, in minutes. This guide is for you if you're weighing up which system to join.

Here's what we'll cover:

• How the two systems compare at a glance
• Who qualifies for each
• How your income, family size, and age tip the decision
• The differences in coverage
• Which is likely better for you

Public vs. private health insurance in Germany: At a glance

Is health insurance mandatory in Germany?

Yes. Health insurance is mandatory for every resident of Germany: you'll need it for your visa, your job, and even to register a business.

You must choose between public (statutory) insurance, private insurance, or, for some newcomers, an expat health plan before you complete your residency registration.

As of 1 January 2026, about 74.2 million people in Germany were covered by statutory insurance and around 8.79 million held full private cover (Bundesministerium für Gesundheit, 2026; Feather, 2026).

What is public health insurance in Germany?

Public health insurance (gesetzliche Krankenversicherung, GKV) is state-backed coverage run by 93 not-for-profit funds (Krankenkassen) on a “solidarity principle”, meaning you pay more when you earn more (GKV-Spitzenverband, 2026). In 2026, it costs 14.6% of your gross salary plus an average additional contribution (Zusatzbeitrag) of 2.9%, around 17.5% combined, split evenly between you and your employer if you're employed full-time (Bundesministerium für Gesundheit, 2026).

Each fund sets its own surcharge, so rates range from about 2.18% to 4.39%; switching funds can seriously cut your costs. GKV covers medically necessary care, and depending on your age, preventive procedures like check-ups and cancer screenings. But if you want a treatment beyond that, you'll usually pay for it yourself.

Public health insurance (GKV): pros and cons

What is private health insurance in Germany?

Private health insurance (private Krankenversicherung, PKV) is coverage from private companies rather than state-backed funds, with premiums based on your age and health at signup rather than your income. Because of that, younger, healthier people usually get a better price. You can also tailor your plan and add more comprehensive cover for a higher premium.

Private insurers come in two forms:

• Joint-stock company (Aktiengesellschaft, AG): a for-profit insurer owned by shareholders, who receive the profits. Policyholders don't share in them.
• Mutual insurer (Versicherungsverein auf Gegenseitigkeit, VVaG): a non-profit organization owned by its members, where profits are returned to policyholders.

You can opt into private insurance if you're a civil servant, self-employed, a student, or an employee earning more than €77,400 a year in 2026 (Bundesministerium für Gesundheit, 2026). The self-employed can choose private cover at any income, though insurers set their own underwriting rules. At Feather, that’s €2,500/month when under 45 years old and €3,750/month for those over 45.

Private health insurance (PKV): pros and cons

Further reading: Is private health insurance worth it?

Should you choose public or private health insurance in Germany?

Choose public health insurance (GKV) if you earn under €77,400 (2026), have multiple dependents to cover, or are older, since costs scale with income and cover your family free.

Private insurance (PKV) tends to suit high earners, civil servants, and young, healthy people who want broader coverage and can lock in lower premiums by joining early.

The right answer depends on your income, family size, and age, so let's take each in turn…

Does your income decide whether you can go private?

In Germany, employees can choose private insurance only if they earn more than €77,400 per year in 2026 (the Versicherungspflichtgrenze); below that threshold, public insurance is mandatory.

Freelancers and the self-employed can go private at any income in theory, though most insurers have their own minimum income thresholds. Their public premiums are higher because there's no employer contribution.

For high earners, private insurance can be cheaper, since premiums aren't proportional to income and are tailored to your risk profile (a healthy person often pays less).

If you're a civil servant, private is especially attractive because you'll receive employer contributions toward it.

Self-employed and looking for help? See our health insurance guide for freelancers.

How does family size affect the choice?

Family size can tip the decision. Under public insurance (GKV), a non-working spouse and children are co-insured free of charge through family insurance (Familienversicherung), which makes it far more affordable for larger families. On private insurance (PKV), each family member needs their own policy and premium.

Private cover can still work out cheaper for small families where the main member joined early, or if you're childfree, thanks to potentially lower premiums.

Note that there may be changes in how spouses are covered by public health insurance in the near future.

How does age affect health insurance costs in Germany?

Your age doesn't affect what you pay for public insurance (GKV), and you won't pay more to cover chronic conditions that become more common with age.

Private insurance (PKV) is different: premiums are set by your age and health at signup, so they rise for older residents switching over (and may exclude some pre-existing conditions).

Keep this in mind: switching back to public is almost impossible after age 55.

All in all, public insurance is often the best option for older residents, thanks to its fixed costs and coverage for pre-existing conditions.

Compare the best plans for you with a personalized recommendation from Feather.

How does coverage differ between public and private health insurance?

Both public (GKV) and private (PKV) insurance in Germany cover doctor visits, hospital stays, medication, and basic dentistry. Public plans limit you to statutory-scheme doctors and add small co-pays; private plans offer free choice of doctor, senior-physician hospital treatment, and often full reimbursement, though how much depends on your tariff.

Here's how they compare across primary care, hospital stays, dental, and mental health.

How do public and private differ for primary care?

Your choice of public or private insurance won't limit which GP you can see. Germany guarantees patients the right to choose their doctor. Under public insurance (GKV), you'll need a doctor who participates in the statutory scheme. Private tariffs may limit you to a provider network, though Feather's private plans give you free choice of doctor without those restrictions.

Under public insurance (GKV), prescriptions carry a 10% co-payment (minimum €5, maximum €10) in 2026. Privately insured patients usually pay upfront and receive full reimbursement.

For alternative or complementary medicine, GKV offers little or no cover, while PKV coverage depends on your tariff.

How does public and private insurance differ for hospital stays?

Under public insurance (GKV), you can be treated at any licensed hospital, though you'll go to the nearest available clinic unless it's an emergency. All plans cover treatment and hospitalization, with a co-payment of €10 per day for up to 28 days a year (maximum €280) in 2026.

Privately insured residents (PKV) often have wider hospital access, can be treated by heads of department, and frequently pay no hospital co-payment (depending on the plan).

What dental care does public and private insurance cover in Germany?

Both public (GKV) and private (PKV) insurance cover basic dental care in full, including fillings and cleanings, and you're free to choose any covered dentist.

For dentures, public insurance pays a fixed subsidy of 60% of standard care, rising to 70% after five years and 75% after ten years of a documented bonus booklet (Bonusheft) (Verbraucherzentrale, 2026). You'll cover the rest yourself, but you can add supplemental dental insurance to close the gap.

Private plans typically reimburse 50% to 100% of prosthetic costs, depending on your plan. Basic cover is roughly equal. But private tends to be cheaper for specialist work than public plus supplemental dental.

Learn more about dental insurance in Germany.

How long do you wait for therapy in public vs. private care?

The big differences in mental health coverage are how many sessions you get and how fast you can start. Whichever plan you're on, you have free choice of psychotherapist as long as they're licensed and part of your scheme. Both public (GKV) and private (PKV) cover approved therapies, including behavioral therapy, depth-psychology and analytical psychotherapy, systemic therapy, and EMDR for post-traumatic stress.

Under public insurance (GKV), you'll need prior approval, but approved therapies are often covered at 100%. Session limits depend on the method: around 60–80 sessions for behavioral therapy and up to 300 for analytical psychotherapy with approved extensions (KBV, 2026). There’s a catch, though: finding a therapist can exceed a year.

Under private insurance (PKV), cover depends on your tariff. Usually, that means fewer sessions covered at around 70% of the cost. The upside is speed: you can typically start within days to weeks.

If getting therapy quickly matters most, private is the better choice despite the cost. If you can wait, the public offers more sessions at a fixed rate.

Learn more about mental health in Germany.

Which is better for you?

For most residents, public health insurance (GKV) is the safer default in Germany, because costs scale with income and cover dependents for free. Private insurance (PKV) is usually better only for high earners above €77,400 (2026), civil servants, and young, healthy people, who can secure lower premiums and broader, faster care — including specialists and psychotherapy — that public plans don't offer.

Public insurance is also the stronger choice as you get older, since your premium isn't tied to your age or pre-existing conditions, and for larger families, since dependents are covered at no extra charge.