How public health insurance works in Germany

Public health insurance (gesetzliche Krankenversicherung, or GKV) is Germany's state-run statutory system, and it covers about 90% of the population. That’s roughly 74.2 million people (GKV Spitzenverband, 2024). It's mandatory for most employees, income-based, and open to yearly switching between providers.

In this post, you'll learn:

• Who qualifies
• What public health insurance costs in 2026
• What it covers
• And how to sign up

New to the country? We also explain how the German health insurance system works and compare public and private health insurance.

Brought to you by Feather, a licensed insurance broker helping expats and internationals in Germany choose and sign up for cover.

Public health insurance in Germany at a glance

• Covers ~90% of residents: Around 74.2 million people are on public health insurance (GKV).
• Mandatory for employees earning under €77,400 per year (the 2026 compulsory-insurance threshold).
• Cost is income-based: 14.6% general contribution + an average 2.9% additional contribution in 2026, plus ~3.6% for long-term care. Employees split this with their employer, the self-employed pay the full ~21.1% themselves.
• There are 93 statutory funds to choose from (Krankenkassen), and you can switch once a year. TK, BARMER and DAK are the most English-friendly.
• Alternative: Private health insurance, mainly for high earners, freelancers and civil servants, with stricter eligibility. Or, expat health insurance, a temporary solution for those moving to Germany.

What is public health insurance in Germany?

Public health insurance in Germany (gesetzliche Krankenversicherung, GKV) is the government-regulated system that covers about 90% of residents. It's mandatory for most employees, priced on your income rather than your health, and lets you switch among 93 statutory funds each year. The best for English speakers are TK, BARMER and DAK.

Here's what else is worth knowing:

• Public health insurance gives you solid, comprehensive benefits, but leaves gaps in a few areas, especially in vision and dental. Many people add cover through a dental insurance policy.
• The cost of statutory insurance is proportional to your income, up to a ceiling of €69,750 a year (€5,812.50 a month).
• You can change funds each year if another offers better benefits, service, or a lower additional contribution.
• The alternative is private health insurance, but it has stricter eligibility criteria.

Read our guide to private health insurance.

Who is public health insurance for?

Public health insurance (GKV) is designed for employees earning under €77,400 a year, most students, KSK members, and pensioners who were previously publicly insured. Full-time self-employed people and high earners can choose it or opt for private insurance instead.

Can employees get public health insurance in Germany?

Employees under 55 earning less than €77,400 per year (the 2026 compulsory-insurance threshold) must join public health insurance. Those earning more can still sign up, but only if it's their first job in Germany or they're currently publicly insured elsewhere in the EU. Otherwise, they take private health insurance.

Employees also have the easiest time signing up. Your cover starts automatically on your first day of work. If you don't register within two weeks, your employer does it for you.

Do students need public health insurance in Germany?

Yes, students must have health insurance to enrol at a German university. If you're covered by your parents' German family insurance, you can stay on it until you turn 25 (the same applies to a spouse's policy), as long as you don't work during that time. Over 25, or with parents living abroad, you can take discounted student health insurance instead.

For those over 30, it gets more complicated. You could sign up as a voluntary member, but it's much more expensive. The best alternative is usually expat health insurance.

Read our guide to health insurance for students.

Can freelancers and the self-employed get public health insurance?

Full-time self-employed people in Germany can choose between public and private health insurance. You'll be accepted into the public system automatically if you were publicly insured for more than 24 months in the last five years, or for 12 or more months immediately before registering as self-employed. Joining the KSK (the artists' social fund) means public health insurance is required.

Read our guide to health insurance for the self-employed.

Can retirees and pensioners get public health insurance in Germany?

If you worked in Germany and were publicly insured, you can stay with your current public health insurer as a pensioner. If you worked and were publicly insured elsewhere in the EU, you can choose to sign up with a German public fund. You'll need to complete an S1 form, and you'll receive the same benefits as under your home country's insurance.

Read our guide to health insurance for retirees.

How much does public health insurance cost in 2026?

Public health insurance in Germany costs 14.6% of your gross income in 2026, plus an average additional contribution (Zusatzbeitrag) of 2.9% set by the Federal Ministry of Health, plus around 3.6% for long-term care insurance (Pflegeversicherung). Contributions are calculated up to an income ceiling of €69,750 per year (€5,812.50 per month). Employees split the total with their employer; the self-employed pay it in full.

Long-term care insurance is 3.6% in 2026, rising to 4.2% for members aged 23 and over who have no children. If you earn above the €69,750 ceiling, your contributions are capped at that amount rather than your full salary.

As a rough example, an employee earning €4,000 gross per month in 2026 pays around €340 a month for public health insurance (their half of the combined rate), with the employer matching the other half.

Student health insurance is more affordable, at roughly €140–160 per month in 2026, including the long-term care portion.

Costs are climbing across the board. In 2026, the combined burden (14.6% + ~2.9% + ~3.6%) already sits above 20% of income, and experts expect further rises this decade.

Read more on the difference between KV, AV, RV, UV and PV payments.

What does German public health insurance cover?

German public health insurance (GKV) covers all medically necessary treatment, plus some preventive care such as cancer screenings. Small co-payments apply to prescriptions, hospital stays and a few other services, and under-18s are exempt from most of them. Exact benefits vary slightly from one fund to the next, but around 95% of coverage is fixed by law.

For premium dental materials, implants or nicer dentures, many people top up with dental insurance.

Which is the best public health insurer in Germany?

Techniker Krankenkasse (TK) is widely rated the best public health insurer in Germany for English speakers, with DAK, BARMER and AOK as strong alternatives. Because around 95% of benefits are fixed by law and identical across funds, the real differences come down to the additional contribution, English-language service, and the small set of extra benefits each fund offers.

Three factors to compare:

1. The additional contribution (Zusatzbeitrag). For 2026, rates range from about 2.18% (BKK firmus, the cheapest nationally open fund) to 4.39% (BKK24), around the 2.9% average.
2. English-language service. If you're a fluent German speaker this won't matter, but otherwise it's crucial for getting the most from your policy.
3. Extra benefits. The ~5% of coverage that varies caters to different needs. Want lower premiums? Look for a fund offering deductibles. Value pregnancy and family perks? Public insurance with DAK is a strong pick.

Compare the best public health insurance in Germany.

How to sign up for public health insurance

To sign up for public health insurance in Germany with one of our recommended funds, follow these five steps:

1. Click the button below to compare them.
2. Click "Sign up" on your preferred fund.
3. Complete the questionnaire.
4. You'll get a confirmation of coverage by email within 2 weeks.
5. Once approved, request your health card. You can usually see a doctor within 2–3 weeks.

Sign up to public health insurance

Prefer another fund? You can also apply by post, online, or in person at their office. The available options differ from one fund to another.

How to switch public health insurance companies

You can switch public health insurers in Germany once you've been with your current fund for at least 12 months. Your new fund handles the paperwork, so there's no need to notify your old insurer or your employer. After you apply, there's a two-month waiting period before the switch actually takes effect.

Here's the process step by step:

1. Check you've been with your current fund for at least 12 months.
2. Choose your new fund.
3. Apply for membership — your new insurer sorts out the details with the old one.
4. Wait out the two-month notice period, after which your new cover begins.

Special termination right: if your employment changes (a new job or losing one) or your fund raises its additional contribution, you can switch immediately, without waiting 12 months. You have a 14-day window to use this right.