Health Insurance in Germany for Expats: GKV vs PKV Explained

Health insurance (Krankenversicherung) is mandatory for every resident in Germany. You cannot live or work here without it. This guide explains the two systems — public (GKV) and private (PKV) — and helps you decide which is right for your situation.

How Does Health Insurance Work in Germany?

What are my options?

You have two types of health insurance in Germany:

1. Gesetzliche Krankenversicherung (GKV) — Public / statutory health insurance
2. Private Krankenversicherung (PKV) — Private health insurance

About 90% of the German population is on GKV. As an employed expat, you will be automatically enrolled in GKV unless you actively opt out (and qualify for PKV).

When do I need to register?

You should register for health insurance before you start your job. Your employer will ask which health insurance provider you have chosen. If you do not pick one, you will be assigned to your employer's default provider.

Tip: Choose your provider before your first day of work. The registration process takes only 10-15 minutes online.

Public Health Insurance (GKV)

How much does GKV cost?

• Base rate: 14.6% of gross salary
• Supplementary premium: ~1.3-1.7% (varies by provider)
• Split: Your employer pays half, you pay half
• Your share: roughly 8% of your gross salary
• Income cap: Contributions are capped at a gross salary of ~€62,100/year (Beitragsbemessungsgrenze). Above this, contributions do not increase
• Maximum monthly contribution: ~€415/month (employee share)

Use our salary calculator to see exactly how much health insurance will cost with your salary.

What does GKV cover?

GKV provides comprehensive coverage including:

• Doctor visits (GP and specialists)
• Hospital stays
• Prescription medications (you pay a small co-pay of €5-10 per medication)
• Mental health treatment (psychotherapy)
• Dental care (basic — crowns and implants require supplementary insurance)
• Pregnancy and maternity care
• Rehabilitation
• Preventive care and cancer screenings
• Sick pay (Krankengeld) after 6 weeks of sick leave

What are the advantages of GKV?

• Family coverage (Familienversicherung): Non-working spouse and children are covered for free. This alone can save €300-600/month compared to PKV
• Income-based premiums: Your premiums do not increase with age or health conditions
• Employer pays half: Your employer covers 50% of the contribution
• Krankengeld included: You receive ~70% of your gross salary if you are sick for more than 6 weeks
• No reimbursement hassle: Doctors bill the insurance directly

Which GKV provider should I choose?

All GKV providers cover the same basic services (mandated by law). The main differences are the supplementary premium rate and additional services.

• TK (Techniker Krankenkasse) — Most popular choice for expats. Excellent English-language support, great app, and online services. Supplementary premium: 1.2%
• AOK — Largest provider with strong local presence
• Barmer — Second largest, good digital tools
• DAK — Good English support
• HKK — Lowest supplementary premium (~0.98%)

Recommendation: If you want English-language support, go with TK. If you want the cheapest option, check HKK.

Private Health Insurance (PKV)

Who can get PKV?

You can opt for private health insurance if:

• Your gross salary exceeds ~€69,300/year (Versicherungspflichtgrenze) for at least one year
• You are self-employed
• You are a civil servant (Beamte)

How much does PKV cost?

PKV premiums are based on your age, health status, and chosen coverage level — not your income. Typical range:

• Age 25-35, healthy: €250-400/month
• Age 35-45: €350-550/month
• Age 55+: €600-900+/month

Your employer also contributes up to ~€400/month toward your PKV premium.

What are the disadvantages of PKV?

• No family coverage: Each family member (spouse, children) needs their own policy, costing €150-400+ per person per month
• Premiums increase with age: Can become very expensive in retirement
• Difficult to switch back to GKV: After age 55, it is nearly impossible to return to public insurance
• You pay upfront: You pay the doctor directly and submit invoices for reimbursement
• No Krankengeld: You need a separate Krankentagegeld policy for long-term sick pay
• Pre-existing conditions: Can lead to exclusions or higher premiums

Is PKV worth it?

PKV can be attractive if you are young, single, healthy, and earning a high salary. You get faster appointments, access to private hospital rooms, and sometimes better coverage for specific treatments.

However, the long-term risks are significant. Many expats who chose PKV in their 30s regret it in their 50s when premiums have tripled and switching back is impossible.

GKV vs PKV: Comparison

Factor	GKV (Public)	PKV (Private)
Best for	Families, average earners, long-term residents	Young, single, high earners planning to leave Germany
Monthly cost (€70K salary)	~€400	€250-450 (age-dependent)
Family coverage	Free for spouse + kids	Each person pays separately
Cost at age 60+	Same income-based rate	Significantly higher
Switching back	Always possible	Very difficult after 55
Doctor availability	Standard wait times	Priority / faster appointments
Krankengeld	Included	Must buy separately
Dental	Basic only	Often comprehensive

Which Should I Choose?

For most English-speaking expats, GKV (public) is the safer choice:

1. If you have or plan to have a family → GKV (free family coverage saves €300-600/month)
2. If you plan to stay in Germany long-term → GKV (premiums stay predictable)
3. If you are young, single, healthy, earning €70K+ and planning to eventually leave Germany → PKV can save money in the short term
4. If you are unsure → Start with GKV. You can always switch to PKV later, but switching back is very difficult

Can I switch from PKV back to GKV?

Yes, but it is difficult. You must:

• Drop below the income threshold (€69,300) for a sustained period, OR
• Become unemployed, OR
• Be under 55 years old

After age 55, switching back is essentially impossible. This is the biggest risk of choosing PKV.

What about supplementary insurance (Zusatzversicherung)?

If you are on GKV, you can buy supplementary private insurance to cover:

• Dental: Crowns, implants, orthodontics (€15-40/month)
• Hospital: Private room, chief physician treatment (€20-50/month)
• Vision: Glasses and contact lenses (€5-15/month)

These supplementary policies are affordable and can fill the gaps in GKV coverage.

Registering for Health Insurance

How to register for GKV

1. Visit the website of your chosen provider (e.g., TK)
2. Fill out the online application (most offer English forms)
3. You will receive a membership confirmation within a few days
4. Give the confirmation to your employer before your first day

What if I already have insurance from my home country?

Travel insurance or insurance from your home country is not sufficient for living and working in Germany. You must register for either GKV or PKV. The only exception is the European Health Insurance Card (EHIC) for short stays.

Related Resources

• Salary Calculator — See how health insurance affects your net salary
• Sick Leave in Germany — How Krankengeld works
• Cost of Living in Germany — Budget planning including insurance
• German Tax Basics — How deductions affect your take-home pay
• Explore English-speaking jobs in Germany and plan your move with confidence