Germany runs two systems in parallel:
- Public (Gesetzliche Krankenversicherung (GKV), meaning "Statutory health insurance") — income-based, family members included for free, simple to use.
- Private (Private Krankenversicherung (PKV), meaning "Private Health Insurance") — risk-based, faster access and premium options, but cost can rise with age and it’s hard to switch back to public.
Rule of thumb:
- For families and average earners → Public (GKV)
- Young, healthy high earners staying long-term → Private (PKV)
- Overview: Two Systems, One Goal
- Who Can Join Each System
- How Much They Cost
- What Each Covers
- Key Pros and Cons
- Public vs Private: Overview
- Tips for Expats and Freelancers
- Final Thoughts and Which Insurance Should You Get?
- Quick Recap
1) Overview: Two Systems, One Goal
- Public Health Insurance (GKV) – financed by income-based contributions (employer pays ~50%). Benefits are standardized, access is broad, and dependents can be covered for free.
- Private Health Insurance (PKV) – a personalized contract. Premiums depend on age, health, and options (dental, private rooms, top specialists). Often faster access; harder to return to public later.
Most people are in Public (GKV); a minority (often high earners, self-employed, and civil servants) use Private (PKV).
2) Who Can Join Each System
If your salary is below the annual threshold, you’re in public by law. Above it (or if self-employed), you can choose.
3) How Much They Cost
- Public (GKV): % of income (base ~14.6% + small fund supplement), capped at an income ceiling; employer pays half.
- Private (PKV): depends on age/health/benefits/deductible; employer contributes for employees (up to the GKV cap). Costs can rise with age.
Let's have a look at some examples:
John works for a company and earns €55,000/year, which is below the private-insurance threshold. He must stay in public insurance (GKV) and he pays around €365/month out of his salary, with his employer covering the same amount.
Lisa is a freelancer earning €55,000/year. She can choose between public insurance (~€730/month) or private (~€400/month).
Mark is employed and earns €85,000/year, which is above the threshold, so he can choose between public and private insurance.
In public (GKV), he pays about €410/month, only slightly more than John, despite earning considerably more, because contributions are capped once you hit the income ceiling.
A private (PKV) plan would cost Mark around €450–€500/month for faster service and extra benefits.
4) What Each Covers
Public (GKV) covers medically necessary care; Private (PKV) lets you add comfort and speed (private rooms, chief physician, stronger dental).
5) Pros and Cons of Each
Public (GKV)
Pros
- Income-based, predictable payments
- Free family coverage for spouse/children
- No health checks; open to all
- Card-based billing (minimal admin)
Easier to switch between public funds
Cons
- Limited “extras” (dental/hospital upgrades)
- Specialist waits can be longer
- High earners may pay more (until the cap)
- Benefits can shift with policy
Private (PKV)
Pros
- Faster access, wider doctor choice
- Premium hospital/dental options
- Often cheaper for young, healthy high earners
- Contractual benefits (less political fluctuation)
- Possible no-claim bonuses
Cons
- Premiums tend to rise with age
- Each family member needs a policy
- Pay-then-reimburse workflows
- Hard/impossible to switch back (esp. after 55)
- Medical underwriting on entry
6) Public vs Private: Overview
A quick side-by-side of how premiums, access, and flexibility differ.
7) Tips for Expats and Freelancers
- Employees:
- Below the threshold (€73,800/year) → Public (GKV) automatic.
- Above the threshold (€73,800/year) → you should weigh Private (PKV) perks vs. long-term lock-in of Private.
- Self-employed: You can choose.
- Public (GKV) uses your declared income (with a minimum).
- Private (PKV) may be cheaper early, pricier later.
- Families: Public (GKV) often wins (free dependents).
- Students/new arrivals: Public student tariffs are usually simplest; ensure any private plan is fully visa-compliant.
8) Final Thoughts and Which Insurance Should You Get?
Choose Public (GKV) if you want simplicity, family coverage, and protection when income drops.
Choose Private (PKV) if you’re young, healthy, well above the threshold, want premium options, and plan to stay long-term — knowing it’s hard to return to public later.
9) Quick Recap
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