Is private health insurance worth it for families in Germany?

How does Familienversicherung work in GKV?

Familienversicherung, the GKV's free co-insurance for family members,[1] lets a non-earning spouse and children ride along on the working parent's GKV contract at no extra cost. The 2026 income limit for the dependant is €565/month (€603 for a minijob). Children stay covered until 18, or 25 if still in education; there is no upper age limit for non-earning spouses. From 2028, GKV adds a surcharge of 2.5 percentage points to the member's contribution rate for a spouse insured this way, about €145 a month for an earner at the 2026 cap. The member pays it alone, with no employer share. It does not apply while a child under 12 lives at home, among other exceptions, and children stay free.[2]

The savings compound fast. For one earner supporting a non-earning spouse and two young kids, GKV charges only what the earner would pay anyway. At the BBG cap in 2026 that is a maximum contribution (GKV-Höchstbeitrag) of €1,226/month (with-kids rate), of which an employee pays half (~€613) with the employer covering the other half. The other three family members add €0/month. The household's total contribution is what one insured person pays, and slightly less than a childless person pays: the long-term care surcharge for people without children adds about €35/month at the cap.[3] From the second child under 25 a further reduction applies,[3] so a family of four sits a little below the flat with-children figure used here.

PKV has no equivalent. Every member needs an individual contract, with individual underwriting at entry. There is no "family rate", and the discount for adding family members is small. That difference in mechanism, flat versus per-person, is what the rest of this guide prices out.

What if one parent is GKV and the other is PKV?

Marital status decides this before income does. Three configurations exist: both parents in GKV (children ride along free), both in PKV (children need their own contracts), and the mixed case. In a mixed household, unmarried parents have a free choice, while married couples run into an income test[4] that can force the children onto the PKV parent.

A common setup: one partner is salaried under the JAEG (so in mandatory GKV); the other is self-employed (so chose PKV). Whether the children can ride along free on the GKV parent's Familienversicherung depends first on marital status, and only then on income.

If the parents are not married (and not in an eingetragene Lebenspartnerschaft, a registered civil partnership), the income-comparison rule[4] does not apply at all. The Bundesverfassungsgericht confirmed this in 2011 (1 BvR 429/11): the resulting unequal treatment of married versus unmarried parents is settled law. In practice, the children go on the GKV parent's Familienversicherung at no cost regardless of who earns more, or, if the family prefers the broader benefit set, they can be placed in PKV. The choice is open.

If the parents are married (or in a registered civil partnership), the rule excludes the children[4] from Familienversicherung when both of these conditions hold:

1. The PKV parent's regular income exceeds 1/12 of the JAEG (the threshold for compulsory GKV, distinct from the BBG used elsewhere in this guide), and
2. The PKV parent's regular income is higher than the GKV parent's.

If both apply, the children lose access to free Familienversicherung. That is the entire effect of the rule. It does not order private cover, and this is where most guides go wrong. Two routes stay open. The children can join GKV in their own right as voluntary, contributing members,[5] and for a newborn that has to be done within three months of the birth.[6] Or they can take a private contract, which does not have to be with the PKV parent's insurer. The Krankenkasse measures "regular income" using current monthly gross for employees and the most recent Einkommensteuerbescheid (annual tax assessment) for self-employed parents, meaning that for the self-employed half of a typical mixed-system couple, the comparison rests on the previous year's tax assessment.

The implication: for a married mixed-system family, the earnings split between the two parents decides whether the children are covered at no cost or whether they cost something, either as contributing GKV members or on their own private contracts. For unmarried mixed-system parents, the question does not arise.

What does PKV cost per family member?

In a very good tariff, a PKV contract for a child costs about €200–€250/month in 2026. What moves the number is mainly the benefit scope you choose and whether the tariff carries a deductible (Selbstbeteiligung). Age matters less during childhood than people expect, but it is not irrelevant: many insurers move a child to a teenage or adult rate at a set age, and some do not. Whether a tariff has such a step, and at what age, is set out in the insurer's current terms and is worth checking before you sign. Each parent adds their own contract on top: in 2026 a healthy parent pays about €500–€600 a month at 30, €650–€750 at 40 and €850–€950 at 45, in a very good tariff with a deductible of up to €600.

The private figures above include the compulsory private long-term care insurance (private Pflegepflichtversicherung), just as every GKV figure in this article includes long-term care, so the two systems are compared like for like. Children are covered in private long-term care without a premium of their own.

A newborn can be added to a parent's PKV contract without any health check at all, via Kindernachversicherung,[7] provided the application is filed within two months of birth. That deadline is absolute, and if both parents are privately insured there is no public fallback: how newborn enrolment works covers the conditions and what missing it costs.

Set against a single-earner GKV household, the comparison for a family of four looks like this.

In total premiums the gap is about €200–€300 a month. In what the earner pays, GKV is ahead by roughly €245–€380/month for this profile: about €613 against €855–€990. The reason is the employer's share. For health cover the employer pays at most €508.59 a month in 2026 in both systems, and in private cover that maximum covers the whole family, so the rest of the higher premium falls on the earner. For long-term care it pays half in both, and private long-term care costs far less than the public contribution, so that half is smaller too.[8] The structural point matters more than the number: GKV's bill is flat in the number of children, PKV's is linear. A third child adds nothing in GKV (the long-term care contribution even falls slightly) and around €200–€250 in PKV. Once the family is complete, the private figure is a fixed sum per person.

If you want the actual numbers for your family rather than a market range, book a free 30-minute call. We run your ages, health profiles, and how the employer subsidy splits across contracts.

When is PKV the better call for a family?

PKV is the better call for a family in two situations: both parents earn above the JAEG, or a parent is self-employed and the children can stay in the other parent's public cover. In each case GKV loses part of what makes it cheap for families: free cover for dependants, or an employer paying half. From 2028, a surcharge for a spouse without income also narrows the gap for single earners.

Both parents above the JAEG. If both partners earn enough to choose, each pays a full contribution in GKV and only the children ride along free, so the comparison turns clearly towards private cover. Two spouses without children at the GKV cap pay roughly €2,522/month combined in 2026, while two healthy 30-year-olds pay €1,000–€1,200/month in a very good PKV tariff, both before the employer's share. That is the widest gap in the whole family picture. Children narrow it without closing it: with two children at €200–€250 each, the private total stays well below two public maximum contributions of €1,226.

A parent is self-employed. This case is easy to overlook. A self-employed parent in voluntary GKV (freiwillige GKV) pays the full contribution with no employer to share it, up to about €1,226/month at the 2026 cap. PKV prices on age and health rather than income: a healthy self-employed parent at 35 pays about €400–€550 a month with a higher deductible, less than half the public maximum. With a partner without income and two children also in private cover, public cover is usually cheaper. The gain is largest when the children can stay in the other parent's public family insurance: for unmarried parents in any case, for married parents as long as the self-employed parent does not earn both more than €6,450 a month and more than the other parent.

From 2028, the gap narrows. For a single earner, GKV adds 2.5 percentage points to the contribution rate for a spouse without income, about €145 a month at the 2026 cap, with no employer share.[2] It does not apply while a child under 12 lives at home or another exception applies; once the youngest turns 12, it does. In the worked example, that closes roughly half of GKV's lead in what the earner pays, and the private benefits weigh more: shorter waits for specialists, broader dental cover for the children, and a single or double room in hospital. Private premiums follow your age when you join, so families who decide while the children are young gain most. We compare both systems for your family before the surcharge reaches you: book a free call.

The family is complete. This is worth being precise about, because it is often listed as a reason to go private and it is not one. Free family cover for the children does not end when the family is complete. What changes on the PKV side is that the cost stops growing, so the comparison becomes a fixed per-person sum instead of an open-ended one. The worked example above is exactly such a family, two parents and two children under 12, and for it GKV comes out around €200–€300/month cheaper in total premiums. Completeness makes the decision calculable. From 2028, the youngest child's age moves it, as the paragraph on the surcharge above shows.

There is also the family that pays more on purpose. At roughly €245–€380 a month more in the earner's share for a family of four, some families decide the private benefits are worth it: shorter waits for specialist appointments, broader dental cover for the children, and a single or double room in hospital. That is a legitimate reason to choose PKV.

If you do go the PKV route with children, the tariff features that matter most are premium suspension during Elterngeld, a benefit analogous to Kinderkrankengeld,[9] expanded pregnancy care, Krankentagegeld that pays during Mutterschutz,[10] and explicit cover for congenital birth defects in the policy terms. These add roughly €20–€60/month per adult contract over a stripped-down tariff. For a couple planning children, that is worth paying. For a couple who are done, it is not. The Krankentagegeld point in particular has a deadline attached: what maternity leave actually pays on private cover works through the timing, which has to be handled before conception.

For the deeper cost mechanics, see how GKV calculates your premium; for the broader profile-by-profile decision logic, see our comparison of PKV and GKV.

How do I actually decide?

To decide between GKV and PKV for a family, start with three questions: how many earners does the household have, is one of them self-employed, and how old is the youngest child? Those answers move the decision further than any tariff comparison. A family with one employed earner and young children pays less in GKV for now; from 2028, once the youngest is 12, a surcharge for the spouse narrows the gap, and private premiums reward joining young. A dual-earner couple above the JAEG, or a well-earning self-employed parent whose children can stay in the other parent's public cover, pays less in PKV.

The family-coverage decision is rarely about minimising this month's bill. It is about which mechanism survives the next decade: adding a child, losing a job, returning to work part-time, a second pregnancy. GKV's €1,226/month maximum contribution holds steady whether you have one child or four, and from 2028 a spouse without income adds a surcharge once the youngest is 12. PKV's advantage is concentrated where the family-coverage rule gives you little or nothing, and it comes with a long-horizon commitment per person.

These pieces interlock differently depending on marital status, the income split between parents, whether you plan more children, and how long you stay in Germany. If you would like the actual math for your family's situation, book a consultation.