How GKV Calculates Your Premium (and What It Means for You)

The base rate: 14.6 % plus 2.9 % equals 17.5 %

Every Krankenkasse charges the same statutory base rate of 14.6 % on your gross income, fixed by federal law (§ 241 SGB V). This rate doesn't change between funds and doesn't change with income brackets. It's a flat percentage applied to whatever earnings count as contribution-liable gross income, up to the BBG.

On top of that, each Krankenkasse charges a Zusatzbeitrag (supplementary contribution) to cover its individual costs. This is where funds compete on price. It varies by fund: the federally-set average for 2026 is 2.9 %, up from 2.5 % in 2025; individual funds typically charge between 2.3 % and 3.2 % depending on their cost structure (TK is at 2.45 % in 2026).

For most calculations the all-in KV rate at an average fund is around 17.5 % of gross. At a cheaper fund (Zusatzbeitrag 2.3 %) it's about 16.9 %. At an expensive fund it's 17.8 %. The difference at the BBG works out to roughly €50/month, real but small relative to total cost.

One side note: the federal Zusatzbeitrag average is also what gets used to calculate the employer contribution (Arbeitgeberzuschuss) for PKV-insured employees, so it appears in tax calculations even for people not in GKV.

Pflegeversicherung sits on top, and the childless surcharge isn't shared

Pflegeversicherung (long-term care insurance) is its own contribution: 3.6 % if you have at least one child or had one (Elterneigenschaft under § 55 Abs. 3 SGB XI, the parent-status condition). For people childless and aged 23 or older, the rate is 4.2 %, a 0.6 percentage-point childless surcharge (Kinderlosenzuschlag).

One detail worth flagging: the Kinderlosenzuschlag falls entirely on the employee, not split with the employer. Everything else in GKV is 50/50: KV splits at 8.75 % each side, PV splits at 1.8 % each side on the basic 3.6 % rate. The childless surcharge is the one piece the employer doesn't share. It's small in absolute terms (at the BBG cap it's about €34.88/month) but it's a structural difference worth knowing about.

Parents of multiple children get a further reduction. Each child under 25 reduces the employee's PV contribution by 0.25 percentage points, capped at 1.00 percentage points off (for 5 or more kids). The reduction applies only to the employee share, not the employer's, and only while children are under 25.

Stack it together and the all-in GKV rate is 21.1 % of gross income with kids, or 21.7 % childless. That's the share of every euro you earn that goes into the statutory system before income tax even enters the picture.

The 50/50 split: who pays what

For employees, the bill is split between you and your employer. KV at the average all-in 17.5 % splits half each, giving 8.75 % on each side of your gross. PV at the basic 3.6 % rate (with kids) splits half each too, at 1.8 % on each side. The PV childless surcharge of 0.6 % is paid entirely by the employee.

Your gross-pay deduction shows up as roughly 10.55 % with kids or 11.15 % childless, capped at the BBG. Your employer pays roughly the same on top, slightly less if you're childless.

For self-employed people there's no employer. You pay the full 17.5 % KV plus 3.6 % or 4.2 % PV yourself, with no split and no employer subsidy. The mechanic for working out the assessment basis is different too.

The BBG: where the percentage stops climbing

That ceiling is the Beitragsbemessungsgrenze (BBG). For 2026 it's set at €69,750/year, or €5,812.50/month. Income above the BBG is not assessed at all for KV/PV contributions. So if you earn €10,000/month gross, you're only billed on the first €5,812.50; the rest is invisible to GKV.

That sounds like a relief, and for low and mid earners it is. The percentage caps out, the bill stops climbing.

The Höchstbeitrag trap

Once you cross the BBG, your monthly GKV bill stops being income-sensitive. It's fixed at the maximum (the Höchstbeitrag) and grows only with the BBG itself. Earning €100,000 versus earning €120,000 makes no difference to your contribution; both pay the same maximum.

In 2026, the GKV-Höchstbeitrag (maximum monthly contribution) is:

€1,261/month childless (KV €1,017.19 + PV €244.13)

€1,226/month with kids (KV €1,017.19 + PV €209.25)

That's the absolute maximum the GKV system charges any single insured. For employees this splits 50/50 with the employer (the employee paying €648 childless or €613 with kids from their own pocket). Self-employed people pay the full amount themselves.

Now the structural problem: this maximum has been climbing aggressively. The driver is the BBG itself, which is set each autumn and tracks general wage growth, but in recent years has run ahead of average wage trends:

The Höchstbeitrag has climbed by an average of 6.9 % per year over 2021–2026, more than double GDP growth and well ahead of average wages. For someone earning €100,000+ gross, that means your GKV bill is on a one-way escalator you cannot influence: your individual income above the BBG doesn't matter, but the BBG itself rises, dragging your contribution with it.

This is the structural argument behind PKV for high earners: you can't avoid the GKV maximum escalator while in the system, and once your income is durably above the BBG, the percentage-of-income mechanic gives way to a flat bill that climbs on its own schedule.

The self-employed maths is different

For freelancers and self-employed people, the GKV calculation works on a different basis. There's no employer, no 50/50 split, and no automatic income reporting through the payroll. Two things change.

The first is the Mindestbemessung (minimum assessment basis). Even if your income is low or zero, voluntary GKV (freiwillige GKV) assumes a minimum income for contribution purposes. The 2026 Mindestbemessung is €1,318.33/month (per § 240 SGB V). Below this, you still pay contributions as if you earned €1,318.33. The resulting minimum monthly contribution lands at €281–€320/month depending on your fund's Zusatzbeitrag.

The second is the rate itself. Self-employed people pay the full 17.5 % KV plus 3.6 % or 4.2 % PV themselves: total around 21.1 % with kids or 21.7 % childless of their income up to the BBG. At the BBG cap they pay the full €1,226–€1,261/month themselves, the same total an employee would split 50/50 with their employer.

The practical implication: GKV for self-employed people is substantially more expensive than for employees at the same gross. A freelancer earning €60,000/year pays roughly €1,085/month all in. The same €60,000 as a salary would mean €478/month employee share with €478/month employer share. That €600/month gap is why PKV is almost always materially cheaper than GKV for self-employed earners at meaningful incomes: without an employer to share the bill, the GKV percentage runs up fast as income climbs, while PKV stays flat against income because it's priced on age and risk rather than what you earn.

Choosing a Krankenkasse: where the variation actually is

Within GKV, you choose a Krankenkasse (sickness fund): TK, Barmer, DAK, AOK, BKK, IKK, and dozens of smaller funds. The choice has surprisingly little impact on what you pay because the base rate is fixed by law.

The variable is the supplementary contribution (Zusatzbeitrag), which in 2026 typically ranges from about 2.3 % at the cheaper end to 3.2 % at the upper end (TK at 2.45 %). At the BBG cap, that translates to roughly €50/month difference between the cheapest and most expensive fund: a real number, but secondary to other factors.

What actually varies meaningfully between funds:

Customer service and English-language support (national funds tend to be more English-ready; regional AOKs vary)

Bonus programmes (some funds reimburse fitness, dental cleanings, alternative medicine to varying degrees)

Optional add-on tariffs (Wahltarife) at extra cost; most expats don't need these

Digital tools and app quality

Specific service-line strengths in areas like digital reimbursement workflows or foreign-coverage networks for short-term travel

The decision is rarely about saving €20/month. It's about which fund you'll deal with for 30 years. The English-language quality of a fund's customer service is usually the most useful filter for newly arrived expats; ask the broker for a current shortlist that fits your situation.

What this means in old age

GKV's percentage-of-income mechanic doesn't stop at retirement. The way pension income is assessed depends on your status.

KVdR (Krankenversicherung der Rentner, statutory health insurance for pensioners) is the more favourable of the two GKV retirement statuses. Eligibility requires the 9/10 pre-insurance rule (Vorversicherungszeit) under § 5 Abs. 1 Nr. 11 SGB V: at least 9/10 of the second half of your working life in GKV. Statutory pension income from the DRV (Deutsche Rentenversicherung) is assessed at the full 17.5 %, but the DRV pays half (~7.3 %) as a subsidy, leaving you with the other half.

Without that Vorversicherungszeit you're voluntarily insured in retirement. This is common for late-arriving expats and members of professional pension funds (Versorgungswerke). The assessment basis is broader: all income is counted, including capital gains, rental income, and private pensions. There's no DRV subsidy on Versorgungswerk pensions or on capital income. You pay the full bill yourself.

The practical implication: if you're an expat who arrives in Germany after 35 and goes into GKV, you may not meet the Vorversicherungszeit by retirement. That puts you in voluntary GKV in retirement, paying the full €1,226–€1,261/month Höchstbeitrag out of your pension if your retirement income approaches the BBG. PKV in retirement has its own dynamics (Altersrückstellungen feed back into the premium to dampen later-life cost growth), but for late-arriving expats GKV old-age maths is often worse than people expect.

For the deeper retirement question, see the PKV vs GKV decision guide.

What this means for your decision

Three takeaways from how GKV's premium maths works in practice.

The BBG cap is a relief for low and mid earners and a trap for high earners. Once your income is durably above the BBG, your GKV contribution is on autopilot: you have no influence on it, and it grows about 6.9 % per year regardless.

The Kinderlosenzuschlag and the 9/10 Vorversicherungszeit are quiet costs. Together they can mean €40–€50/month more during working years and a substantially higher retirement bill if you don't meet the 9/10 threshold.

The self-employed GKV maths is substantially worse than the employed maths because there's no employer subsidy. For freelancers and self-employed people earning meaningfully above the Mindestbemessung, this is the single biggest structural argument for considering PKV.

If you'd like the maths run for your specific situation, including your income trajectory, family setup, and what your GKV bill is likely to be in 5, 10, or 20 years, book a consultation. The percentages are rule-bound. What they mean for you isn't.