Private Health Insurance in Germany: PKV Decision Guide

What is private health insurance (PKV) in Germany?

PKV (private Krankenversicherung) is one of Germany's two health-insurance systems. It prices each person individually on age and health, gives every family member their own contract, and covers a broader benefit set than the statutory system. Around 10 % of residents are in PKV; the other 90 % are in GKV, the statutory scheme.

New to the German system altogether? The complete guide to health insurance in Germany covers both sides from the beginning; this page goes straight into the private one.

Everyone living in Germany must hold health insurance of one kind or another (§ 193 Abs. 3 VVG). The split between the two systems is not about the quality of medicine, since both buy care from the same hospitals and the same doctors. It is about the mechanism: how the premium is calculated, who rides along on one contract, and how the cost behaves across a lifetime.

PKV is a contract; GKV is a membership. That distinction does more work than it looks like. In GKV you join a Solidargemeinschaft, a risk pool where healthy high-earners subsidise sick low-earners by design, and the benefit catalogue is set by law (the Leistungskatalog in SGB V), which means the Bundestag can change what you are entitled to. In PKV you sign a private insurance contract under the VVG. The benefits are written into your tariff conditions and the insurer cannot unilaterally reduce them for the life of the contract. What can change is the price.

You pay the bill, then get reimbursed. This is the practical difference expats hit in week one. GKV runs on Sachleistungsprinzip: you show your card, the doctor bills the Krankenkasse, and you never see an invoice. PKV runs on Kostenerstattungsprinzip: the doctor invoices you personally, you pay it, and you submit the invoice to your insurer for reimbursement. Most insurers now settle within days through an app, and hospitals usually bill the insurer directly for inpatient care, but you should expect to float a few hundred euros of outpatient costs at any given moment. People who cannot or do not want to do this find PKV administratively annoying regardless of how good the tariff is.

There is no single "PKV". GKV has around 94 Krankenkassen that differ almost solely on the Zusatzbeitrag; the benefits are effectively identical. PKV has 33 carriers offering hundreds of tariffs that differ materially in what they cover, how they handle dental, whether they include Chefarzt treatment, and how aggressively they have historically raised premiums. Choosing PKV therefore isn't one decision but two: the system, then the tariff. Most of what goes wrong for people in PKV traces back to the second one.

Those differences drive everything else in this guide.

Who can get PKV in Germany?

PKV is a free choice for three groups regardless of income: the self-employed, freelancers, and civil servants (Beamte). Employees can choose only once gross salary clears the JAEG (Jahresarbeitsentgeltgrenze, €77,400/year in 2026), and only after exceeding it across a full calendar year, unless they start a new job already above it, which opens the choice from day one.

For employees the timing detail trips people up. Clearing the JAEG for a single month isn't enough; you have to exceed it across a full calendar year before the switch right opens. The one exception: career starters who begin employment already above the threshold are versicherungsfrei (exempt from compulsory GKV) from day one.

Two groups skip the JAEG entirely. Self-employed people and freelancers can choose PKV at any income level. The threshold doesn't apply to them.

Civil servants (Beamte) sit outside this logic entirely. They're versicherungsfrei in GKV, and Beihilfe (a civil-service medical subsidy) plus PKV is the default setup. Most expats won't be affected directly, but if you're married to a German Beamter, the family math changes: Familienversicherung (free GKV cover for non-earning spouses and children) doesn't run through a civil-servant spouse.

The threshold isn't static. It rises by roughly 3–4 % most years, set each autumn by the labour ministry (BMAS) via the Sozialversicherungs-Rechengrößenverordnung. That has consequences for people already in PKV. If a JAEG hike pushes you back below the line, you'd normally fall back into GKV-Pflicht (compulsory GKV membership). But you can apply for an exemption under § 8 Abs. 1 Nr. 1 SGB V to stay private. The exemption has a three-month application window and is irreversible for the current employment.

How is a PKV premium calculated, and what does it cost?

PKV pricing has no income input. The premium is set at signing from five factors: your entry age (fixed for the life of the contract), your health at underwriting, the tariff scope, the deductible (Selbstbeteiligung), and any optional add-ons. A healthy applicant in a comprehensive tariff typically pays €300–€400/month at age 25–30 and €450–€650/month at age 35–40 in 2026.

Each input, in turn:

1. Entry age, fixed for the contract. The price you sign at 30 doesn't reset to a 42-year-old's price when you turn 42.
2. Health status at underwriting. Chronic conditions present at entry can mean surcharges, exclusions on specific treatments, or in rare cases refusal to insure. Anything that develops after you join the contract is fully covered, and your individual premium is not affected by it.
3. Tariff scope: what's covered (single room, Chefarzt access, dental tier, alternative medicine) and how generously.
4. Deductible (Selbstbeteiligung), the annual out-of-pocket share you accept before the insurer reimburses.
5. Optional add-ons such as Krankentagegeld (a daily sick-pay allowance) or a Beitragsentlastungstarif (a top-up that lowers your contribution in retirement).

The entry-age effect is the one worth acting on. A healthy 28-year-old joining a comprehensive tariff today might pay around €380/month gross; the same tariff for a 42-year-old new entrant could be €550–€650. Read those as a price list by entry age, not as a preview of your own future bill: joining at 42 costs more than joining at 28, but nobody's premium climbs from €380 to €600 because they had birthdays. Once you are in, the contract keeps pricing you from the age you joined at, which is why the gap gets locked in for life.

The deductible is the lever you set yourself. Moving from no Selbstbeteiligung to €600/year typically takes 10–15 % off the premium, and €1,200/year can take 20–25 % off. The arithmetic only works in your favour if you would genuinely absorb a bad year without it hurting: at a €1,200 deductible you are betting roughly €1,000 of annual premium saving against €1,200 of worst-case exposure, which is a good bet for someone with reserves and a poor one for someone without. Note that the deductible usually applies to outpatient costs only, not to inpatient or dental, so read the tariff conditions rather than the headline number.

Two profiles get priced outside the normal ranges. Civil servants need only a Beihilfe-ergänzender Restkostentarif covering the 30–50 % their employer's Beihilfe doesn't, which typically lands at €150–€300/month rather than the full-tariff figures above. Applicants with a documented chronic condition may see a risk surcharge (Risikozuschlag) of 20–100 % on the base premium, or a permanent exclusion on treatment related to that condition. Both are set at underwriting and both are worth testing anonymously before you formally apply.

For employees the employer contribution (Arbeitgeberzuschuss) halves the actual cost. Your employer pays half your PKV premium, capped at €613.22/month outside Sachsen for health insurance and Pflegeversicherung combined in 2026 (€584.15/month in Sachsen, where the employer share of Pflegeversicherung is lower). It is tax-free under § 3 Nr. 62 EStG, and any unused portion can be applied to privately insured family members.

Put together, the quoted premium and the amount that actually leaves your account are two quite different numbers:

The illustrative figures are a mid-range comprehensive tariff, not a quote. What is not illustrative is the structure: the surcharge and the care component are always in there, the employer always covers half up to the cap, and the number people quote at parties is almost always the gross one.

On the GKV side the mechanic is the mirror image: a percentage of gross income (21.1 % with children, 21.7 % childless in 2026, including Pflegeversicherung), capped at the BBG of €5,812.50/month, which puts the maximum contribution at €1,261/month childless or €1,226/month with children. For the full step-by-step, see how GKV calculates your premium.

How do PKV and GKV compare?

They differ on ten core dimensions, and the gap is widest on premium basis, family coverage and the retirement cost mechanic. GKV runs on income-based contributions with free family cover. PKV runs on risk-based individual contracts with private-tier benefits and a contract built to be actively managed over decades.

Two of those rows carry more weight than the rest. Family coverage is the single biggest swing factor, because GKV's Familienversicherung makes the bill flat in the number of dependants while PKV's is linear. Pre-existing conditions is the one that can remove the choice altogether, since GKV has to take you and PKV does not. If you only check two lines before reading further, check those. § 204 VVG is also worth knowing on the private side: it lets you switch tariffs within your existing insurer without a new health check, which is the main reason a PKV contract is something you manage rather than something you simply hold.

Two patterns emerge. GKV is structurally simpler and more forgiving: automatic family coverage, no underwriting, a predictable contribution mechanic. PKV gives you more lever per euro: broader benefits, faster access, no income exposure, and a contract built to be actively managed.

What that means in practice depends entirely on the profile. Three worked examples cover most expats: Anna (single high-earner) saves roughly €430–€460/month with PKV, Markus (freelancer, mid-income) around €600/month, while David and Sofia (single-earner family of four) land near break-even with GKV about €80–€100/month cheaper.

In GKV, Anna pays the maximum employee share at the BBG cap: about €648/month for health and care insurance combined (childless rate). In a comprehensive PKV tariff at her age she would be looking at a gross premium around €380–€440/month, halved by the employer contribution, so roughly €190–€220/month as her own share. Her profile, young and healthy and durably above the JAEG, is the textbook fit: a low entry age sets a competitive base premium that the contract then keeps.

What would flip it: children. Anna's saving assumes she stays a single-person household. If she has two children within the decade, each needs an own contract at €150–€250/month while GKV would have covered them free, and the €440 gap narrows to roughly break-even. Her decision is really a bet on her next ten years, not on her current payslip.

As a self-employed person on freiwillige GKV (voluntary GKV membership) at his income level, Markus pays full freight on health plus care insurance: about €1,176/month all in, with no employer to share it. In PKV, a comprehensive tariff at his entry age sits around €500–€600/month. The gap is structural rather than incidental: without an employer share, the GKV percentage runs up fast, while PKV prices him on age and health.

The catch for freelancers is the reverse direction. Markus's income is variable, and GKV has a mechanism for that: in a bad year he can have his contribution reassessed downward against actual profit, with the Mindestbemessungsgrundlage of €1,318.33/month in 2026 (§ 240 SGB V) setting the floor, which puts the minimum contribution including Pflegeversicherung at roughly €281–€320/month. PKV has no such valve. The premium is the premium whether he bills €90k or €20k. Anyone whose income genuinely swings should size the PKV premium against a bad year rather than an average one, and treat Krankentagegeld as part of the base cost rather than as an add-on.

In GKV, David's employee share at the BBG cap is €613.22/month, and Sofia plus both children ride along free under Familienversicherung, so that is the entire household bill. In PKV every member needs a contract: David around €525, Sofia around €500, and each child €150–€250, coming to roughly €1,325/month gross.

The employer subsidy helps more than people expect here. Under § 257 Abs. 2 SGB V it is calculated on the total David pays for his health insurance including co-insured children, so the children's premiums raise the basis the cap is applied to rather than being divided out of a fixed pot. Half of €1,325 is €663, above the 2026 ceiling, so the employer pays the full €613.22 and David is left with about €712/month.

That €613.22 appearing on both sides is not a coincidence. The subsidy is capped at exactly what the employer would have paid into GKV, which at the BBG with children is half of €1,226.44. So the family ends up roughly €99/month worse off in PKV, in exchange for private-tier benefits across all four people. One asymmetry to note: the subsidy is tied to the employee's own contract and does not travel to Sofia's if she were insured separately, and a GKV-insured spouse generates no transferable amount at all. For the full family calculation, see family health insurance in Germany.

Worth reading the full height of each bar, not just the part you pay. Anna's GKV cover costs €1,261/month all in against €410 for her PKV tariff, but she feels €648 against €205, because the employer carries half either way. Markus has no employer at all, so for him the full height and his own share are the same bar. That is why the freelance case produces the widest gap of the three even though his income is the lowest.

The pattern across the three: GKV's bill is flat in the number of dependants, PKV's is linear. One earner above the cap plus three riders is where GKV's design is unbeatable; one person, or two earners both above the cap, is where PKV's is.

How do premiums develop as you get older?

Your entry age is fixed for the life of the contract, so premiums never rise because you personally got older. They do rise with cost trends across the whole tariff, and the system builds two counterweights into the contract: the ageing reserve (Altersrückstellung) and the statutory 10 % surcharge that ends after the year you turn 60.

Entry age stays fixed. A premium you sign at 30 stays priced on a 30-year-old's risk profile. Adjustments happen collectively across a tariff under § 155 Abs. 3 VAG, never individually, so someone joining at 30 is still priced from that profile at 50 in the same tariff.

Altersrückstellungen build silently inside every premium. The insurer accumulates a capital reserve within the tariff calculation across the contract's life to dampen later-life cost growth. A 10 % statutory surcharge under § 149 VAG is added between age 21 and the end of the calendar year in which you turn 60, then ends, removing exactly 10 % of the pre-60 premium. From age 65, accumulated reserves are deployed under § 12a VAG as Limitierungsmittel to stabilise the premium against future increases rather than actively reduce it. See the Altersrückstellung glossary entry for the mechanics.

A Beitragsentlastungstarif is the lever you control. Paying an additional amount during working life buys a fixed euro reduction from a chosen age, typically €250–€500/month of relief, though it can be set higher. Combined with the surcharge ending and the Krankentagegeld portion falling away at retirement, the premium drops meaningfully at the retirement transition. The deeper mechanics are covered in will PKV be too expensive when you retire.

How does switching work, in both directions?

Going into PKV is straightforward once you are eligible: an application, a health check, and a cancellation of the GKV membership. Coming back is the constrained direction. Below 55 there are three statutory routes; from 55, § 6 Abs. 3a SGB V closes the main one for most people who have been outside GKV for five years.

Getting in. Once eligible, the sequence is an anonymous pre-inquiry (Risikovoranfrage) to see what terms the market would offer, then a formal application with the health questionnaire, then cancellation of GKV with the statutory notice. The health check is the step that decides your terms, so it is worth understanding before you apply: see how the PKV health check works.

Switching tariff inside PKV. This is the most under-used lever in the system and the usual first answer to a premium increase, so it is worth understanding properly. § 204 VVG gives you a legal right to move into any other tariff at your existing insurer that offers broadly equivalent cover, carrying your full Altersrückstellungen with you and with no new health check for the equivalent portion. Your entry age stays intact. If the new tariff includes benefits your old one didn't, the insurer may underwrite that difference alone or apply a Risikozuschlag to it, but it cannot re-underwrite everything you already had.

Why it works in practice: insurers close old tariffs to new business, the remaining pool ages, and premiums in that closed tariff then climb faster than in a comparable open one. Moving into a newer tariff at the same company can therefore cut the premium without giving up substantive cover. Insurers rarely volunteer the option, so it is on you or your broker to ask which tariffs you are entitled to move into and what each would cost.

Changing insurer entirely is the other route, and it is usually the worse one. You face full fresh underwriting at your current age and health, and only the Basistarif-equivalent share of your reserves travels with you as the Übertragungswert (§ 12 Abs. 1 Nr. 5 VAG); everything accumulated above that stays with the old insurer. That share is highly individual, so treat any generic percentage with suspicion. Your insurer must calculate the figure annually and show it in your Standmitteilung under § 146 VAG, which means you can always check the real number before deciding. From an entry age around 50 upward, the reserves you would forfeit usually outweigh the saving. What to do when your PKV premium goes up walks through both routes.

Getting back to GKV below 55. Three routes, set out in §§ 5, 9 and 10 SGB V. Compulsory insurance, triggered by a life event such as taking a salaried job below the JAEG or claiming Arbeitslosengeld I. Voluntary insurance, available after enough statutory pre-insurance time, where EU pre-insurance can count via the E104 certificate. Family insurance through a spouse who is GKV-mandatory-insured, subject to the €565/month income limit. Once you are back in, § 188 Abs. 4 SGB V keeps you there automatically unless you opt out within two weeks.

From 55 it tightens. § 6 Abs. 3a SGB V blocks the compulsory route when two things apply together: no GKV insurance in the past five years, and at least half that period spent either versicherungsfrei or self-employed as your main occupation. The voluntary and family routes remain, but in practice the decision you make at 35 is a long-horizon one. That is not a flaw in the design; a contract priced on your age-30 entry only works if the system can rely on you staying in it.

What do expats specifically need to weigh?

Five factors weigh more for expats than for German-born residents: time in Germany does not gate the PKV decision (savings start day one), EU pre-insurance time via the E104/S041 forms can count toward later GKV access, underwriting can be tighter for very recent arrivals, PKV's worldwide cover usually beats GKV's EU-only EHIC reach, and an Anwartschaftsversicherung preserves a PKV contract through international moves.

Time in Germany doesn't gate the decision. PKV's monthly savings kick in from day one. A freelancer earning €65k saves around €600/month versus GKV; a high-earning employee saves €400–€460/month. Over a three-year posting that's €15,000–€25,000 of real cash, regardless of whether you stay long enough for the Altersrückstellungen to mature.

Your previous EU insurance time can count. If you arrived from another EU country with statutory cover, that period can count toward German Vorversicherungszeit requirements, which matter for KVdR access in retirement and for some voluntary-GKV routes. The portable evidence is the E104/S041 form. Worth requesting from your previous insurer before you leave, even if you are heading straight into PKV; it is much harder to obtain years later.

Underwriting can be tighter for very recent arrivals. Some insurers want a minimum German residence period or a documented run of legal income before writing a comprehensive contract. This is company practice rather than a statutory rule and it varies. A broker who works with expats will know which carriers accept which profiles at what point, so it rarely needs to be a blocker, but it is a reason not to apply blind on day 30.

PKV usually travels better. Most comprehensive PKV tariffs include worldwide cover for trips of up to a month, and many extend further. GKV's foreign coverage is limited to EU/EEA countries via the EHIC card plus a small set of bilateral agreements; the US, Canada and China are not included. For expats who travel home regularly or work across borders, this can matter as much as the headline premium.

If you leave Germany, the contract doesn't have to die. A kleine Anwartschaftsversicherung suspends the contract for a small monthly fee while preserving your entry age and accepted health status. A große Anwartschaftsversicherung also keeps Altersrückstellungen building and is the cleaner choice if you intend to come back. GKV has no equivalent: leave the country and the contract simply ends.

What is the GKV sick-pay (Krankentagegeld) gap?

GKV sick pay (Krankengeld) is capped at €135.63/day in 2026 from week 7 of illness and runs out after 78 weeks per illness. For an above-JAEG earner, that cap leaves a €700–€1,000/month gap below previous take-home pay. PKV's Krankentagegeld has no statutory ceiling: you pick the daily allowance, and it pays until occupational disability is established.

The mechanic in detail. For the first six weeks of any single illness, your employer pays 100 % of your salary (Lohnfortzahlung, § 3 EFZG). After that, GKV pays Krankengeld at 70 % of gross up to €135.63/day in 2026 (§ 47 Abs. 6 SGB V). Over a month that is about €4,069 gross at the absolute ceiling, and social-insurance contributions still come off, so the net is lower again.

PKV handles this differently. You pick a Krankentagegeld tariff with a daily allowance (typical market range €100–€200/day) and a waiting period (43 days is standard for employees with full Lohnfortzahlung), and the insurer pays for as long as you remain unable to work.

There is a catch worth knowing. Krankentagegeld ends when Berufsunfähigkeit is established, defined in MB/KT § 15 as losing more than 50 % of your ability to work in your current profession on a foreseeable long-term basis. It then runs off for at most three months. Whether you have income after that depends on having a separate Berufsunfähigkeitsversicherung. The two products are designed to fit together.

Which common PKV myths are false?

Four claims circulate online that do not hold up: that premiums become unaffordable in old age, that submitting claims raises your individual premium, that PKV is always cheaper than GKV, and that Mutterschaftsgeld in PKV is €210 per month. Each has a structural mechanic that explains why the common framing is wrong.

"PKV becomes unaffordable in old age." Two mechanics cut the cost at retirement. The statutory 10 % surcharge under § 149 VAG ends after the calendar year in which you turn 60. The Krankentagegeld portion typically falls away too, since it covers working-age income loss. Accumulated Altersrückstellungen then stabilise the premium against future increases under § 12a VAG, and a Beitragsentlastungstarif adds a fixed reduction on top.

"Submitting claims raises your premium." Adjustments are collective, not individual. Under § 155 Abs. 3 VAG the trigger is whether claim costs across an entire tariff's insureds come in more than 10 % above plan, or mortality more than 5 % off. Your own claims do not count against your own premium.

"PKV is always cheaper than GKV." Not universally. Anna's profile shows a clear PKV-favourable gap; David and Sofia's family of four sits close to break-even with GKV slightly ahead. Income, age, family structure and time horizon decide it.

"Mutterschaftsgeld in PKV is €210 per month." It is a one-off lump sum of €210 from the Bundesamt für Soziale Sicherung covering the entire Schutzfrist, not a monthly figure (§ 19 Abs. 2 MuSchG). A Krankentagegeld contract can fill the income gap during Mutterschutz under § 192 Abs. 5 VVG.

What changes through 2027 affect this decision?

Both systems get pricier on a confirmed path. The GKV Höchstbeitrag rises around €133/month in 2027 (€1,261 to roughly €1,394) and the JAEG switching threshold jumps to about €84,800, both faster than wages. PKV's long-run cost growth runs +3.1 %/year versus GKV's +3.8 %/year (WIP 2005–2025); the pending GOÄ-Reform adds up to +13.2 % cumulative PKV cost over its first three years once enacted.

The +3.8 % long-run GKV figure is the average over 2005 to 2025; the 2021 to 2026 stretch ran hotter at +6.9 % per year thanks to accelerated BBG resets. The GOÄ-Reform, the new private fee schedule for doctors, is drafted but not yet law, with an expected start in 2027 or 2028.

Neither system always wins. The premium your future self pays follows a different driver in each. Income above the BBG keeps you on a rising GKV maximum you do not shape. A PKV premium tracks claims experience and your tariff choice, with its own dynamics, but it is the one you can actively manage.

How should you actually choose?

Five questions decide it for almost any expat profile: your family setup, your income stability above the BBG, your age and health at entry, how much you value private-tier benefits, and whether you understand what the long-term commitment involves.

1. Will you have children, or a non-earning partner, in the next decade? Families often tip toward GKV via Familienversicherung. This variable moves the answer more than any other.
2. Is your income stable above the BBG? For employees, the PKV advantage is largest when you sit durably above the cap. For the self-employed, the GKV percentage without an employer share usually makes PKV cheaper at almost any income level.
3. What is your age and health right now? PKV is priced on entry age and accepted health. The price you secure at 30 is materially different from the one at 42, and a tighter health history can mean surcharges or exclusions.
4. How much do you value private-tier benefits? Faster specialist appointments, Chefarzt access, single or double rooms, comprehensive dental. For some readers these are nice-to-have; for others they are the decision.
5. Do you understand the long-term commitment? If you can articulate the Krankentagegeld-to-BU handover and the post-55 rules in your own words, you have enough to decide.

For high-earning singles and self-employed people without family plans, especially at younger entry ages, PKV is usually the better choice. For anyone with a young family, an income that is not durably above the BBG, or work that cycles in and out of self-employment, GKV is the structurally safer answer. The middle ground is wider than comparison sites suggest, and the right call depends on details that do not fit on a chart.

Not sure which side you fall on? Check your eligibility in a free 30-minute call. We run your actual numbers, including which tariffs are likely to be open to your health profile and how the employer subsidy works out in your case.