Private health insurance in Germany, explained in English

If you moved to Germany for work, health insurance is one of the first decisions you face, and one of the hardest to reverse. Most English-language sources on this topic are written by comparison portals that earn on the click. This page is written by the person who would advise you, and it tells you the parts that argue against private cover as clearly as the parts that argue for it.

I am Goran Ovčar, a licensed insurance broker (Versicherungsfachmann BWV, § 34d GewO). I have worked in private health insurance since 1 May 2005, in more than 10,000 conversations, and I advise around 1,000 clients on an ongoing basis. I work as a broker, so I am tied to no single insurer. 5.0 out of 5 from 179 Google reviews.

Two systems, two logics.

Germany runs two parallel systems. Not a better and a worse one, but two different ways of pricing the same thing.

Statutory (GKV) prices by income. Your contribution is a percentage of what you earn, and the benefit catalogue is identical for everyone. Someone at the ceiling pays several times what a modest earner pays and receives the same treatment. Family members without their own income are covered at no extra cost.

Private (PKV) prices by risk. Your premium depends on your entry age, your health at application and the cover you choose. Income plays no part. Every family member needs their own contract, so there is no free family cover.

One thing that surprises most newcomers: in the private system your benefits are a contractual promise. Politics can change the statutory catalogue, it cannot change your private contract. That cuts both ways. It also means a weak tariff stays weak, which is why the choice of tariff matters more than the choice of insurer.

Are you allowed to switch?

The income threshold, and the trap in it. The threshold is called Versicherungspflichtgrenze or JAEG. For 2026 it is 77,400 € per year (Sozialversicherungs-Rechengrößenverordnung 2026).

Here is the part most English-language sources state wrongly. Under § 6 Abs. 4 SGB V your income must clear the threshold of the current year and of the year in which you want to switch. For a switch on 1 January 2027 the binding figure is therefore the 2027 threshold, expected at around 84,600 €. That figure is not yet official. It becomes binding with the Rechengrößenverordnung for 2027.

Only regular income counts: base salary and contractually guaranteed payments. Discretionary bonuses and irregular overtime do not. A junior doctor who only clears the threshold through on-call shifts is below it in the eyes of the law.

What it costs in 2026.

Compare what leaves your account, not the premiums. Your employer pays half of your statutory contribution, and also subsidises private cover, capped at 613.22 € per month. So the number that matters is your own share in each system, not the two premiums side by side.

Why I do not put a savings figure here. You will find pages promising you a fixed amount saved per year. I will not, because the honest answer is that it depends on things only you can tell me: your entry age, your health at application, the cover you choose and your actual gross income. The 617 € average covers every age and every tariff in the German market. A healthy 30-year-old and a 50-year-old with a pre-existing condition are not in the same conversation, and an average that spans both tells neither of them anything useful.

What I will do instead: run your own figures with you, in both systems, gross and net, and show you the result whichever way it comes out. That takes one conversation.

A claim you will meet elsewhere, and why it is wrong. Some sources advertise a monthly cashback of 150 to 200 €. Premium refunds (Beitragsrückerstattung) exist, but they are paid once a year, they depend on the tariff, and you only receive them if you submit no invoices at all. Presenting them as a fixed monthly deduction makes the sum look better than it is.

How you actually pay a doctor. Private patients receive the invoice themselves and settle it with the practice, then claim it back from the insurer. Invoices normally allow several weeks. I will not quote you a reimbursement time, because it varies by insurer and by case.

The question people actually worry about.

Premiums do rise. The main driver is medical inflation, and it affects both systems. Between 1970 and today the statutory maximum contribution rose at a comparable rate to private premiums.

Against that, the private system pre-funds. Insurers build ageing reserves for exactly this. Across the industry these stood at 355.4 billion € at the end of 2025 (PKV-Verband). That money is invested and belongs to the collective of the insured.

Three concrete levers exist later in life:

• § 204 VVG gives you the right to move to another tariff with the same insurer while keeping your accrued ageing reserves. No new health assessment for equivalent cover.
• Beitragsentlastungstarife let you pre-pay now to reduce the premium from retirement onward.
• Raising the deductible or dropping optional components.

What the numbers say. 97.7 % of privately insured adults pay less than the maximum statutory contribution, and 99.83 % pay less than 1,000 € a month (PKV-Verband, analysis of average monthly premiums, 2024).

A real case from my own files, and its counterpart. One anonymised contract sits at 380.32 € per month after 47 years, against 405.00 € in the statutory comparison, after an active tariff change under § 204 VVG. A second contract in the same files runs the other way and ends up above the statutory figure. Both as of 2023, both individual cases, neither representative. I show you both, because showing only the first one would be advertising.

Two floors nobody mentions.

If a private premium ever becomes unaffordable, German law provides two floors. Almost no English-language source explains them, and they change the risk picture.

Basistarif. Every private insurer must accept you into it. No health assessment, no risk surcharge, no benefit exclusion. The premium is capped at 1,017.18 € per month (2026) plus long-term care, and it is halved if you are in genuine hardship. Benefits are comparable to the statutory catalogue.

Standardtarif. Only for contracts taken out before 1 January 2009, from age 65, or from 55 with income below the threshold. Capped at 848.62 € per month (2026) plus long-term care, and for married couples jointly capped as well.

Important detail that is usually left out: in both cases your accrued ageing reserves are credited against the premium. The cap is the ceiling, not the price you actually pay.

And where it goes wrong.

Health questions are the decisive part. German insurers ask in detail, usually about the last three to five years for outpatient treatment and up to ten for inpatient. Under § 19 VVG you must answer completely and truthfully. An omission, even an innocent one, can cost you the contract years later.

Never apply directly first. A rejection or a surcharge is recorded and other insurers can see it. The right sequence is an anonymous pre-enquiry through a broker: your case is presented without your name, and you learn how each insurer would decide before anything is on record. This costs you nothing and it is the single most valuable thing a broker does.

What can come back: a risk surcharge (Risikozuschlag, a higher premium), a benefit exclusion (Leistungsausschluss, one condition not covered), a deferral, or a rejection. Mild and treated conditions are often insurable without any of these.

One more check that surprises people: many insurers run a credit check (Bonitätsprüfung) alongside the health assessment.

Where private cover is most often the wrong answer.

There is no free family cover. Each child needs an own contract at an own premium. In the statutory system children and a non-earning spouse are covered at no additional cost. For a single earner with several children, that difference is usually decisive, and it usually decides against private cover.

Newborns are protected, if you act in time. Under § 198 VVG your insurer must accept your newborn without any health assessment, provided you apply within two months of birth and the parent has been insured for at least three months. Miss the deadline and your child faces a normal health assessment. This is one of the few hard deadlines in the whole system.

Parental leave. Statutory cover becomes contribution-free during parental leave. Private cover does not: your premium continues, and the employer subsidy stops when the salary stops. Budget for it before, not during.

German terms that decide thousands of euros.

These have no English equivalent and they are where the money actually is. Every one of them has a full article on the German side of this site.

• GOÄ: the fee schedule for private medical treatment. It sets a base rate that doctors may multiply. Whether your tariff reimburses above the standard multiplier decides whether you get a bill you have to pay yourself.
• Hufeland-Verzeichnis: the catalogue of complementary and alternative treatments. Whether your tariff refers to it decides if osteopathy or naturopathy is covered.
• Zahnstaffel: a cap on dental benefits in the first years of the contract. A tariff with 100 % dental cover can still pay very little in year two.
• Sachkostenliste: the list governing which dental materials are reimbursed and at what level.
• Kostenerstattungsprinzip: the reimbursement principle: you pay, then claim. It is why the invoice arrives at your address and not at the insurer's.
• Primärarztprinzip: some cheaper tariffs require you to see a GP first. Attractive on price, restrictive in practice.

If a tariff comparison does not mention these, it has not compared anything.

And when it closes.

A return to the statutory system is possible if your income falls below the threshold, if you move to part-time work, if you become employed rather than self-employed, or through family cover via a spouse.

From age 55 it is effectively closed under § 6 Abs. 3a SGB V. This is the most important sentence on this page. If you are over 50 and considering a switch, weigh it as a permanent one.

In retirement there is one more route, the 9/10 rule: if you were statutorily insured for nine tenths of the second half of your working life, you can enter the statutory pensioners' scheme (KVdR). Years in private cover do not count toward it. For someone who arrives in Germany mid-career, this rule is usually already out of reach, which is worth knowing early.

Size tells you nothing.

There are 3,836 open full-cover tariffs across 44 companies in Germany (PSP online). They are not equally stable.

Two figures show how well an insurer can absorb premium increases: the RfB ratio, the share of surplus set aside for the benefit of the insured, and the net investment return, which feeds the ageing reserves.

Some of the largest names sit below the average. Source: company annual reports, analysis by psponline, as of 30 June 2026.

Also look at: the premium history over ten and twenty years, whether the insurer handles § 204 VVG tariff changes cooperatively, and whether the tariff you want is still open to new business or already closed.

When private cover fits, and when it does not.

It often fits if you are:

• an employee comfortably above the threshold, with no plan to drop below it
• self-employed or freelance, where income is not the deciding factor
• a civil servant, where Beihilfe makes private cover the standard route
• young and in good health, since your entry age fixes the basis for life
• someone who values direct access to specialists and is prepared to pay for it

It is usually the wrong choice if you are:

• a single earner planning several children, because free family cover is worth a great deal
• close to the threshold and unsure your income will stay above it
• planning to reduce your hours in the coming years
• over 50, since the way back closes at 55
• planning to leave Germany within a few years and return to a statutory system elsewhere

I would rather tell you that private cover does not suit you than sell you a contract you regret in fifteen years. That is the point of this page.

Work it out yourself first.

All tools are free, need no registration and store nothing. They are in German. If you would rather go through them with me in English, just book a conversation.

• Am I even eligible? The eligibility check walks through your status and the income thresholds.
• Which type am I? The type finder sorts basic, comfort and premium cover by what matters to you.
• What would it cost? The premium calculator gives a realistic range.
• Statutory or private? The comparison calculator works out gross and net for both systems.
• Where must my child be insured? The child calculator applies the rules of § 10 SGB V.
• I already have an offer. The double-check compares the tariff you are looking at against a benchmark and shows what it does not cover.

A broker, not an agent.

• Versicherungsfachmann (BWV), licensed under § 34d GewO
• In private health insurance since 1 May 2005, more than 10,000 conversations
• Around 1,000 clients under ongoing advice
• 5.0 out of 5 from 179 Google reviews
• I compare 3,836 open tariffs across 44 companies
• Advice in English and German

The consultation costs you nothing. As is standard in this industry, I am paid a commission by the insurer if you take out a policy after the advice. That is why there is no reason for me to push: only a recommendation that still fits in twenty years is a good one.

Goran Ovčar
Mergenthau 1, 86438 Kissing
kontakt@versichertrichtig.de · +49 8233 7796822