Public (GKV) or private (PKV) health insurance: income threshold, contributions, family and switching back

Germany's health insurance system is unusual in having two parts: people are insured either in the statutory system (gesetzliche Krankenversicherung, GKV) or with private insurers (private Krankenversicherung, PKV). The choice has long-term financial consequences.

The compulsory insurance threshold (Jahresarbeitsentgeltgrenze)

Employees must be insured with a statutory health insurance fund as long as their gross annual salary does not exceed the threshold (€77,400 in 2026). Above this threshold, employees can switch to private insurance. Self-employed people can choose private insurance regardless of income.

The solidarity principle and free family cover

In the statutory system, contributions are a percentage of income: 14.6% plus the fund's additional contribution (around 2.9% on average in 2026), shared equally by employee and employer. The big advantage of the GKV is that a spouse without their own income and all children are insured free of charge (Familienversicherung).

Individual premiums in private insurance

In private insurance, premiums do not depend on salary but on your age when you join, your health and the plan you choose. For young, single high earners, private insurance is often cheaper and offers extra benefits such as a single room and treatment by the head physician.

Hurdles to switching back from PKV to GKV

The law deliberately makes it difficult to return from private to statutory insurance. Employees can switch back if their salary falls below the threshold. From the age of 55, returning to the statutory system is practically impossible.

Next step

For families, statutory insurance is almost always the better deal thanks to free cover for children; switching to private insurance should be a carefully considered decision.