Private health insurance in Germany: cost and who can join

01 Who can choose private health insurance in Germany

Germany has two systems: public health insurance (gesetzliche Krankenversicherung, GKV) and private health insurance (private Krankenversicherung, PKV). Everyone who lives here has to be insured in one of them. A private policy has to come from an insurer licensed in Germany and cover outpatient and hospital treatment (§ 193 VVG). Whether you can choose depends on how you work.

Employees

As an employee you can choose private cover if your regular gross salary is more than €77,400 a year (2026). A salary of exactly that amount counts as below the threshold. The health insurance fund looks ahead: it takes twelve times your current monthly salary plus regular bonuses, even if you start in the middle of the year or on a fixed-term contract. If you start in October on €7,000 a month, that makes €84,000, and you are above the threshold for 2026.

If you take up your first job in Germany above the threshold, you are free of compulsory insurance from your first working day. You then have two options: private insurance, or voluntary membership of a public fund. For voluntary membership you have to tell the fund within three months of starting work (§ 9 SGB V).

In our experience private cover starts to pay off at about 5 percent above the threshold, in 2026 at around €81,300.

Self-employed and freelancers

If you are self-employed full time, you do not have to join public insurance. You can join a public fund voluntarily only if you were publicly insured for long enough before; periods in a public scheme of another EU or EEA country or Switzerland count. Non-EU nationals who were never publicly insured in Germany or the EU therefore usually have private insurance as their only option.

In our experience private cover becomes worth a look from a profit of around €2,500 a month, depending on your age. Insurers sometimes accept founders who cannot show any income yet. If your main income comes from a job below the threshold and you freelance on the side, you stay in public insurance through your job.

The threshold for 2027

For 2027 the federal cabinet approved a threshold of €84,150 on 7 October 2026. It includes a one-off extra increase of €3,600. The Bundesrat still has to consent.

If you are an employee with private cover on 31 December 2026, the extra increase does not apply to you. Your threshold for 2027 is €80,550. If your salary falls below that, you can apply within three months to stay with your private insurer. Starting a job in Germany in 2026 with private cover from day one puts you in this group.

If you start work in Germany in 2027, the €84,150 applies. With a salary that is not above it, you join a public fund from your first day, and there is no option to opt out.

02 What private health insurance costs

Your premium depends on your age when you join, your health and the level of cover you choose. Your salary plays no part. These are the monthly premiums for health insurance that we see for employees:

The level of cover makes a large difference. At 35, a basic tariff typically costs €350 to €500 a month, a mid-range tariff €400 to €700 and a top tariff €600 to €900.

Your employer pays half of your premium, in 2026 up to €508.59 a month for health insurance. This also applies to your children's policies. Private long-term care insurance (Pflegepflichtversicherung) is compulsory as well; your employer pays up to €104.63 a month towards it, or up to €75.56 if you work in Saxony. With a premium of €600, your employer pays €300 and you pay €300.

Self-employed people get the same tariffs but pay the full premium themselves. As a private patient you usually receive the doctor's bill, pay it and claim the money back from your insurer.

03 Public or private: the numbers side by side

In public insurance you pay a share of your salary: 14.6 percent plus an additional contribution that each fund sets, 2.9 percent on average in 2026. It is charged on salary up to €69,750 a year. Above the threshold you therefore pay the maximum, and your employer pays half of it. Long-term care insurance comes on top in both systems.

For families the result depends on who works. With two employed parents and two children, Max Eilert calculates around €735 a month in private insurance after the employer's share, against around €1,300 in public insurance. In public insurance, children and a partner without their own income are covered at no extra cost. If your partner does not work, the comparison can come out the other way, because in private insurance every family member needs their own policy.

In a family with one earner, Max Eilert puts the partner without income and the children into private insurance together with the earner, each with their own premium. Free family cover in public insurance is open only to the spouse, registered partner and children of someone who is a member of a public fund (§ 10 SGB V). With the earner in private insurance, the family has no such member to be covered through. Your employer pays half of these policies as well, with the same monthly maximum of €508.59 for the whole family.

04 Just arrived: visa, Blue Card and expat policies

For a national visa to work in Germany, German embassies do not accept travel insurance as proof of health cover. They expect cover from the day you arrive: an incoming policy until public insurance starts with your job, or a long-term private policy with an insurer in Germany.

Full private cover can start on the day you arrive, and at the latest on your first working day. The insurer asks for proof of your previous health insurance, and the best proof shows that you were insured without a break. If you take out the policy before you travel, it also serves as proof of cover for the visa, and you need no separate incoming policy.

The foreigners' authority (Ausländerbehörde) checks your health insurance again when it issues or extends your residence permit. Membership of a public fund is accepted without further checks. A private policy is assessed case by case; some authorities expect it to match public cover and to have a low deductible.

The EU Blue Card requires a salary of at least €50,700 in 2026, or €45,934.20 in shortage occupations, for recent graduates and for IT specialists without a degree. Both are well below the €77,400 threshold. Many Blue Card holders therefore start in public insurance and can choose only once their salary passes the threshold.

Staying for two or three years: expat tariffs

If you know you will leave again after two or three years, Max Eilert strongly advises private cover, provided you can choose it (section 01). For such stays there are temporary expat tariffs, and we arrange them. German law allows them for people with a fixed-term residence permit: the contract may end after five years at the latest, and a follow-up contract counts towards the same five years, even with another insurer (§ 195(3) VVG).

Insurers may calculate these tariffs without an ageing reserve (§ 146(3) VAG), so you pay nothing into a reserve that would stay with the insurer when you leave. Max puts it plainly: for someone who knows they will only be here for two or three years, private cover without a reserve is “a thousand times better than public insurance”. If you end up staying longer, you need a regular policy before the five years are over.

As an employee you can in principle get the employer's contribution for an expat tariff too. The law ties it to conditions on how the insurer runs the tariff (§ 257(2a) SGB V), and for a temporary tariff without an ageing reserve that is not clear-cut, so we check whether your employer pays the contribution for the specific tariff. If you are self-employed, there is no employer contribution. We know of no case in which the foreigners' authority in Dresden refused one of these tariffs. Each authority decides case by case, so other cities may see it differently.

05 Health questions: what insurers want to know

Before a private insurer accepts you, it asks about your health. Everything a doctor has examined or treated has to go into the application, including treatment in your home country. If you leave something out, the insurer can later change the contract, withdraw from it or contest it (§ 19 VVG).

We start with six questions. If you can answer no to all of them, we can usually get you an offer within a short time. They are our first filter; the insurer's application asks in more detail.

If one of the six applies to you, we first make an anonymous pre-application (page in German): we describe your case to several insurers without your name and find out who would accept you and on what terms. You have not applied yet, and no insurer files anything under your name.

Medical records from your home country

Treatment abroad goes into the six questions and into the application just like treatment in Germany. What differs is how easily an insurer can assess the records. Reports from doctors in Germany work best. Reports from German-speaking countries and other industrialised countries are accepted without discussion, and reports from elsewhere in Europe rarely cause problems. For treatment outside the EU, especially in developing countries, the difficulty is often whether any records exist at all. Missing records do not change what you have to declare. If your reports are in English or another language, we translate them for the pre-application.

06 Deadlines for 1 January

Which deadline applies depends on how you are insured today.

You are a voluntary member of a public fund

Your notice has to reach the fund by 31 October. Your membership then ends on 31 December, as long as you show proof of private cover by then (§ 175 SGB V). For 1 January 2027 your salary must be above €84,150, because you are not yet privately insured on 31 December 2026.

Your salary passed the threshold this year

You do not give notice. Your compulsory insurance ends with the year if your salary is also above next year's threshold. Your fund writes to you about your options, and you then have two weeks to declare that you are leaving (§ 188 SGB V). Without that declaration you stay in as a voluntary member.

You are new to Germany

There is no year-end deadline for you. If you earn more than the threshold, private cover can start on your first working day.

07 Leaving Germany or going back to public insurance

There is no free return from private to public insurance. You go back only if you become compulsorily insured again, for example because your salary drops below the threshold. You can then cancel your private policy within three months, backdated to the start of the compulsory insurance (§ 205 VVG). From age 55 the way back is largely closed: anyone who was not publicly insured in the five years before usually stays exempt.

If you move to another EU or EEA country, your policy can continue, and the insurer pays at most what it would pay in Germany. If you move further away, the standard conditions of German private insurers end the policy unless you agree otherwise with your insurer. For a temporary stay outside the EU you can ask to convert it into a dormant policy (Anwartschaft). A small one keeps your health status for your return and costs around €1 to €20 a month; a large one also keeps your age at joining and costs around €40 to €150.

Part of every premium goes into an ageing reserve that keeps premiums stable in old age. If you cancel, the reserve stays with the insurer. It is not paid out, and only part of it moves with you if you switch to another German private insurer.

A planned short stay is no argument against private cover. For two or three years in Germany, Max Eilert recommends a temporary expat tariff without an ageing reserve: it runs for a fixed term of up to five years, and you leave no reserve behind with the insurer when you go.

08 Frequently asked questions

09 How advice in English works

Max Eilert is an independent insurance broker in Dresden and advises in English. The first call takes about 30 minutes and is free of charge; the insurer you sign with pays our commission.

Have these ready: your gross salary and start date, your visa or residence permit, and your answers to the six health questions. Book a slot below, call +49 351 4569 2585 or send a WhatsApp message. The booking calendar is in German; the call itself is in English.