Health Insurance in Germany: GKV vs PKV

Gesetzliche Krankenversicherung (GKV) is Germany's public health insurance system. About 90% of residents are insured through GKV. It is income-based, covers comprehensive medical care, and is the default for most people.

How It Works

• Contributions are income-based: 14.6% of gross salary, split equally between employer and employee (you pay 7.3%). Plus a supplementary contribution (Zusatzbeitrag) averaging around 2.9% in 2026 (up from 1.3% in 2021), also split. TK's Zusatzbeitrag from 1 January 2026 is 2.69%, below the average
• Long-term care insurance (Pflegeversicherung): Additional 3.4% for childless individuals over 23, or 2.3-3.05% for parents (deducted from your salary)
• Maximum contribution: Capped at the Beitragsbemessungsgrenze (€5,175/month in 2026). If you earn more, your contribution does not increase further
• Coverage is comprehensive: Doctor visits, hospital stays, prescription medications, mental health care, basic dental, maternity care, preventive screenings, and more
• No deductibles for most services: You show your insurance card (Gesundheitskarte) at the doctor and pay nothing upfront

What GKV Covers

• General practitioner (Hausarzt) and specialist visits
• Hospital treatment (semi-private room standard)
• Prescription medications (€5-10 copay per prescription)
• Mental health therapy (up to 60+ sessions covered after approval)
• Basic dental care (cleanings, fillings). Crowns and bridges: 60-75% covered after Bonusheft (dental bonus booklet) history
• Maternity and prenatal care (100% covered)
• Sick leave pay (Krankengeld): 70% of gross salary from day 43 of illness, for up to 78 weeks
• Preventive screenings and vaccinations

Private Krankenversicherung (PKV) is available to self-employed individuals, freelancers, civil servants, and employees earning above the annual threshold of €77,400/year (2026). Unlike GKV, premiums are based on your age, health, and chosen coverage level rather than income.

Who Can Get PKV?

• Self-employed and freelancers: Can choose PKV regardless of income
• Employees above the threshold: Those earning above €77,400/year gross can opt out of GKV
• Civil servants (Beamte): Receive government aid (Beihilfe) and typically use PKV for the remainder
• Students over 30: Once the mandatory GKV student tariff ends, some switch to PKV

PKV Advantages

• Faster appointments: Private patients often get same-day or next-day specialist appointments
• Better hospital coverage: Private room, chief physician treatment
• Comprehensive dental: 80-100% coverage for crowns, implants, orthodontics
• Customizable plans: Choose your coverage level and deductible
• Lower premiums for young, healthy individuals: A 28-year-old might pay €200-350/month for comprehensive coverage

PKV Risks

• Premiums increase with age: Unlike GKV, PKV premiums rise as you get older, regardless of income changes. At 50-60, premiums can reach €700-1,000/month
• Difficult to switch back: Returning to GKV after choosing PKV is very difficult, especially after age 55. You must either become employed below the income threshold or become unemployed
• Family members not covered: Each family member needs their own policy (unlike GKV's free Familienversicherung for non-working spouse and children)
• Pre-existing conditions: Can lead to exclusions or surcharges

Bottom line: PKV is great for young, single, high-earning professionals. It becomes expensive for families and older adults. Think long-term before choosing PKV.

Students in Germany benefit from a heavily subsidized health insurance rate through public insurers.

Student Tariff (GKV)

• Cost (1 January 2026): €141.16/month under age 23 and €146.29/month between 23 and 29 at TK (including long-term care insurance / Pflegeversicherung). Other GKV funds are similar but vary slightly depending on each fund's supplementary Zusatzbeitrag
• Eligibility: Enrolled degree students at a public German university, under age 30 or before the 14th semester (whichever comes first)
• NOT eligible: Studienkolleg, language-course, and other preparatory students are not on the GKV student tariff. They need a bridge plan instead (Mawista Student from ~€28/month or Feather expat from ~€72/month) and must confirm the chosen plan is accepted by their university for matriculation before buying
• Coverage: Same comprehensive coverage as regular GKV members
• Enrollment: Choose a public insurer before or during university enrollment. Your university requires a health insurance confirmation (Mitgliedsbescheinigung) for Immatrikulation

Top Public Insurers for Students

Insurer	Monthly cost (Jan 2026, student tariff)	Strengths
TK (Techniker Krankenkasse)	€141.16 (<23) / €146.29 (23-29)	Best English support, excellent app, lowest published student rate among the big four, most popular with international students. Zusatzbeitrag 2.69% in 2026
AOK	Similar to TK; regional Zusatzbeitrag varies by branch (AOK Bayern, AOK Nordost, etc.)	Local branches everywhere, strong in-person support
Barmer	Similar to TK; fund-specific Zusatzbeitrag applies	Good digital services, nationwide
DAK-Gesundheit	Similar to TK; fund-specific Zusatzbeitrag applies	Solid coverage, local offices in most cities

By law, every GKV fund delivers identical benefits. The visible differences are the supplementary Zusatzbeitrag (a few euros a month at the student tariff), the customer-service experience, and minor bonus programs. Most international students pick TK for its English support, lowest Zusatzbeitrag among the big four, and full online enrollment.

The under-30 PKV opt-out window (one-shot)

If you are a degree student under 30 and enroll in GKV, you have three months from the start of studies to opt out of GKV into private insurance. The decision is one-shot and irreversible for the rest of your degree (until graduation, age 30, or you earn above the PKV income threshold as an employee). Most students stay on GKV because the cheapest under-30 PKV (e.g. ottonova Study Secure ~€125/month under 30, ~€144/month over 30) is barely cheaper than the GKV student tariff, while removing free family coverage if you ever start a family later.

After Age 30

Once you turn 30 (or complete your 14th semester), the subsidized student tariff ends. You then have three options:

1. Voluntary GKV membership: Continue with your public insurer at the regular rate, which works out to roughly €267-€275/month at the TK voluntary tariff (the fund applies a minimum-income assumption when calculating your contribution if you have no salary). Other GKV funds are within a few euros
2. Switch to PKV: Private insurance is priced on age and health rather than income; for a healthy 30-year-old, ottonova Study Secure runs ~€144/month. Compare with a broker who does a proper pre-assessment, not a portal quote, since portal quotes assume perfect health and routinely understate the price you will actually be offered (around a quarter of applicants are rejected and another quarter are surcharged)
3. Incoming/expat insurance: Budget plans from providers like Mawista (~€28-€72/month), Feather (~€72/month), DR-WALTER, or Care Concept. Coverage is thinner, and not every Ausländerbehörde or university accepts these for residence-permit renewals or matriculation. Confirm acceptance before relying on them as your only cover

Quick Comparison

Feature	GKV (Public)	PKV (Private)
Premium basis	% of income	Age, health, coverage
Employee cost	~8.5% of gross salary	Fixed monthly premium
Student rate	~€141-€146/month (1 Jan 2026)	Not available (except travel insurance)
Family coverage	Free (Familienversicherung)	Separate policy for each member
Dental	Basic (60-75% for major work)	Comprehensive (80-100%)
Specialist access	Referral often needed, longer waits	Direct access, faster appointments
Sick pay	70% of salary (after 6 weeks)	Must be added as optional rider
Premiums with age	Income-based (stable)	Increase with age
Switch back	N/A (you start here)	Very difficult after 55

Choose GKV If...

• You are a student (mandatory until age 30)
• You plan to have a family (free coverage for non-working spouse and children)
• You value predictability (contributions scale with income)
• You want to stay flexible (easy to switch between GKV providers)
• You might have income fluctuations (freelancers with variable income benefit from income-based premiums)

Choose PKV If...

• You are young, single, and earn well above €77,400/year
• You are a freelancer under 35 with good health and want lower premiums now
• You want premium medical care (private room, chief physician, fast specialist access)
• You are confident you will maintain a high income throughout your career
• You are a civil servant (Beamte) receiving Beihilfe

Switching Between GKV Providers

You can switch between public health insurers (e.g., from AOK to TK) after being a member for at least 12 months. The process is straightforward:

1. Choose your new insurer and sign up with them
2. The new insurer handles the cancellation with your old provider
3. Allow 2 months for the transition

GKV to PKV

• Employees: Your gross salary must exceed €77,400/year for at least 12 consecutive months
• Self-employed: Can switch at any time
• Students over 30: Can switch after mandatory GKV eligibility ends
• Note: Once you switch to PKV, returning to GKV is very restricted

PKV to GKV

Returning to public insurance is deliberately difficult to prevent people from using cheap PKV when young and switching to GKV when premiums rise. Treat the move into PKV as one-way:

• Under 55: Must become employed with a salary below €77,400/year, or become unemployed and register with the Agentur für Arbeit
• Over 55: Switching back to GKV is nearly impossible. You are essentially locked into PKV for life
• Freelancers: Can switch to GKV by taking up employment (even part-time above a certain threshold)

Incoming Students: Travel Insurance vs GKV

Many students arrive with travel health insurance or incoming student insurance (DR-WALTER, Care Concept, Mawista). Important caveats:

• These are not substitutes for German statutory health insurance for degree-seeking students
• Most universities require proof of GKV exemption (Befreiung) if you are not enrolled in GKV. You must visit a GKV provider (TK, AOK) and get an exemption letter before enrolling at university
• Some Ausländerbehörden do not accept incoming insurance for residence permit renewals, especially after the first year
• Travel insurance is fine for exchange students (1-2 semesters) and language course participants
• Generic Schengen-tourist travel policies are being rejected at German student-visa interviews: buy a student-grade incoming policy (Mawista Student, Coracle, DR-WALTER incoming, ottonova) rather than a generic Schengen tourist plan, or the consulate may make you replace it on the spot
• GKV does not backdate to your entry date: the period between entering Germany and activating GKV after Anmeldung is on your incoming policy, not on a retroactive GKV claim. Make sure the incoming policy actually covers that window

Enrollment Steps (GKV)

1. Choose a provider: TK is the most popular for international students. Compare supplementary contributions at krankenkassen.de
2. Apply online or in person: TK, Barmer, and DAK offer full online enrollment. AOK may require an in-person visit at a local branch
3. Documents needed: Passport, university admission letter, Meldebestatigung (if already registered), IBAN (for premium deductions)
4. Receive your Gesundheitskarte: Your electronic health insurance card arrives by mail within 2-3 weeks. The same-day membership confirmation PDF (Mitgliedsbescheinigung) is what doctors, universities, and the Ausländerbehörde actually accept in the meantime, so do not wait for the physical card to start using your insurance
5. Get your Mitgliedsbescheinigung: This confirmation letter is needed for university enrollment. Request it from your insurer at the walk-in or via the app; most provide it immediately as a PDF

Using Your Insurance

• Find a doctor: Use jameda.de or doctolib.de to find English-speaking doctors near you
• GP (Hausarzt) first: Register with a general practitioner. Many specialists require a referral (Uberweisung) from your GP
• Prescription costs: You pay a copay of €5-10 per prescription. Medications that cost less than the reference price may be fully covered
• Dental: Get a Bonusheft (dental bonus booklet) from your dentist. Regular checkups (1x/year) build your bonus, increasing coverage for major dental work from 60% to 75% over 10 years
• Mental health: Therapy is covered. Finding a therapist with availability can take weeks; start early if needed. Psychotherapist directories: therapie.de, psychotherapiesuche.de

Emergency Care

For emergencies, go to the nearest hospital emergency room (Notaufnahme) or call 112. For non-emergency after-hours medical issues, call 116 117 (Arztlicher Bereitschaftsdienst). Both services are covered by your insurance at no additional cost.