'Health Insurance in Germany: GKV, PKV, Pflegeversicherung, and

Health insurance in Germany is mandatory for anyone living in the country on a non-temporary basis: employees, students, family members, the self-employed, and many foreigners with long-term residency status. The main choice is usually between gesetzliche Krankenversicherung (GKV) and private Krankenversicherung (PKV), and health insurance almost always comes with Pflegeversicherung—long-term care insurance.

Below is a practical overview for beginners: what is mandatory, what depends on your status, and which additional policies you should consider only after assessing your actual expenses.

What Is Mandatory in Germany

Type of Insurance	German Name	Who It Applies To	What to Keep in Mind
Health Insurance	Krankenversicherung	For virtually all residents of Germany	Without it, you cannot work, study, or obtain many types of residency status
Long-Term Care Insurance	Pflegeversicherung	Usually linked to health insurance	Does not replace health insurance and specifically covers the risk of needing long-term care
Supplemental health insurance policies	Dental supplemental insurance, hospital supplemental insurance, etc.	Optional	Terms, limits, and waiting periods vary significantly depending on the plan

In Germany, health insurance is not an optional choice. It’s important not just to “buy a policy,” but to choose the right system for your status: employee, student, apprentice, self-employed, family member, or high-income earner.

GKV: Public Health Insurance

GKV is the system of statutory health insurance funds, such as AOK, TK, Barmer, DAK, and others. The funds compete on service, additional benefits, and the Zusatzbeitrag, but the basic rules are set by law.

The following are typically covered under GKV:

Employees with income below the Jahresarbeitsentgeltgrenze;
Students, provided they meet the requirements for the student rate;
students in vocational training (Ausbildung);
many recipients of social benefits;
Family members are covered through Familienversicherung (family insurance), provided the income and residence requirements are met.

For employees, the total GKV contribution consists of the basic Beitragssatz and the Zusatzbeitrag specific to each health insurance fund. In 2026, the basic total Beitragssatz is 14.6% of income within the Beitragsbemessungsgrenze. The average Zusatzbeitrag for 2026 is set at 2.9% as a guideline, but each health insurance fund sets its own actual Zusatzbeitrag. Typically, the employee and employer split the contribution equally, including the additional contribution.

Family Insurance

Under the GKV, free family coverage is available for a spouse, registered partner, and children, provided they live in Germany and do not exceed the established income limit. This rule is important for families where one spouse works while the other is not yet employed or is still adjusting after moving to Germany.

Family insurance is not automatically included “just because you’re married.” The health insurance provider checks the status, income, place of residence, and documents of family members.

Students and Vocational Training (Ausbildung)

Students and those in vocational training (Ausbildung) are often covered by GKV, but the rules differ. For students, age, enrollment status at the university, duration of study, and the basis for calculating premiums are important factors. Therefore, it’s best not to use a fixed amount “for all students”: the monthly payment varies due to the Zusatzbeitrag of the specific health insurance fund and long-term care insurance.

For an Ausbildung (apprenticeship), premiums are usually tied to the apprentice’s salary, and the employer contributes to the payments according to general rules.

PKV: Private Health Insurance

PKV is not available to everyone. For salaried employees, the key threshold is the Jahresarbeitsentgeltgrenze. In 2026, it amounts to 77,400 euros gross per year. If income is below this threshold, the employee is generally still required to be insured under the GKV. Self-employed individuals, civil servants, and certain other groups may have access to PKV under specific rules.

PKV is not considered the “best version of GKV for everyone.” It operates on a different pricing system: premiums depend on age, health status at enrollment, the selected coverage, the deductible, and the terms of the contract. Premiums may increase over time, and switching back from PKV to GKV is often restricted for adults.

The benefits of private health insurance (PKV) may include expanded coverage, faster appointments with certain specialists, a private room, or treatment by the chief physician, if included in the plan. But you need to check all of this in the terms of the contract, not in the advertising description.

Before switching to private health insurance (PKV), check:

whether premiums will increase in 10–20 years;
How spouses and children are insured;
which services are excluded or limited;
what deductible you’ll have to pay out of pocket;
Is it possible to return to the GKV in your situation?
How the plan works during parental leave, unemployment, self-employment, or relocation.

Pflegeversicherung: Long-Term Care Insurance

Long-term care insurance covers the risk of needing long-term care, not routine medical treatment. It provides assistance for those with a long-term care level (Pflegegrad), home care, outpatient care, or inpatient care, but it does not cover all costs in full.

In 2026, the overall contribution rate for statutory long-term care insurance is 3.6%. A surcharge applies to childless insured individuals over the age of 23, so the rate for them is 4.2%. For parents with multiple children, reductions apply depending on the number and ages of the children; in Saxony, the split between employee and employer differs from that in other states.

Usually, long-term care insurance follows health insurance: if you’re in the GKV, long-term care insurance is arranged through the associated long-term care fund (Pflegekasse); if you’re in the PKV, you need private mandatory long-term care insurance.

Supplementary Health Insurance

Supplementary policies do not replace Krankenversicherung. Their purpose is to cover what the basic insurance covers only partially, with limits, or does not cover at all.

Dental Supplementary Insurance

Zahnzusatzversicherung covers part of the costs for dental care: dentures, implants, crowns, professional cleanings, or more expensive materials, if provided for in the plan. This is one of the most popular supplemental policies because dental costs can be high.

Before purchasing, consider not only the price, but also:

coverage limits in the first few years;
percentage of coverage;
Exclusions for treatment that has already begun;
Requirements for the treatment and cost plan;
coverage for professional cleaning;
Rules for missing teeth.

Supplemental Insurance for Vision Aids

A policy for eyeglasses and contact lenses can be useful for those who regularly replace their vision aids. However, it isn’t always cost-effective: there are often limits on the duration of coverage, maximum reimbursement amounts, and restrictions based on diopter strength. Compare your expected expenses for eyeglasses with the premiums over several years.

Supplemental Hospital Insurance

Krankenhauszusatzversicherung (supplemental hospital insurance) can cover a private or semi-private room, a choice of doctor, or expanded services during hospitalization. This is a “need-based” policy: it’s important for those who want a specific level of comfort and are willing to pay for it on a regular basis.

Before signing up, check what exactly counts as a “Wahlleistung,” whether there are restrictions on clinics, if there’s a waiting period, and how the premium applies to pre-existing conditions.

How to Choose Insurance Without Paying More Than Necessary

Determine your status: employee, student, in vocational training (Ausbildung), self-employed, family member, civil servant (Beamter), or high-income earner.
Check whether you are required to be enrolled in the GKV or if you can choose between the GKV and the PKV.
If you choose GKV, compare the Zusatzbeitrag, service quality, English- or Russian-language support, the app, preventive care coverage, and family plans.
If you’re considering private health insurance (PKV), think long-term—don’t just focus on the initial premium.
Choose supplemental policies only after assessing likely costs, coverage limits, and exclusions.
Do not sign up for a plan if you do not understand the deductible (Selbstbehalt), waiting period (Wartezeit), exclusions (Ausschlüsse), and the rules for premium increases.

Common Mistakes

Don’t choose private health insurance (PKV) just because the initial premium is lower.
Do not include your spouse’s and children’s insurance.
Confusing Krankenversicherung and Pflegeversicherung.
Assume that the Zusatzbeitrag is the same for all health insurance providers.
Use the old income threshold for switching to private health insurance (PKV).
Do not purchase additional policies without checking the coverage limits and waiting periods.
Signing up for a private plan without understanding how to switch back to GKV later.

FAQ

Is it possible to live in Germany without health insurance?

For regular long-term residence, work, or study—no. Health insurance is a mandatory part of the system.

Does the employer pay half of the health insurance premium?

For employees in the GKV, premiums are usually split between the employee and the employer. This applies to both the basic premium and the Zusatzbeitrag. For PKV, the employer contributes within the established rules and maximum limits.

When can an employee switch to private health insurance (PKV)?

This usually applies when a person’s regular annual income exceeds the Jahresarbeitsentgeltgrenze. In 2026, this threshold is 77,400 euros gross per year. The rules differ for the self-employed, civil servants, and certain other groups.

Does GKV cover dental care in full?

No. Basic GKV covers necessary treatment according to its own rules, but expensive materials, implants, advanced prosthetics, and some preventive care often require a copay or a separate policy.

How much does student insurance cost?

There is no single flat rate for everyone. The premium depends on the assessment base, the Zusatzbeitrag of the selected health insurance provider, long-term care insurance, age, and student status. It’s best to check the amount with a specific health insurance provider before enrolling.

Does long-term care insurance cover all care costs?

No. It reduces the financial burden, but often does not cover the full cost of care, especially in a residential Pflegeheim. Therefore, it is important to understand the limits and possible copayments.