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SHORT ANSWER
Everyone living in Germany needs health insurance. Employees are in public insurance (GKV) unless they earn more than the income threshold. In 2026 the threshold is 77.400,00€; for 2027 it is planned at 84.150,00€. If you earn between these values and want private insurance (PKV), your cover has to start by 31 December 2026.
Threshold 2026
77.400,00€
gross per year
Threshold 2027 (planned)
84.150,00€
7.012,50€ per month
2027 if private on 31.12.2026
80.550,00€
grandfathering rule
Contribution ceiling 2027
6.375,00€
per month (2026: 5.812,50€)
The 2027 values were approved by the Federal Cabinet on 7 October 2026. The Bundesrat is expected to decide on 20 November 2026.
Is health insurance mandatory in Germany?
Yes. Germany has a general obligation to be insured: everyone who lives here needs health insurance, either in the public system or with a private insurer. You usually need proof of cover for your visa or residence permit, and your employer needs it for payroll from your first day.
Long-term care insurance (Pflegeversicherung) is also compulsory. It automatically follows your health insurance: public members are in public care insurance, private members take out private compulsory care insurance.
Public or private: who can choose?
Whether you can choose depends on your employment status and, for employees, on your salary.
| Your situation | Public (GKV) | Private (PKV) |
|---|---|---|
| Employee earning up to the threshold | Compulsory | Only as a top-up (e.g. dental, hospital) |
| Employee earning above the threshold | Voluntary membership possible | Free choice |
| Self-employed or freelancer | Voluntary membership possible | Free choice, regardless of income |
| Civil servant (Beamter) | Possible, but usually unattractive | Common, combined with state aid (Beihilfe) |
| Student | Student rate | Exemption possible on application |
For employees, the test uses your regular gross annual salary: monthly salary × 12 plus guaranteed payments such as a fixed 13th salary. Bonuses that are not guaranteed usually don’t count. Your employer makes the assessment.
What health insurance costs in 2027
Public health insurance (GKV)
Contributions are a percentage of your salary, up to the contribution ceiling. The general rate is 14,6 % plus an extra rate (Zusatzbeitrag) that each insurer sets itself. The official average extra rate for 2027 is 2,9 %. Employees and employers each pay half.
| Employee, maximum per month | 2026 | 2027 (planned) |
|---|---|---|
| Contribution ceiling | 5.812,50€ | 6.375,00€ |
| Health insurance (7,3 % + 1,45 %) | 508,59€ | 557,81€ |
| Long-term care, with children (1,8 %) | 104,63€ | 114,75€ |
| Long-term care, childless (2,4 %) | 139,50€ | 153,00€* |
Calculated with the average extra rate of 2,9 %. *A draft law plans to raise the childless surcharge in 2027; the amount is not final yet. In Saxony, employees pay 0,5 percentage points more for long-term care.
Children and non-working spouses are usually insured for free through family insurance.
Prefer public insurance? Apply online with Techniker Krankenkasse (TK), our partner for public health insurance: for employees · for students · all other members
Private health insurance (PKV)
Private premiums don’t depend on your salary. They depend on your age when you join, your health and the benefits you choose. Employers pay half of the premium, up to the same maximum they would pay in public insurance. Each family member needs their own contract.
Example: an employee born in 1990 pays 885,20€ per month for Allianz MeinGesundheitsschutz Best 100 with dental Zahn 75 and compulsory care insurance. After the employer’s contribution, the employee’s share is 442,59€ – compared with 648,09€ in public insurance at the maximum contribution (premiums and values as of 2026, without risk surcharges). If no bills are submitted, Allianz also refunds up to 30 % of the premium for Best and Zahn 75.
Calculate your own numbers
Compare public and private insurance with your salary and year of birth in one minute – including the no-claims bonus.
Public vs. private compared
| Topic | Public (GKV) | Private (PKV) |
|---|---|---|
| Contribution based on | Income, up to the ceiling | Age at entry, health, chosen benefits |
| Family | Spouse and children usually free | Own contract for each person |
| Benefits | Set by law, can change | Guaranteed in your contract for life |
| Hospital | Multi-bed room, doctor on duty | Single or double room, chief physician (depending on tariff) |
| Dental prostheses | Fixed subsidy for standard care | Percentage of the bill, e.g. 75 % |
| Billing | Doctor bills the insurer directly | You receive the bill and claim it back |
| Refund if you stay healthy | No | Possible, depending on the insurer |
| Sick pay | Included from week 7 | Added separately (daily sickness allowance) |
The 31 December deadline: what to do now
If your salary is between 77.400,00€ and 84.150,00€, 2026 is your last chance to switch to private insurance with that salary. If you are privately insured on 31 December 2026, the planned 2027 threshold for you is 80.550,00€.
- Check your regular salary. Base salary × 12 plus guaranteed payments. Ask HR if you are unsure.
- Compare costs and benefits. Use the calculator and think about family plans, health history and how long you will stay.
- Answer the health questions. Underwriting takes several weeks, so start in good time.
- Leave public insurance correctly. Your public insurer must confirm the end of your membership. We coordinate the timing so you are never without cover.
- Inform your employer. Payroll needs the private insurer’s certificate to pay the employer contribution.
Privately insured on 31 December 2026 but earning less than 80.550,00€ in 2027? You would become compulsorily insured again. In most cases you can apply for an exemption within three months, by 31 March 2027.
Five things to consider before you go private
- Family: planning children or a non-working partner? In public insurance they are covered for free, in private insurance each person pays.
- Health: pre-existing conditions can lead to risk surcharges or exclusions. Which diagnoses matter.
- Going back: a return to public insurance is possible before age 55 in specific cases and generally not from 55. When you can go back.
- Life changes: part-time work, parental leave or self-employment affect the two systems differently.
- Leaving Germany: private contracts can often be paused or continued abroad. What happens when you leave.
We recommend adding a daily sickness allowance and a switching option that lets you upgrade later without new health questions.
Can you go back to public insurance?
Before age 55, yes – but not simply by choice. You can return when you become compulsorily insured again. In several of these cases you can also choose to stay private.
| Situation | What happens | Your options |
|---|---|---|
| Your salary falls below the threshold (new job, pay cut, fewer hours) | Compulsory public insurance from the change | Return to public insurance. If you reduce to half-time or less, an exemption can be possible under certain conditions. |
| The threshold rises faster than your salary | Compulsory public insurance from 1 January | Return to public insurance – or apply for an exemption and stay private. |
| You receive unemployment benefit (Arbeitslosengeld I) | Compulsory public insurance | Return – or stay private with an exemption if you were not publicly insured in the five years before. |
| You work part-time during parental leave | Compulsory public insurance if below the threshold | Return – or stay private with an exemption for the parental leave. |
| You have no or low own income and your spouse is publicly insured | Free family insurance can apply | Return via family insurance; this counts like compulsory insurance for cancelling your private contract. |
Rules you should know
- Exemption: apply to the public insurer within three months after compulsory insurance starts. The exemption cannot be withdrawn later.
- Cancelling private insurance: if you return, you can cancel your private health and care insurance within three months, retroactively to the start of compulsory insurance.
- Keeping the door open: with a pause option (Anwartschaftsversicherung) you can return to your private tariff later without new health questions. Private top-ups such as dental or hospital cover can complement public insurance.
- From age 55: if you were not publicly insured in the last five years and were private, exempt or self-employed for at least half of that time, you generally stay outside public insurance.
Of course we support you with every change: whether you go back to public insurance or stay private, we check your options, deadlines and applications with you.
Arriving in Germany: insurance before your first day at work
Your German health insurance usually starts with your employment contract. For the time before – for example a visa appointment, the first weeks after arrival or a family member who joins earlier – you need temporary cover. Incoming health insurance for expats closes this gap and is often accepted for visa applications. Incoming insurance for expats.
Frequently asked questions
Is health insurance mandatory in Germany?
Yes. Everyone who lives in Germany must have health insurance, either public (statutory) or private.
What is the income threshold for private health insurance in 2027?
It is planned at 84.150,00€ gross per year (7.012,50€ per month). Employees who are privately insured on 31 December 2026 have a lower planned threshold of 80.550,00€. The values still need approval by the Bundesrat.
Can I still switch to private health insurance in 2026?
Yes, if your regular gross salary is above 77.400,00€ and your private cover starts by 31 December 2026. Start early, because the health questions and underwriting take several weeks.
How much does public health insurance cost in 2027?
Employees pay half of 14,6 % plus half of their insurer’s extra rate on their salary up to 6.375,00€ per month. With the average extra rate of 2,9 %, the maximum employee share for health insurance is about 557,81€ per month, plus long-term care.
Can I go back from private to public health insurance?
Before age 55, when you become compulsorily insured again – for example if your salary falls below the threshold, the threshold rises faster than your salary, or you receive unemployment benefit. In several cases you can choose between returning and staying private with an exemption. From age 55 a return is generally not possible.
What happens to my children’s health insurance?
In public insurance, children and non-working spouses are usually covered for free through family insurance. In private insurance, each family member needs their own contract.
Sources (checked 20 October 2026)
- Deutsche Rentenversicherung – Beitragsbemessungsgrenzen 2027 sollen steigen
- krankenkassen.de – Rechengrößen 2027
- Apotheken Umschau – Durchschnittlicher Zusatzbeitrag 2027
- lohn-info.de – Beitragssätze Pflegeversicherung
- finanz.de – Pflegebeiträge 2027
- § 6 SGB V – Versicherungsfreiheit (incl. age 55 rule)
- § 8 SGB V – Befreiung von der Versicherungspflicht
- § 205 VVG – Kündigung des Versicherungsnehmers
- Allianz – Private Krankenversicherung
This page gives general information and does not replace personal advice. Tax aspects are not considered; finanXpats does not provide tax advice.