Health insurance

Zero of the 45 profession files mentioned this, which is why it is here. For anyone actually moving to Germany it matters more than several of them.

Insurance is compulsory. Everyone resident must be covered (§193 VVG). You cannot opt out, and you will need proof of cover to register an address, get a residence permit, or start a job.

The system splits in two, and the choice between them is one of the most consequential financial decisions you will make in Germany — because one direction is very hard to reverse.

GKV vs PKV

GKV — gesetzliche Krankenversicherung PKV — private Krankenversicherung
Premium based on Your income, up to a ceiling Your age and health at entry
Employer pays Half Half, up to the GKV equivalent
Family Non-earning spouse and children covered free Each person needs their own policy
Over a lifetime Rises with income, stops at the ceiling Cheap when young, rises steeply with age
Going back — Very difficult, effectively closed after 55
Who can choose Everyone Only certain groups — see below

GKV in practice

  • A base rate of 14.6% of gross income, split equally between you and your employer, plus a Zusatzbeitrag set by each individual Krankenkasse, also split.
  • Pflegeversicherung (long-term care) on top, with a surcharge for the childless and reductions for people with several children.
  • Contributions apply only up to the Beitragsbemessungsgrenze, a ceiling that is re-set every year — above it you pay no more, so GKV becomes proportionally cheaper the more you earn.
  • Familienversicherung is the feature people underestimate: a non-earning spouse and your children are insured at no additional cost. For a single-income household with children this is worth a great deal and has no PKV equivalent.
  • You may switch Krankenkasse freely; benefits are largely standardised by law, so the differences are service, Zusatzbeitrag and optional extras.

Who may leave GKV for PKV

Not everyone. Only:

  • Employees earning above the Jahresarbeitsentgeltgrenze (JAEG) — a threshold higher than the contribution ceiling and re-set annually. Both figures move; look up the current ones rather than trusting any written here.
  • The self-employed and Freiberufler — including a Meister with their own business, a pharmacy owner, or a practice-owning physiotherapist.
  • Beamte — see below.
  • Students, under their own rules.

The one-way door

PKV is cheap for a healthy 30-year-old and expensive for a 60-year-old, because premiums are priced on age and health at entry, not income. Provisions exist to dampen the rise, but the direction is fixed.

Returning to GKV is hard, and after 55 it is effectively closed unless your circumstances change fundamentally. People who go private in their thirties on a good salary and later reduce hours, have children, or become ill have limited options.

Treat PKV as a decision for the next forty years, not for the next payslip. It suits high, stable earners without dependants; it suits a single-income family with children poorly.

Beamte are the exception

Civil servants — police, teachers, firefighters, customs, tax officials — receive Beihilfe: the state pays a large share of their medical costs directly, commonly 50–80%, rising with family circumstances.

They then insure only the remaining share privately, at a fraction of a full PKV premium. This is a major part of why Beamte net so much more than their gross suggests, and it is the mechanism referred to in Beamte vs. Angestellte.

Several Bundesländer now also offer a pauschale Beihilfe, a flat subsidy that makes staying in GKV viable for Beamte who prefer it — a genuinely useful option for anyone with a family or pre-existing conditions.

Arriving from abroad

  • EU/EEA/Switzerland: the EHIC covers temporary stays. Once you take up residence and work, you join the German system.
  • A visa or residence permit requires proof of cover. Incoming-expat policies are accepted for arrival and job-seeking but are not a substitute for proper insurance once employed.
  • Employment normally means automatic GKV membership unless you earn above the JAEG and actively choose otherwise. For most arrivals the default is both automatic and sensible.
  • Pre-existing conditions are irrelevant to GKV acceptance and central to PKV pricing — another reason the default is often the right answer.

Sources

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