Health insurance in Germany: how public and private work

Everyone living in Germany needs health insurance. Most people are in the public system, and some can choose private cover instead. Each has its strengths: here's how they compare.

What to know

1. Know the two systems

   Public insurance is run by the public funds (Krankenkassen). Private insurance is sold by insurance companies. Having one or the other is compulsory for anyone who lives here.

   Public (gesetzliche Krankenversicherung). Most employees are in it by law.

   Employees are insured in a public fund unless their pay is above an income threshold, and so are students, trainees, people on unemployment benefit and most pensioners. A fund open to you must accept you, whatever your health.

   Private (private Krankenversicherung). Open to some, by their work and pay.

   Employees above the threshold (€77,400 a year in 2026), the self-employed and civil servants can generally choose it instead. Who can, and from when: the check.

   Long-term care insurance. Comes with either.

   Care insurance (Pflegeversicherung) is compulsory too, and follows your health cover: a public fund's own, or a private policy alongside a private health policy (§ 23 SGB XI).

2. See what each charges

   Public charges a share of your income. Private charges a premium for you, set by your age when you join, your health and the cover you choose.

   Public: a share of pay, up to a ceiling. 14.6 % plus your fund's own additional rate.

   The additional rate averages 2.9 % in 2026, and each fund sets its own. Contributions stop growing at a ceiling of €69,750 a year (€5,812.50 a month) in 2026, and an employer pays half. Voluntary members, such as the self-employed, pay on all their income, with a minimum.

   Private: a premium per person. It doesn't follow your income.

   It rises over the years as medical costs do, and doesn't fall when your income does. For an employee, the employer pays half, up to what it would pay towards public insurance (§ 257 SGB V). Every application comes with health questions, which decide whether an insurer accepts you and at what price.

3. Know who's covered

   Public: a family through one member. Children, and a spouse with little income.

   Children, and a spouse or civil partner with income up to €565 a month in 2026, are covered through a member at no extra cost (family insurance, § 10 SGB V). From 2028 the member pays a surcharge of 2.5 percentage points for a spouse, unless an exception applies, such as a child under 12 at home. The conditions and the age limits: family insurance in Germany.

   Private: everyone pays. Each child and a spouse need a policy of their own.

   An employer's half counts the family's premiums too, up to the same cap. Married parents in different systems meet one more rule: what private costs over a lifetime.

4. Know what happens when you're ill

   Sick pay. Public insurance pays it; private only if you add it.

   An employer pays your wages for the first six weeks. After that, public insurance pays sick pay (Krankengeld) of 70 % of gross pay, at most 90 % of net (§ 47 SGB V). In private insurance you add daily sick pay (Krankentagegeld) to the policy, or there is none. The self-employed arrange it either way.

   Bills. Public: your card. Private: you generally pay and claim.

   With public insurance the fund pays the doctor. With private insurance you generally get the doctor's bill, pay it and claim it back; hospitals often bill the insurer directly.

   What's covered. Public: largely set by law. Private: what your tariff says.

   A private tariff can pay for more, such as a single room or a chief physician, or less, and its benefits are set by contract. Public benefits change when the law does.

5. Know what changes over time

   Public contributions follow your income, in work and in retirement. A private premium keeps following age and costs, and in retirement the employer's half stops. There is no switching back on request, and from 55 the way back is generally closed (§ 6 Abs. 3a SGB V).

   Can you go private? Check it →

The rules and figures as of 26 September 2026. Your public fund decides whether you're compulsorily insured, and each insurer decides on its own applications.

Primary sources checked on 26 October 2026: the statutes and official pages linked above.