Public contributions follow your income. A private premium follows your age and health when you join, and the cover you choose, for each person insured. Here's how both play out over a lifetime.
An illustration, not a forecast or a quote
One employee, public or private, from 35 to 85
What they pay themselves a month for health cover, after the employer's half while working and the pension insurance's share in retirement, in euros of each year.
Added up, in today's money
| Years | Public | Private |
|---|---|---|
| Working, 35 to 66 | €195,000 | €113,000 |
| Retired, 67 to 85 | €40,000 | €84,000 |
| All 51 years | €235,000 | €198,000 |
A month, at each age
| Age | Public, a month | Private, a month |
|---|---|---|
| 35 | €509 | €300 |
| 45 | €684 | €403 |
| 55 | €919 | €542 |
| 61 | €1,097 | €588 |
| 66 | €1,272 | €682 |
| 67 retired | €451 | €954 |
| 75 | €571 | €1,208 |
| 85 | €767 | €1,624 |
What the illustration assumes
- An employee aged 35 in 2026, paid above the ceiling (€69,750 a year), so public contributions are the most anyone pays: 14.6 % plus the average additional rate of 2.9 %, half each for employer and employee.
- A private premium of €600 a month at 35, before the employer's half: an example for a healthy person, not a quote. Premiums vary widely with the cover and the insurer.
- Pay, the ceiling, pensions and premiums all rise 3 % a year, the pay growth the government assumes. The same rate for both, so the differences come from how each system charges, not from a guess at which rises faster. In real life premiums and contribution rates have risen faster than pay in some years.
- The 10 % statutory surcharge leaves the premium after 60.
- Retirement at 67, on a statutory pension of €2,000 a month in today's money, with pensioners' insurance on the public side.
- Health cover only: long-term care insurance comes on top in both. No children, and no sick pay in the private policy.
- The totals are in today's money: each year's payments brought back by the same 3 % a year, so a euro at 85 counts for what it buys at 35. Added up in euros of each year instead, they come to €456,000 public and €472,000 private.
What to know
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See it over a lifetime
An illustration of one employee, from 35 to 85. In this example, private costs them less while they work and more once they retire, when the employer's half stops. See the illustration ↑
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Count your family in
Children. Free in public insurance; a premium each in private.
A newborn can be added to a parent's private policy without risk surcharges or waiting periods if registered within two months of the birth, for cover no higher or broader than the parent's; the terms may ask that the parent has been insured for up to three months first (§ 198 VVG). An employer's half counts the children's premiums too, up to the same cap (§ 257 SGB V).
Married parents in different systems. The children may have to go private too.
If the privately insured parent earns more than the other, and more than a twelfth of the threshold a month (€6,450 in 2026), the children generally can't be covered through the publicly insured parent (§ 10 Abs. 3 SGB V).
A spouse without income. Covered through you in public insurance, not in private.
Public family insurance covers a spouse or civil partner with income up to €565 a month in 2026; from 2028 the member pays a surcharge of 2.5 percentage points for it, unless an exception applies, such as a child under 12 at home. In private insurance, a spouse pays a premium of their own.
Civil servants. Beihilfe pays more for a family.
Under the federal rules it pays 80 % for a child and 70 % for a spouse with low income, and 70 % for you once you have two children (§ 46 BBhV), so the private policies cover less. The states have rules of their own.
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Look ahead to retirement
Private: the employer's half stops. The pension insurance pays a smaller subsidy.
On your statutory pension it pays half of the public rates (14.6 % plus the average additional rate), at most half the premium (§ 106 SGB VI). Nothing is paid on a company or private pension.
Public: contributions follow your pension. In pensioners' insurance, on your pensions only.
Pensioners' insurance (KVdR) needs public insurance for nine-tenths of the second half of your working life (§ 5 Abs. 1 Nr. 11 SGB V). Then you pay on your pensions, and the pension insurance pays half on the statutory one. Without it, you're a voluntary member and pay on all your income.
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Know your options if premiums climb
Another tariff with the same insurer. Your right, keeping your reserves.
You can move to any of its tariffs with equivalent cover and keep the ageing reserve you've built up (§ 204 VVG). A move to the same or less cover needs no new health check. Ask your insurer in writing which of its tariffs you can move to, and what each would cost.
A higher deductible, or less cover. A lower premium, more paid yourself.
Worth weighing against what you'd then pay for treatment in a bad year.
The basic tariff. Capped at the highest public contribution.
Every private insurer offers it (Basistarif), with benefits much like public insurance; contracts from before 2009 also have a standard tariff (Standardtarif).
Another insurer. Priced at today's age, with part of your reserve.
A new insurer prices you at today's age and health, and only part of your ageing reserve moves with you: for contracts since 2009, the part matching the basic tariff.
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Plan for the way back, and for leaving
Back to public insurance. Through a job below the threshold, or family insurance, before 55.
The way back is to become compulsorily insured again, for example through a job below the threshold, or to qualify for family insurance. From 55 compulsory insurance generally no longer opens it (§ 6 Abs. 3a SGB V). The self-employed generally have no way back while they stay self-employed.
Out of work after 55, you stay private, and while you get unemployment benefit (Arbeitslosengeld) the employment agency pays your premiums, up to what it would pay for public cover (§ 174 SGB III).
Leaving Germany. Your reserve stays behind if you cancel.
Moving within the EU or EEA, a private policy generally carries on, paying what it would pay in Germany (§ 207 VVG); moving further, most policies' terms end it unless agreed otherwise. Cancel it, and the ageing reserve stays with the insurer. An option policy (Anwartschaftsversicherung) keeps your right to return without new health questions for a fraction of the premium, and in its larger form your age at entry too.
The rules as of 26 September 2026, and the illustration is not a forecast. What an insurer would charge you turns on your age, health and the cover you choose.
Primary sources checked on 26 October 2026: the statutes and official pages linked above.