Private health insurance in Germany: is it for you?

Your tariff sets what's paid, such as a single room or the chief physician in hospital, and the insurer can't cancel it (§ 206 VVG). Public benefits are largely set by law, and change when the law does.

It's set when you join, by your age, your health and the cover you choose, and it doesn't follow your pay. Health questions decide whether an insurer accepts you and at what price: it can add a surcharge or exclude a condition (§ 203 VVG). An employee's employer pays half, up to what it would pay towards public insurance (§ 257 SGB V).

How much you get back depends on the tariff. Insurers have to put most of their surplus into a reserve for premium refunds (§ 22 KVAV).

Under the federal rules it pays 50 % of your costs, 70 % once you retire or have two or more children, and more for your family (§ 46 BBhV), so a private policy covers only the rest. The states have rules of their own. In public insurance, a civil servant generally pays the whole contribution (§ 250 SGB V).

They're covered through you at no extra cost (family insurance, § 10 SGB V): children, and 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 a spouse, unless an exception applies, such as a child under 12 at home. In private insurance, each person has a premium of their own, children included.

14.6 % of pay plus your fund's additional rate, 2.9 % on average in 2026, on pay up to €69,750 a year, and an employer pays half (§§ 241, 249 SGB V). In retirement they follow your pension and other income.

It can't turn you down (§ 175 SGB V), and what you pay turns on your income, not your health. It pays the doctor directly: you show your card.

Public insurance then pays sick pay (Krankengeld): 70 % of gross pay, at most 90 % of net (§ 47 SGB V). The self-employed can choose to include it (§ 44 SGB V). In private insurance there's sick pay only if you add it to the policy (Krankentagegeld).

A private premium doesn't rise just because you get older, but it does when medical costs rise, in retirement too (§ 203 VVG). A 10 % surcharge paid until 60 goes towards holding it down from 65 (§§ 149, 150 VAG). Once you retire, the employer's half stops; the pension insurance pays half the public rates on your state pension instead, at most half the premium (§ 106 SGB VI).

The way back is to become compulsorily insured again, through a job below the threshold or unemployment benefit, for example, or to qualify for family insurance: there's no switching on request. From 55, after five years without public insurance, compulsory insurance generally no longer brings you back (§ 6 Abs. 3a SGB V).

Unemployment benefit (Arbeitslosengeld) normally brings public insurance with it. From 55, after five years without public insurance, you generally stay private instead (§ 6 Abs. 3a SGB V), and while you get the benefit, the employment agency (Agentur für Arbeit) pays your premiums, up to what it would pay for public cover (§ 174 SGB III). If money runs short, every private insurer has to offer the basic tariff (Basistarif): capped at the highest public contribution, and halved while you need income support, or would need it to pay the premium (§ 152 VAG).

Civil servants, because Beihilfe pays half or more of their medical costs. High earners in good health, because the premium follows age and health, not income, all the more when a spouse earns too and nobody would be covered free.

A family on one income, because a spouse with little or no income and the children are covered through one member (§ 10 SGB V). Anyone whose income may fall, with part-time work, a career break, a lean year of self-employment or retirement, because contributions fall with it. And health never comes into it.