How does the healthcare system work in Germany? (GKV & PKV)

1. Statutory health insurance in Germany (GKV)

GKV (Gesetzliche Krankenversicherung) is the public health insurance system in Germany. It covers the majority of the population.

Who is covered by GKV ?

• Statutory health insurance is mandatory for:
• employees earning less than €77,400 gross/year (2026)
• students (in most cases)
• job seekers
• retirees under certain conditions

Structure of the German public healthcare system

GKV is managed by independent health insurance funds (Krankenkassen):

• AOK
• TK (Techniker Krankenkasse)
• Barmer
• BKK

👉 They compete with each other, are non-profit, and regulated by the state through the SGB V (Social Code Book V).

How GKV contributions are calculated

Funding is based on social contributions:

• Base rate : 14,6 %
• Average additional contribution (Zusatzbeitrag, specific to each health insurance fund): about 2.9%

👉 They vary depending on income. Approximately 17.5% of gross salary on average in 2026.

📌 Important :

• Contributions are capped (income ceiling: €69,750 in 2026)
• The employer pays half of the contributions

Advantages of GKV

• no medical selection
• free family coverage (children + non-earning spouse)
• solidarity-based

Limitations of GKV

Some treatments are only partially covered, or not covered at all:

• advanced dental care (implants, inlays, high-end crowns)
• single or double hospital rooms
• alternative medicine (osteopathy, acupuncture, etc.)
• glasses for adults
• certain preventive treatments

BONUS: Supplementary health insurance plans exist to fill these gaps, even if you are unable or do not wish to switch to private coverage.

2. Private health insurance in Germany (PKV)

PKV (Private Krankenversicherung) is the private alternative to the public system.

Qui peut accéWho can access PKV ?

• Employees whose income exceeds the annual threshold (€77,400 gross per year in 2026, adjusted annually)
• Self-employed individuals, freelancers, and liberal professions
• Most civil servants
• Certain students

👉 Enrollment is individual and voluntary.

Structure of the German private healthcare system

The system is managed by private insurance companies.

Examples : Generali, Allianz, AXA.

👉 The legal framework is defined in particular by the Versicherungsvertragsgesetz (VVG).

How PKV contributions are calculated

Unlike GKV, PKV is based on individual risk:

• age at entry
• health status
• level of coverage chosen

👉 Contributions are not income-based.

Advantages of PKV

• more flexible and customizable coverage
• better dental care coverage
• single or double hospital rooms possible
• shorter waiting times for appointments
• higher-quality hospital treatment
• better coverage for alternative medicine
• stronger preventive care coverage

Limitations of PKV

• each family member must be insured separately
• possible exclusions based on health status
• mandatory medical questionnaire at entry

Conclusion

Choosing between GKV and PKV is an important decision that can have a long-term impact on your budget, healthcare coverage, and your family’s protection.

There is no universally best option, only a solution tailored to your personal situation and life plans in Germany.

Understanding the differences between both systems is essential to avoid costly mistakes in the long run.

👉 Unsure about the best health insurance in Germany for your situation? Fill out our form to receive personalised advice: Form – Health insurance advice in Germany

For more information : https://fin-quest.de/en/health