PKV or GKV: differences and decision criteria

Can you choose at all?

The choice between statutory and private health insurance is not open to everyone. For employees, compulsory insurance in statutory health insurance ends when regular annual earnings exceed the annual earnings threshold (Jahresarbeitsentgeltgrenze, § 6 para. 1 no. 1 SGB V). For 2026 this compulsory insurance threshold (Versicherungspflichtgrenze) is €77,400 per year, which is €6,450 per month. If it is exceeded, compulsory insurance ends in principle at the end of the calendar year (§ 6 para. 4 SGB V).

Civil servants (Beamte) are exempt from statutory health insurance if, under civil-service law, they are entitled to continued payment of salary and to government assistance with healthcare costs (Beihilfe) or free medical care (Heilfürsorge) (§ 6 para. 1 no. 2 SGB V). Self-employed people and freelancers can also insure privately. How this looks in your specific case depends on your form of employment and your previous insurance.

PKV for employees: switching, threshold and employer subsidy

PKV for civil servants (Beamte): Beihilfe, residual-cost insurance and family

PKV for self-employed people and freelancers: tariffs, deductible and daily sickness allowance

How contributions differ

In statutory health insurance, the contribution is based on income subject to contributions. Income is only taken into account up to the contribution assessment ceiling (Beitragsbemessungsgrenze); in 2026 this is €69,750 per year. The general contribution rate is 14.6 percent, plus an additional contribution set by each health insurance fund (on average 2.9 percent). Employees and employers each bear half of the contributions. Children, spouses and registered partners can be covered free of charge through family insurance (Familienversicherung).

In private health insurance, the contribution does not depend on income but, among other things, on age and state of health at entry, the chosen tariff and scope of benefits, and a possible deductible. There is no free family insurance as in GKV; family members are insured individually. For old age, insurers build up ageing reserves (Alterungsrückstellungen). Contributions can nevertheless rise: insurers may adjust them if costs have risen permanently and an independent trustee agrees.

Criteria for your decision

• Eligibility: do you belong to the groups of people who can insure privately?
• Income and predictability: how secure is your income over the next few years, including during parental leave, part-time work or self-employment?
• Family: are you planning children, or is your partner not working? In PKV every person needs their own contract.
• Benefits: which benefits do you need? The statutory range of benefits is uniformly regulated; in PKV you agree it by contract.
• Health: in PKV the insurer asks health questions before the contract is concluded. Pre-existing conditions can lead to a risk surcharge, a benefit exclusion or rejection.
• Contribution in old age: how sustainable is the contribution even if your income falls?

Limits of this overview

This article does not replace advice. Calculation figures such as the compulsory insurance threshold and the contribution assessment ceiling are adjusted every year; the values given apply to 2026. Whether a switch makes sense for you depends on your professional, health and financial situation. A later switch back to statutory health insurance is not possible in every case.