HEALTHCARE / THE ALPENROSE GUIDE

Public or private health insurance: what to compare

Start with the cover you can access, then compare costs, family needs and future changes. A practical guide to making a health-insurance decision in Germany.

6 min readBeginnerBy Alpenrose Partner

Updated 10 September 2026

A health-insurance decision can affect your monthly budget, the way your family is covered and what happens if your work changes. A low first-year premium answers only one part of that decision. Before comparing offers, establish which routes are actually available to you and when your cover must begin.

This guide is for internationals making that first comparison or reviewing an existing arrangement. Use it to organise the questions you need answered. A salary figure or a short online questionnaire cannot establish your individual insurance status on its own.

Start with eligibility

Germany's statutory system is called gesetzliche Krankenversicherung, or GKV. Private health insurance is private Krankenversicherung, or PKV. Statutory membership can be compulsory, voluntary or through eligible family cover. For employees, the general annual earnings threshold relevant to compulsory insurance is EUR 77,400 in 2026. Exceptions and other eligibility rules apply; earning more does not oblige you to take private insurance. BMG: statutory membership and family insurance

Prepare your employment status, intended start date, regular earnings and insurance history. If you have recently arrived from abroad, tell the insurer where you were covered and under which arrangement. Ask it to confirm your available route and start date for your particular circumstances. Students, self-employed people and civil servants should not apply the ordinary employee threshold as if it settled their own position. BMG: switching between statutory and private insurance

A useful enquiry is: 'I currently have [type of cover] in [country]. I will be [employed/self-employed/studying] from [date]. Please confirm which membership route applies, what evidence you need and whether there is a gap before that date.' Keep the reply with your arrival documents.

Understand the two different earnings limits

For statutory contributions, the 2026 income ceiling is EUR 69,750 a year, or EUR 5,812.50 a month. This ceiling limits the earnings used in the contribution calculation; it is a different figure from the general compulsory-insurance threshold. The general statutory rate is 14.6%, with an additional rate set by the individual health fund. Employees and employers generally share these health contributions equally. BMG: statutory contributions and 2026 income ceiling

Do not calculate your own contribution by applying 14.6% to your full salary and stopping there. Ask for the health fund's actual additional rate, the earnings being assessed and the separate long-term care contribution. Voluntary members can have additional types of income taken into account. Your status therefore matters to the calculation as well as to eligibility. BMG: statutory contributions and 2026 income ceiling

Two different 2026 figures: EUR 69,750 is the annual statutory contribution ceiling; EUR 77,400 is the general annual employee compulsory-insurance threshold. Neither number alone determines your individual insurance route. — 2026 figures from BMG. The two limits serve different purposes; special rules and personal eligibility still matter.

Compare the whole household

Eligible spouses, registered partners and children can have statutory family cover without a separate contribution. It is conditional: residence, income and other requirements matter, and a child's eligibility can be affected by the other parent's insurance and earnings. Ask for a separate answer for each person rather than assuming that the family is covered because one parent has joined. BMG: statutory membership and family insurance

Private cover generally involves a separate premium for each insured person. Build a household comparison that includes everyone who needs cover, any deductible and long-term care insurance. A premium quoted for one adult is not a household budget. Ask how the arrangement would work during parental leave or if one partner stopped working. BMG: private insurance, premiums and reimbursement

For example, a single employee and a household with a non-working partner may receive the same headline quote for that employee. Their useful comparison is different because the second household also needs a confirmed arrangement for the partner. This example illustrates a question to resolve; it does not establish eligibility or favour a particular system.

Look at benefits and day-to-day use

In private insurance, the agreed benefits and the individual's assessed risk affect the premium. Health information can influence acceptance or terms; special statutory tariffs have their own rules. Under the usual reimbursement model, patients receive bills and seek reimbursement under their policy. Private health cover must also be accompanied by private compulsory long-term care insurance. BMG: private insurance, premiums and reimbursement

For either route, ask about the care that matters to you: ongoing treatment, medicines, psychotherapy, dental care, rehabilitation and treatment outside Germany. Request the relevant benefit conditions instead of relying on a word such as 'premium'. Ask how referrals, prior approvals and reimbursement work, and which costs you might initially need to pay yourself.

Keep income during illness as a separate question. Ask when any sickness benefit or daily sickness allowance would start, how the amount is determined and what gap remains. Someone becoming self-employed should revisit this explicitly rather than assuming that an employment-based arrangement continues unchanged.

Consider a change in income or work

Private premiums are not automatically reduced just because your income falls. Statutory contributions depend on the applicable income and membership rules, including minimum assessment rules in some circumstances. Both systems can experience contribution or premium increases. Compare a plausible quieter working year as well as today's income. BMG: private insurance, premiums and reimbursement BMG: statutory contributions and 2026 income ceiling

Write down two likely changes in the next few years: perhaps self-employment, reduced hours, a child or a period abroad. For each, ask what happens to eligibility, household cover and the amount you pay. You do not need to predict every future event; you do need to understand the changes that are already part of your plans.

Do not assume you can switch back whenever you want

Returning from private to statutory insurance is subject to legal conditions. Becoming compulsorily insured may create a route, but age and insurance-history restrictions can prevent it; the rules from age 55 are particularly important. The Federal Ministry of Health explains the conditions. Treat a proposed future return as something to verify, not as a guaranteed fallback. BMG: switching between statutory and private insurance

Before ending existing cover, obtain confirmation of the replacement and its start date. Check cancellation requirements with the current provider and resolve any gap between arrival, employment and the new policy. An application, a quote and confirmation of active cover are different milestones.

Turn the comparison into a useful conversation

Use the optional health-insurance worksheet to record your available routes, household needs and open questions. Bring the unresolved points to the insurer or an adviser. For a conversation with Alpenrose, identify what is changing in your life and which part of the insurance or financial planning you want help with.

Keep detailed medical records out of an initial general enquiry; ask for the appropriate secure process if they are required. The useful result is a confirmed route, an understood household cost and a clear next action. The worksheet helps you prepare that discussion; it does not select a tariff or submit an application.

Editorial sources and 2026 figures checked on 10 September 2026. Confirm current rules and terms for your circumstances before changing cover.