GKV versus PKV 2025: Health insurance for expats in Germany explained

Health insurance in Germany is compulsory under German law. For expats living here or considering the move, it means engaging with something that can feel more intimidating than the language or the bureaucracy.

Everyone who lives and works here must be insured, and Germany offers two options to choose from: Statutory health insurance (GKV) or private health insurance (PKV). As an expat, this won’t just be one of your most important financial decisions; it also determines the quality and level of health coverage you and your family will receive.

In practice, however, most expats automatically start out in GKV. Usually, your employer registers you when you begin working, and as the process is straightforward, once enrolled, many never revisit the decision.

This article will break German health insurance into digestible bites and walk you through everything you need to know.

German health insurance: The dual system

Germany has implemented a dual health insurance system: Statutory health insurance (Gesetzliche Krankenversicherung or GKV) and private health insurance (Private Krankenversicherung or PKV). Both provide access to some of the world’s best healthcare services, but they operate differently. 

For employees, compulsory health insurance in Germany has a threshold of €73.800 (as of 2025). If your salary falls below that figure, you must remain in GKV. If your salary is above the threshold, you can choose between GKV and PKV. Freelancers and the self-employed often have the choice regardless of income, although PKV requires a minimum annual income of €30.000, or €45.000 if you’re 51 or over. 

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How does GKV work?

Statutory health insurance is tied to income. In 2025, contributions amount to around 20% of your gross salary (including long-term care insurance), split equally between you and your employer. However, there is a contribution ceiling at €66.150. Once you approach this limit, you’re effectively paying the maximum rate, with no reduction even if your income continues to rise.

A key advantage of GKV for expats is access to family insurance in Germany. Dependents can be added for free, provided they don’t earn above a small income threshold. For families with only one main earner, GKV is the cheaper option.

The downsides? You may encounter longer waiting times for specialists, and there are limits to what the statutory system covers. Extras like a private hospital room are not included. With PKV, you’ll generally have better access to privacy, healthcare specialists, and a higher standard of medical services.

How does PKV work?

Think of private health insurance like a menu: you can start with a tariff that offers coverage comparable to statutory health insurance and then add extra benefits as your needs evolve. Your premium depends on your entry age, health and the level of cover you select, not simply on your current age. This means two healthy 30-year-olds could pay lower premiums than someone joining at 50, who will likely face higher costs. In essence, the earlier you enter PKV, the more cost-efficient it will be over the long run.

PKV premiums aren’t tied to income, so if you earn above €73.800 it can be the more attractive option. Even better, if you’re employed, your employer covers up to 50% of your contribution. While each family member needs a separate contract, children’s lower premiums mean higher-income households can still achieve better overall value and coverage.

The perks? With PKV, you’ll see specialists in a matter of days rather than waiting months under GKV. You also gain access to high-quality medical services such as innovative treatments, the most up-to-date medications, preventive screenings, and advanced diagnostic options. On top of that, you benefit from private rooms, broader treatment choices, and often English-speaking service lines, all with policies designed to keep premiums manageable as you age.

GKV versus PKV: Side-by-side costs

• GKV in 2025:  Around 20% income-based contribution (including long-term care insurance), capped at €66,150. If you’re employed, your employer covers half of this amount.
• PKV in 2025: Premiums are based on your entry age, health, and chosen tariff. The earlier you switch to PKV, the cheaper it will be, with up to 50% of the contribution covered by your employer if you are employed.

And don’t forget the add-on: Long-term care insurance, called Pflegepflichtversicherung, which everyone has to take out. If employed and insured under GKV, Pflegepflichtversicherung is automatically included in your payslip deductions. If you’re in PKV, you’ll need to add it to your policy.

Checklist for expats: Are you eligible for GKV or PKV in 2025?

Use this quick checklist to determine which German health insurance system works best for you:

• Are you employed and earning less than €73.800 a year? You’ll stay in GKV for now, but if you’re close to the threshold, a personal consultation can help explore future options.
• Are you employed and earning more than €73.800 a year? You can choose between GKV and PKV.
• Are you self-employed or a freelancer? You may qualify for both systems, and a personal consultation will clarify whether PKV already makes sense for you.
• Do you have a spouse or children to insure? Family cover works differently between GKV and PKV, so it’s worth getting a consultation to see which is better.
• Do you have pre-existing health conditions? Acceptance rules and premiums vary, which is why speaking with an advisor can help you understand whether PKV is still the right choice. 

Finding the right health insurance for expats in Germany 

German health insurance is among the best in the world. Whichever route you choose, you’ll be well looked after. However, with its faster access to specialists, private rooms, and broader medical treatments, PKV often tips the scales in its favour.

If you’re an expat living in Germany and meet the eligibility criteria, opting for private cover can make more sense.