For most families in Germany, public health insurance is the simpler and cheaper route for children: eligible children are covered at no extra cost through a parent's membership. Private health insurance means a separate, paid contract for every child, and in some family setups it is not a choice but a requirement. Which one applies to you depends on three things: how each parent is insured, whether you are married, and how much the better-earning parent makes.
This guide walks through the rules for employees, freelancers, students and families moving to or living in Germany, with the 2026 figures.
TL;DR
- If a parent is in public health insurance, children can usually join through free family insurance, as long as they stay under the income limit and age limits.
- If both parents are privately insured, the child needs their own private contract, and each child is a separate premium.
- In a married couple with one public and one private parent, free family insurance is blocked when the private parent earns more than the public parent and more than €6,450 per month in 2026.
- Where free cover is blocked, voluntary public cover for a child runs around €250 per month, similar to or slightly above private child cover.
- Private insurance is hard to leave later, so decide with the whole family's next ten years in mind, not just this year's premium.
Table of Contents
- How children are insured in each system
- When a child can use free public family insurance
- When your child must be privately insured
- What each option costs for a child
- Benefits and day-to-day experience for kids
- Perspective: how we advise families
- Questions to ask before you decide
- Getting help choosing
- FAQ
- Sources
How children are insured in each system
The two systems treat children very differently, and that difference is the main reason families pause on this question.
In public health insurance, contributions are based on income. Children, and spouses with little or no income, can be covered through family insurance without paying contributions. Your child gets their own insurance card and the same benefits you do.
In private health insurance, premiums depend on age, health status and the benefits you select, not on income. Every child needs a separate paid contract, and treatment is generally paid upfront and then reimbursed by the insurer. There is no free family mechanism in private cover, as Verbraucherzentrale points out.
That is why a family of four with one private contract holder and two children is not simply "private cover plus a bit". It is four separate policies.
When a child can use free public family insurance
Family insurance is not automatic. The Federal Ministry of Health states that children can be family-insured without contributions if they:
- live in Germany,
- stay below the income limit, which is €603 per month in 2026,
- and are not otherwise subject to compulsory insurance, exempt from it or insurance-free.
The legal basis is Section 10 of Book V of the Social Code. It also requires that the family member is not principally self-employed.
Age limits
The same ministry guide says family coverage normally ends at 18. It continues to 23 if the child is not employed, and to 25 during school, vocational training or qualifying voluntary service. Section 10 also allows coverage without an age limit for a qualifying disability.
For a university student, this matters. A child who is in public family insurance can often stay covered while studying, up to the age cap, without paying a euro. If you are curious how this plays out for people who arrive in Germany with children, our guide to family coverage in public health insurance goes into the application steps.
Both parents publicly insured
This is the easy case. The NRW family portal states that if both parents have public insurance, the child can, subject to the conditions, be covered without a premium. You may still buy private cover for the child if you want it, but premiums then apply. In practice, few families do this when the free option exists.
When your child must be privately insured
There are two situations where free family insurance is off the table.
Both parents are privately insured
If both parents are privately insured, the child cannot use public family insurance, according to the NRW family portal. The child needs premium-based private cover. Many private insurers allow you to add a newborn to your policy without a new health assessment within a set window after birth, but the terms differ by insurer, so ask before the birth rather than after.
One public parent, one private parent
This is where families get surprised. The rule depends on whether you are married.
- Married or registered partners: free family insurance is excluded under Section 10(3) when the privately insured partner is not a public member, earns above one twelfth of the annual income threshold, and regularly earns more than the publicly insured partner. Verbraucherzentrale puts the 2026 monthly figure at €6,450.
- Unmarried parents: the NRW family portal says the child can generally choose public family coverage or private insurance, because the income test applies to married parents.
The €6,450 monthly figure corresponds to the annual threshold of €77,400 for compulsory public insurance in 2026, as the ministry states.
A quick example
Anna is publicly insured and earns €3,000 a month. Her husband Tomas is privately insured and earns €7,500 a month. They are married. Tomas is above €6,450 and earns more than Anna, so their child cannot use free family insurance. The child needs private cover or voluntary public membership.
Swap the numbers: if Tomas earned €5,500 and Anna €3,000, the child could join Anna's public insurance for free, even though Tomas is privately insured. And if Anna earned more than Tomas, the income comparison would also let the child in. Because this is a legal eligibility test, not a preference, always check the numbers before you decide.
What each option costs for a child
| Situation | What the child pays |
|---|---|
| Family insurance is available | Nothing, covered through the public parent |
| Family insurance blocked, voluntary public cover | Around €250 per month |
| Private cover | Depends on age, health and plan; from around €120 per month in our experience |
When free cover is blocked, the child must generally be privately insured or become a voluntary public member. Verbraucherzentrale reports that voluntary public cover for a child costs around €250 per month, similar to or slightly above private child cover.
So the cost gap between the two systems for a child is often small. The real difference lies in what comes with the premium and what happens over time.
A useful sense check on the public side: the 2026 general contribution rate is 14.6%, with an average additional contribution of 2.9%, and a contribution ceiling of €5,812.50 per month, according to the ministry. Our overview of contribution rates shows how those figures turn into a monthly bill for the parent.
For private premiums, the calculation method is worth understanding before you compare quotes.
Benefits and day-to-day experience for kids
Public cover
Benefits are standardized. A child on public insurance gets the same statutory benefits as an adult member, and the family generally does not pay upfront, as gesund.bund.de explains. You show the card, and the practice bills the insurer.
Private cover
Benefits depend on the plan you choose. Privately insured people generally pay for treatment and medicines first and then claim reimbursement. For a family with young children, that means a steady flow of pediatrician invoices, prescriptions and paperwork. Many parents find this manageable with an app, others find it a burden. It is worth deciding honestly which you are.
What private plans can add for children is a higher level of cover, such as better dental or orthodontic benefits. Our page on what private health insurance covers lays out the typical areas.
Perspective: how we advise families
We see the same pattern again and again. A well-paid new arrival chooses private insurance for themselves because the premium looks attractive, then discovers the partner and children make the household bill look very different. The question is rarely "which system is better". It is "what does the whole family look like in five and ten years".
Our rule of thumb: if you are married, have a partner with a lower income who is publicly insured, and plan to have children, price the public option first. Free family insurance can offset a lot. If both of you are high earners and the children cannot join anyway, private cover starts to look much more competitive, and the plan quality becomes the main discussion.
The point we stress most is reversibility. Private premiums are not based on income and can rise over time, and returning to public insurance is usually excluded. A decision that looks cheap for a single person at 30 may feel heavy with three children and one income during parental leave. We would rather you choose slowly than switch back in a hurry.
— Marco
Questions to ask before you decide
Work through these in order. They usually settle the question.
- Are both parents privately insured? Then the child needs a private contract. Compare plans on child-specific benefits.
- Is one parent publicly insured? Check marital status and the income test above before assuming anything.
- Will income change? Parental leave, a career break or a move to part-time can change who earns more and what the household can carry. Verbraucherzentrale advises reassessing family-insurance eligibility when income or insurance circumstances change.
- How long will you stay in Germany? Families planning a few years abroad weigh this differently from those settling permanently.
- How will your child be at 18, 23 or 25? Age limits mean your child will eventually need own cover. Students have their own route, covered on our page about private health insurance for students.
Other family types
Freelancers: family insurance is not available for a family member who is principally self-employed, so a self-employed spouse needs their own cover. Your children can still be family-insured through a publicly insured parent if the conditions are met.
Employees above the threshold: you may generally choose private insurance, but that choice affects the children as described above. If you earn above €77,400 a year in 2026, think about the family, not only the individual premium.
Newcomers within the first weeks: the paperwork is often the hardest part. Our 90-day guide covers what to organize first, and the page on health insurance for newcomers in Germany explains your options by status.
Getting help choosing
Myhealthcarebroker is an independent consultancy: we are not tied to a single insurer, we compare across providers, and we explain the German process in clear English. For families, we check family-insurance eligibility first, then compare public and private routes for every household member. Our service is free to you.
If you want a quick view of your numbers, use the public vs. private calculator. If you would rather talk it through, start with our independent comparison.
For families who would like extra hands with appointments and paperwork after signing up, we also run a healthcare concierge service.
FAQ
Is health insurance for children in Germany free?
Often yes, in public health insurance. The federal government's service portal confirms that children can be added to a public member's coverage at no extra cost under certain conditions. In private insurance, every child has a paid contract.
Can my child be on public insurance if I am privately insured?
It depends on your partner. If your partner is publicly insured and you are unmarried, the child can generally choose public family coverage. If you are married, the income test applies: the child is excluded when you earn more than your partner and more than €6,450 per month in 2026.
How long can my child stay in free family insurance?
Normally until 18, until 23 if not employed, and until 25 during school, vocational training or qualifying voluntary service, according to the ministry's guide. A disability can allow coverage without an age limit. Income above €603 per month ends eligibility.
Is private insurance for children better than public?
Not automatically. Public benefits are standardized and families rarely pay upfront. Private plans can offer higher levels of cover, but you pay invoices first and claim them back, and premiums can rise over time. The better option is the one that fits your family's income, status and plans.
Can we switch back to public insurance later?
Usually not easily. Returning to public insurance from private cover is typically excluded, apart from specific situations. Talk to an independent adviser before you sign a private contract for the family.
Sources
- Health insurance | gesund.bund.de
- Versicherte in der gesetzlichen Krankenversicherung | Federal Ministry of Health
- Versicherungspflichtgrenze | Federal Ministry of Health
- Beiträge der gesetzlichen Krankenversicherung | Federal Ministry of Health
- Health Insurance for Children | Familienportal NRW
- Familienversicherung in der Krankenkasse | Verbraucherzentrale
- Krankenkasse: Pflichtversichert, freiwillig oder privat? | Verbraucherzentrale
- Apply for family coverage under public health insurance | Bundesportal