Yes, you can have a chronic condition and still get private health insurance in Germany, but it is not guaranteed and it is rarely cheap. Insurers assess your health before they sign, and they can accept you as is, add a surcharge, exclude the condition, or decline. For many people with a serious, long-term illness, public health insurance is the safer and often cheaper choice. This guide explains how the decision works, who it suits and what to do before you apply.
TL;DR
- Private insurers in Germany run a health check before the contract starts. Depending on the result, they can reject you, add a risk surcharge or exclude specific services.
- Once the contract is in force, your premium cannot be raised because your health gets worse. Surcharges and exclusions agreed at the start generally stay.
- Public health insurance offers Disease Management Programs and a lower co-payment cap for people with serious chronic conditions, which is often the stronger deal.
- If you are already in private health insurance or cannot be accepted, the Basistarif is a legal fallback with no risk surcharges.
- Never leave a condition off the health questionnaire. Even unintentional omissions can lead to the insurer ending the contract.
Table of Contents
- Who can choose private cover in the first place
- How private insurers treat a chronic condition
- Why honesty on the health questionnaire matters
- What you give up, and keep, in each system
- What public health insurance offers for chronic conditions
- The Basistarif: private cover without health surcharges
- Ageing reserves and why switching later is hard
- Worked scenarios
- Our perspective
- A sensible order of steps
- How Myhealthcarebroker can help
- FAQ
- Sources
Who can choose private cover in the first place
Before chronic illness even enters the picture, you need to be eligible. Employees can opt out of the public system only if their gross annual income is above the Jahresarbeitsentgeltgrenze, the compulsory insurance threshold. In 2026 it is 77,400 euros, and it is adjusted every year. Self-employed people, freelancers and civil servants follow different rules, and students have their own route with specific conditions.
If you are unsure which group you belong to, start with our eligibility check for switching from public to private health insurance. Students can read about private health insurance for students in Germany, and anyone who just arrived will find the basics in our guide to health insurance for newcomers in Germany.
How private insurers treat a chronic condition
Private health insurance is a private contract, so freedom of contract applies on both sides. The Federal Ministry of Health notes that applicants can be turned down, and that accepted applicants with pre-existing conditions may face risk surcharges or exclusions of services.
The process looks like this:
- You fill in a health questionnaire covering past diagnoses, treatments, medication and hospital stays, usually over several years.
- The insurer assesses the risk, sometimes after requesting medical records from your doctors.
- You receive one of four outcomes: acceptance at the standard premium, acceptance with a surcharge, acceptance with an exclusion, or a rejection.
The insurers' own association, pkv.de, describes these same outcomes. Each company applies its own acceptance guidelines, so the same diagnosis can lead to different answers at different insurers. That is one reason a single quote request tells you little.
Risk surcharges
A risk surcharge (Risikozuschlag) is an extra amount added to your monthly premium because of your health history. It is usually expressed as a percentage of the base premium. Surcharges tend to remain in place for the life of the contract unless you later renegotiate them with the insurer. A surcharge also grows in absolute terms when the base premium grows with age and rising medical costs.
Service exclusions
An exclusion (Leistungsausschluss) means the insurer will not pay for treatment linked to a specific condition. For a chronic illness this can be the very thing you need most: the medication, the specialist visits or the hospital stays that come with it. You would pay those costs yourself, while still paying a full premium for everything else.
Rejection
Insurers can decline an application outright. A rejection does not stop you from being insured. You stay in or return to the public system if you qualify, or you can look at the Basistarif, which we explain below.
Why honesty on the health questionnaire matters
The temptation to leave out a diagnosis that seems minor is real, and it is a costly mistake. According to the Federal Ministry of Health, failing to disclose a condition, even unintentionally, can lead the insurer to end the contract retroactively. The consequence can be that you lose cover at exactly the moment you need a claim paid.
Practical habits that help:
- Request your own records from your doctors and pharmacy before you fill in the form.
- Include conditions treated abroad if the question asks about them. Bring translations if you can.
- Answer every question, and where the form allows free text, add context instead of leaving a gap.
- Keep a copy of the completed questionnaire and the insurer's confirmation.
This is also where independent advice earns its keep. A broker who knows how the different insurers read the same answers can tell you how to phrase an answer accurately, though never to hide or soften a fact.
What you give up, and keep, in each system
Here is a side-by-side view of the points that matter most when you live with a long-term condition.
| Point | Public health insurance | Private health insurance |
|---|---|---|
| Entry with a pre-existing condition | Open to those who qualify, no health check | Health check, with possible rejection, surcharge or exclusion |
| Contribution basis | Based on income, not on health | Based on age, health and chosen tariff |
| Chronic care programs | Disease Management Programs (DMP) | Depends on tariff and initial underwriting |
| Co-payment cap | 1% of annual gross income for serious chronic conditions, 2% otherwise | Set by your tariff, for example deductibles |
| Premium change if health worsens | Not applicable | Cannot be raised for that reason after signing |
The Verbraucherzentrale advises people with chronic illnesses to approach a switch to private cover with real caution. Its reasoning is that the private system treats your health as an individual risk, which can lead to lasting surcharges or restricted coverage that compound with later premium increases.
We agree with that logic as a starting point. It does not mean private cover is always wrong, but the burden of proof is on the private option.
What public health insurance offers for chronic conditions
Public health insurance has structured support for long-term illness. The Federal Ministry of Health describes Disease Management Programs that coordinate care for conditions such as diabetes, asthma and heart disease, with evidence-based treatment paths. Participants also benefit from a lower co-payment limit of 1% of annual gross income instead of 2%.
Two more points matter:
- Contributions are linked to income, not to your diagnosis. A new condition does not change what you pay.
- Each fund must offer certain special tariffs, and some are linked to care programs. The ministry lists them on its page about Wahltarife and bonus programs.
If you are above the threshold and healthy today, remember that public insurance stays available while you remain eligible for it. If you want to compare providers, see our overview of public health insurance providers in Germany.
The Basistarif: private cover without health surcharges
The Basistarif is a legally defined tariff that every private insurer must offer under certain conditions. It exists so that residents who qualify can be covered regardless of health status. Under the Federal Ministry of Health, insurers may not charge risk surcharges or exclude services for pre-existing conditions in this tariff, and the premium is capped at the maximum contribution of the public system, which stood at 1,017.19 euros as of 1 January 2026.
That cap sounds generous until you compare it with an average public contribution. For most people, the Basistarif is a safety net, not a first choice. Its benefits are comparable to public cover, so it does not deliver the extras that attract people to private insurance in the first place.
We explain what the Basistarif is, how the premium cap works and what happens under hardship, and how people end up in it by accident in a separate guide. If you want to see how it differs from a standard private plan, we also have a comparison of the Basistarif, standard tariffs and the Notlagentarif.
Ageing reserves and why switching later is hard
Private insurers build ageing reserves (Alterungsrückstellungen) to keep premiums more stable as you get older. These reserves are tied to your contract. According to pkv.de, if you change insurers you may lose some of them unless your contract was signed in 2009 or later. The Verbraucherzentrale explains the principle: risk is assigned to a group of people who entered at the same age, not to you as an individual.
For someone with a chronic condition, there is a second problem. A new insurer would underwrite you again, based on today's age and health. A diagnosis you collected after signing your first contract would then count as a pre-existing condition. In practice, this means the first choice carries a lot of weight, and a change of mind can be expensive.
Worked scenarios
These are illustrations of how the logic plays out, not quotes or predictions of price.
A software engineer with well-controlled asthma, earning above the threshold. Insurers may accept this at standard terms, with a surcharge or with an exclusion, depending on severity and medication history. Applying to several insurers through one comparison shows which of them treat the condition most mildly. Public insurance with a Disease Management Program remains a serious alternative.
A researcher with type 1 diabetes. This is a serious, lifelong condition. A private insurer may decline or apply a heavy surcharge. The public system, with a 1% co-payment cap and a DMP, is likely to be more predictable. For people in this situation, we normally advise staying public unless an insurer's offer is clearly better in writing.
A family moving to Germany, one child with a chronic condition. In private insurance, each family member is underwritten and priced individually, so the child's condition affects that child's premium. In public insurance, children can often be covered under a family arrangement without separate premiums, depending on the parents' status. Check the rules for your own case before deciding.
A freelancer who is healthy today. Here the question is more about the future. If a chronic illness develops after signing, the premium cannot be raised for that reason. Some people value that protection, and it is among the strongest arguments for private cover for those who are healthy at the start.
Our perspective
We talk to people every week who have heard that private insurance is simply better. For people with a chronic illness, the honest answer is often the opposite, and we would rather say so up front than sell a policy that causes problems later.
Our approach is to start from your situation, not from a product. Is your income above the threshold? How serious is the condition, and how is it treated today? Do you plan to stay in Germany long term, with a partner or children? Those answers shape which route makes sense.
We are independent and compare across providers, which matters here because acceptance rules differ between insurers. Some will offer standard terms where another asks for a surcharge. We would also tell you when the best move is to stay in or choose public insurance. Our service is free for you, as we are paid a regulated commission by the insurer only if you sign a policy, which is why we put the fit and the long-term cost ahead of the speed of the application.
One more rule from us: do not cancel anything until the new cover is confirmed in writing. A gap, or a half-finished switch, is the worst outcome.
— Marco
A sensible order of steps
- Confirm your status. Check whether your income, employment type or student status allows you to choose private cover at all.
- Gather your medical history. Collect diagnoses, dates, medications and treatments from the past several years.
- Compare public and private on cost over time. Our public vs private calculator gives you a first picture, and it beats a calculator on a napkin for catching the long-term difference.
- Ask for a risk assessment before you commit. Insurers can assess your case, and a broker can help you approach several of them at once. Follow our step-by-step switching timeline so you do not leave public insurance too early.
- Decide with the written offer in hand. Compare surcharges, exclusions and the effect of future premium increases, not only the first-year price.
- Keep the fallback open. Know where you would be insured if the application is declined.
If you want to see what a typical private plan includes before you ask about your own case, read what private health insurance covers in Germany.
How Myhealthcarebroker can help
If you want an honest second opinion, Myhealthcarebroker compares private and public health insurance across providers in clear English, from the first eligibility check through to the application and ongoing support. You can start with our page on private health insurance in Germany with advice in English or request a free quote. If you would also like help dealing with doctors and paperwork once you are insured, take a look at our healthcare concierge service.
FAQ
Can private health insurance in Germany refuse me because of a chronic illness?
Yes. After the health check, an insurer can reject an application, add a risk surcharge or exclude services linked to the condition. Acceptance rules differ between insurers, so a refusal at one does not mean refusal everywhere. If you are refused, you are not left without cover: the public system or the Basistarif may be open to you.
Will my premium go up if my condition gets worse after I sign?
No, not for that reason. Once the contract is concluded, the insurer cannot raise your premium because your health deteriorates. Premiums can still rise for other reasons, such as higher medical costs and your age, so expect increases over time.
Is public health insurance better for chronic illness?
Often, yes. Public insurance does not assess your health, offers Disease Management Programs and caps co-payments at 1% of gross income for serious chronic conditions. Private insurance can still make sense for a mild, well-managed condition if the offer is clear in writing. Compare both before you decide.
Can I switch from private to public insurance later if I develop a chronic condition?
That depends on your age, income and employment status, because returning to the public system is restricted for many people once they have left it. Do not assume the door stays open. Check your own situation with a specialist before you sign a private contract.
What happens if I forget to mention a condition on the questionnaire?
The insurer can end the contract retroactively, even if the omission was unintentional. Your claims may then be at risk. Gather your records first and answer every question as completely as you can.
Sources
- Versicherte in der gesetzlichen Krankenversicherung, Federal Ministry of Health
- Private Krankenversicherung, Federal Ministry of Health
- Chronisch kranke Menschen, Federal Ministry of Health
- Wahltarife, Bonusprogramme und Zusatzleistungen, Federal Ministry of Health
- Ablehnung und Kündigung in der privaten Krankenversicherung, pkv.de
- Private Krankenversicherung nicht für jeden sinnvoll, Verbraucherzentrale
- Was Alterungsrückstellungen bewirken, Verbraucherzentrale