If you earn above the income threshold in Germany, you can choose between two routes: stay in public health insurance and top it up with supplementary policies, or leave the public system for full private cover. The first route keeps your options open and costs a predictable share of your salary. The second can deliver richer benefits, but it prices you by your own risk profile and is hard to undo. This guide compares them on the points that decide the question: who can choose, what each route covers, what it costs, how families are treated and what happens if your life changes.
TL;DR
- Only employees earning above the annual income threshold of €77,400 (2026), plus self-employed people and civil servants, can choose private health insurance. Everyone else is in the public system.
- Public insurance plus supplementary cover keeps your membership and adds targeted extras: dental, hospital comfort and daily sickness allowance.
- Private health insurance replaces public cover entirely, with premiums based on your age, health and chosen benefits, and no free family cover.
- Returning to public insurance later is restricted, and for people aged 55 or older it can be barred altogether.
- Compare both routes with your real situation (family plans, career, age) before you sign anything.
Table of Contents
- Who can actually choose between the two
- Route one: public insurance plus supplementary cover
- Route two: substitutive private health insurance
- Side by side: what changes
- What each route costs
- Families: the biggest swing factor
- The one-way door
- Perspective: how we help people decide
- Get a comparison for your own situation
- Questions people ask
- Sources
Who can actually choose between the two
Most employees in Germany have no choice at all. Public health insurance is compulsory for employees whose income stays below the mandatory insurance threshold, and only those above it may opt for substitutive private health insurance. In 2026 that threshold is €77,400 per year, or €6,450 per month. You become exempt at year-end if you earned more than the limit and are expected to earn more than the next year's limit as well.
Outside the employee group, private health insurance is generally open to civil servants, self-employed people and employees above the threshold. Students and people on certain visas follow their own rules, which is why we keep separate pages for students and for newcomers arriving in Germany.
A quick clarification, because the terms trip people up. Staying in public insurance above the threshold is called voluntary membership. You are not forced into the system, you simply choose to remain in it. That is the starting point of the first route below.
Route one: public insurance plus supplementary cover
With this route you keep your public membership and add private policies that fill specific gaps. Supplementary cover tops up publicly financed benefits rather than replacing them. You pick the gaps that matter to you and ignore the rest.
The three add-ons people ask about most:
- Dental. Supplementary policies can cover part of the cost of dental replacements, such as crowns and implants, that public insurance only partly pays for.
- Hospital comfort. Policies can add private-patient benefits such as chief-physician treatment or a single- or two-bed room.
- Daily sickness allowance (Krankentagegeld). Employees can use it to help bridge the gap between public sickness benefit and their net salary.
All three come from the Verbraucherzentrale overview of supplementary policies. The same consumer organization also suggests a sober check before buying an expensive hospital policy: work out whether paying a single-room surcharge directly when you need it would be cheaper. For many healthy people it is.
Where this route fits best
It suits people who value flexibility: those who may leave Germany, change employers, start a family or see their income drop. It also suits anyone who is happy with the standard of public care and wants insurance only against the specific costs that annoy them.
Where it falls short
Supplementary policies are separate contracts, each with its own premium, health questions and waiting periods. Several of them together can add up. You also stay inside the public system's rules on provider access and appointments, so cover for the extras does not turn you into a fully private patient.
Route two: substitutive private health insurance
Private health insurance replaces public membership. You sign a contract with a private insurer, and the premium reflects the benefits you choose and your risk profile at entry. Substitutive cover uses risk-profile-based private premiums, not a percentage of salary.
That has two consequences. Young, healthy applicants often find the entry premium attractive for the benefits offered. At the same time, later entry and age-related costs can raise premiums, so the price you see at 30 is not the price you can assume at 55.
Private plans also let you shape the contract through a deductible (Selbstbeteiligung). A higher deductible lowers the premium but raises what you pay when you claim. Our guide to deductibles in German private insurance walks through the tiers and the hidden costs. For the product itself, see our private health insurance guide and what private health insurance covers.
Side by side: what changes
| Point | Public plus supplementary | Private (substitutive) |
|---|---|---|
| Who can choose | Anyone insured publicly | Employees above €77,400 (2026), self-employed, civil servants |
| Contribution basis | Share of income up to a ceiling | Age, health and benefits at entry |
| Employer share | Half of the contribution | Subsidy, capped at half the premium or the statutory maximum, whichever is lower |
| Spouse and children | Free co-insurance under conditions | Own premiums for each person |
| Extras | Added policy by policy | Built into the tariff |
| Way back | Stay or change fund | Restricted, can be barred from 55 |
The sections below unpack the rows that matter most.
What each route costs
Public insurance
Public contributions are calculated on your income up to a ceiling. In 2026 the contribution assessment ceiling is €69,750 per year, or €5,812.50 per month. The general rate is 14.6%, and each fund adds its own Zusatzbeitrag, which averages 2.9% in 2026. Employer and employee split the total equally, including the Zusatzbeitrag.
Because of the ceiling, your public premium stops growing at a certain income. A high earner pays no more than someone just above the ceiling. For a worked breakdown, see our page on public health insurance contribution rates in 2026.
Then add the supplementary policies you choose. A dental policy and a daily sickness allowance, for instance, each bring their own monthly premium, and you should price the full bundle before comparing it with a private tariff.
Private insurance
Employers contribute to private premiums too. The employer subsidy is limited to half the premium or the maximum contribution the employer would pay for a public member, whichever is lower. So an expensive tariff does not mean the employer pays half of it.
Nursing care insurance is part of the picture as well. After five years of cover, contributions to private nursing care insurance are capped at the public maximum, which is €209.26 per month in 2026. For people entitled to Beihilfe (civil servants), the cap is €83.70.
One administrative change helps employees: since 2026, private insurers send contribution data electronically to the tax administration, where employers can retrieve it, replacing paper certificates.
A practical way to compare
Do not compare the cheapest private premium with the public contribution alone. Build both sides honestly:
- Public contribution for your salary, plus the supplementary policies you would actually buy.
- Private premium for the tariff with the benefits you need, minus the employer subsidy if you are an employee.
- Premiums for your partner and children under each route.
- A realistic view of what happens to both figures in ten and twenty years.
Our public vs private calculator handles the first three steps with your own numbers.
Families: the biggest swing factor
In public insurance, spouses and children may be co-insured free of charge, subject to conditions. In private insurance, family members are not co-insured for free: each person pays their own premium.
A single professional and a couple where both partners work full time may find private cover financially sensible. Single people and childless couples who both work are the group the Verbraucherzentrale identifies as potentially better off, though it warns that returning to public cover is usually excluded or tied to conditions. Once a single-earner household with children enters the picture, the arithmetic often turns the other way, because the free family cover in public insurance is worth a lot.
The one-way door
This is the point we ask every client to think about before anything else. Germany has deliberately limited re-entry into the public system to reduce the risk segmentation that would follow if people moved freely each way. In practice, the rule affects you directly: return from private to public insurance is generally restricted, and it is barred for people aged 55 or older who meet the prior-insurance and status conditions set out by the health ministry.
The usual way back is a qualifying job whose income falls below the threshold. If you want to see how that works in practice, read our guide to returning to public insurance when income falls. Staying public with supplementary cover, by contrast, can be changed at any time without that barrier.
Perspective: how we help people decide
We see the same pattern again and again. A newcomer in Germany lands a well-paid job, receives a glossy private offer and assumes the higher salary means private is the natural next step. Often it is not. The decision rests on your family plans, your expected career path in Germany and how long you intend to stay.
Our advice is to work backwards from the exit. Ask yourself where you will be in 15 years and what happens to your premium if your income, household or country changes. If the answer is uncertain, public insurance with a few well-chosen supplementary policies is the lower-regret option. If your situation is stable, you are young and healthy, and you want specific benefits, private cover can be an excellent fit.
Because we are independent and not tied to a single insurer, we compare across the main private and public providers and tell you which route fits, including when the answer is to stay public. The service is free to you; we receive a regulated commission from the insurer if you sign up.
— Marco
Get a comparison for your own situation
General rules only go so far. Myhealthcarebroker checks your eligibility, compares private and public options side by side and explains the result in clear English, whether you are an employee, a freelancer, a student or moving with a family. We stay with you through the application and afterward.
Start with our free private health insurance quote, or look at the independent comparison to see how we work. If you are still planning your move, our guide for newcomers covers the first 90 days.
Questions people ask
Can I add supplementary insurance if I stay in public health insurance?
Yes. Supplementary policies are separate contracts that sit on top of your public membership. Typical choices are dental cover, hospital extras such as a single room or chief-physician treatment, and daily sickness allowance. Insurers may ask health questions, so apply while you are healthy.
Is private health insurance always better than public with extras?
No. Private cover can offer richer benefits, but premiums depend on your risk profile, family members pay their own premiums and returning to public insurance is restricted. For people with children or an uncertain future in Germany, public insurance with supplementary policies is often the safer fit. The right answer depends on your own numbers.
What is the income threshold for choosing private insurance in 2026?
For employees it is €77,400 per year, or €6,450 per month. You become exempt from compulsory public insurance at year-end if you exceeded the limit and are expected to exceed the next year's limit too. Self-employed people and civil servants follow different rules.
Can I go back to public insurance after switching to private?
Only in limited cases. A job with income below the threshold is the usual route, and for people aged 55 or older the way back can be barred. Think about this before you switch, not after.
Sources
- Wechsel zwischen GKV und PKV, Federal Ministry of Health
- Health insurance, gesund.bund.de
- Beiträge der gesetzlichen Krankenversicherung, Federal Ministry of Health
- Zusatzversicherungen zur gesetzlichen Krankenversicherung, Verbraucherzentrale
- Private Krankenversicherung: Nicht für jeden sinnvoll, Verbraucherzentrale
- Privatversichert in Anstellung, pkv.de
- Pflegebeitrag der Privaten Pflegeversicherung, pkv.de
- Statutory and private health insurance in Germany and Chile, Cambridge University Press