Private health insurance in Germany (PKV) for expats

Employees above the threshold. The threshold is €77,400 in 2026; for 2027 it is €84,150 (expected)[2]. Above it, you can choose. If this is your first job in Germany, you can also join the GKV voluntarily – but you must apply within three months of starting work[3]. If you choose PKV, your employer contributes up to half.

Self-employed and freelancers. You are not automatically in the GKV. Voluntary membership usually requires previous public insurance periods, which many newcomers don't have – so PKV is often the realistic route[3].

Civil servants (Beamte). Your employer (federal or state) covers 50–70 % of your medical costs through Beihilfe; you insure the rest privately with a top-up tariff[4].

Premiums rise over the years. From the start, a statutory 10 % surcharge is added to build old-age provisions. It stops at 60, and from 65 the provisions are used to lower your premium.

The lever is the tariff, not the entry price: we look at how a tariff's premiums have developed over the last 10–15 years[6]. Later, § 204 VVG lets you switch to another tariff with the same insurer without a new health check and without losing your old-age provisions[7].

As an employee under 55, you can only return to the GKV if your gross salary falls below the threshold. From 55 it is practically no longer possible[1]. A good PKV decision gives you decades of solid cover; a poor one ties you to an unstable tariff you can hardly leave. That's why it deserves time.