German Health Insurance Explained: Krankenkasse, Costs and the German You Need
German health insurance is compulsory for everyone who lives in Germany. Most people are in the statutory system (gesetzliche Krankenversicherung, GKV) with a Krankenkasse. In 2026 it costs 14.6% of gross pay plus a fund-specific extra (average 2.9%), shared half and half with your employer. Employees earning over 77,400 euros a year may switch to private insurance (PKV).
This article is general information for newcomers, not financial or legal advice. Your Krankenkasse or an independent advice service can check your own case.
Two systems: GKV and PKV
Germany runs two parallel systems; as a new employee, your income decides which one you are in.
| Statutory (GKV) | Private (PKV) | |
|---|---|---|
| German name | gesetzliche Krankenversicherung, your Krankenkasse | private Krankenversicherung |
| Who is in it | most employees, trainees (Azubis), students, people on unemployment benefit, pensioners | employees above the income threshold who choose it, many self-employed people, civil servants (Beamte) |
| Price based on | your income (a percentage) | your age, health and chosen tariff |
| Family | children and a spouse with little or no income can be insured free (Familienversicherung) | every person needs their own contract |
| Doctor bill | the practice bills the Krankenkasse directly; you show your card | you often get the bill (Rechnung) and claim the money back |
Who must be in which system (Versicherungspflichtgrenze 2026)
The key number is the Versicherungspflichtgrenze (also called Jahresarbeitsentgeltgrenze). In 2026 it is 77,400 euros gross per year. Below it, employees are compulsorily insured in the GKV. Above it, you may stay in the GKV as a voluntary member (freiwillig versichert) or move to a private insurer.
A second number matters for your payslip: the Beitragsbemessungsgrenze, 5,812.50 euros per month in 2026. Contributions are only calculated on income up to this ceiling, so the GKV contribution has a maximum.
From 2027, the GKV savings law (GKV-Beitragssatzstabilisierungsgesetz, passed by Bundestag and Bundesrat on 10 July 2026) raises both limits by an extra 3,600 euros a year on top of the normal adjustment. Check the final 2027 figures in December.
Self-employed people can usually choose, but must be insured somewhere.
How much is German health insurance per month?
In the GKV you pay a percentage of your gross income:
| Part | 2026 rate | Who pays |
|---|---|---|
| General rate (allgemeiner Beitragssatz) | 14.6% | half you, half your employer |
| Extra contribution (Zusatzbeitrag) | average 2.9%, each Krankenkasse sets its own | half you, half your employer |
Example with the average rate: you earn 3,000 euros gross a month. 14.6% + 2.9% = 17.5%, which is 525 euros. You pay half: 262.50 euros. Your employer pays the other 262.50 euros. It is deducted from your salary automatically. Our guide to the German payslip explains the other lines, including long-term care insurance (Pflegeversicherung), which is a separate contribution.
Maximum: because of the ceiling of 5,812.50 euros, an employee in a fund with the average extra rate pays at most about 508.59 euros a month for health insurance in 2026, however high the salary.
Voluntary members without an employer pay the full amount themselves; private insurers quote a premium based on age, health and tariff.
Familienversicherung: free cover for family members
In the GKV, children and a spouse or registered partner can be insured free of charge through your membership, if their own income stays below a limit. In 2026 the limit is 565 euros a month, or 603 euros for income from a minijob.
The same law restricts free cover for spouses from 2028: members will pay a surcharge of 2.5% of their contributory income for a co-insured spouse or partner, unless an exception applies (for example, the spouse is raising children under 12 at home or caring for a relative). Children stay free. If this affects you, ask your Krankenkasse in 2027.
Is healthcare 100% free in Germany?
No, but most of it is free at the point of use. When you see a GKV doctor, you show your card and pay nothing for the visit. You pay small co-payments (Zuzahlungen) for some things. These are the amounts valid in 2026, and the higher amounts already set by the July 2026 savings law:
| Service | Co-payment 2026 | From 1 January 2027 |
|---|---|---|
| Prescription medicine (Rezept) | 10% of the price, minimum 5, maximum 10 euros | minimum 7.50, maximum 15 euros |
| Hospital stay | 10 euros per day, max. 28 days a year | 15 euros per day |
| Physiotherapy and other therapies (Heilmittel) | 10% of the cost + 10 euros per prescription | 10% + 15 euros per prescription |
You never pay more than the medicine itself costs. There is also a yearly cap (Belastungsgrenze): 2% of your household’s gross yearly income, or 1% for people with a serious chronic illness. Once you reach it, your Krankenkasse can exempt you for the rest of the year, so keep your pharmacy receipts. At the pharmacy, the co-payment is what you pay at the counter; the phrases are in our post on German at the pharmacy.
Not or only partly covered: many dental treatments, glasses for most adults, and IGeL services that the practice offers for a fee.
Public or private: which is better in Germany?
There is no single answer, and anyone selling you a contract has an interest:
- GKV is usually the safer default if you have a family, a modest or changing income, or you plan to stay long-term. The cost follows your income, and family members can be included.
- PKV can be cheaper when you are young and healthy and earn above the threshold, and some private tariffs offer faster appointments or a single room in hospital. But premiums depend on age and health and can rise over the years, and each family member needs a contract.
- Going back is hard. Once you are private, returning to the GKV is restricted, and from age 55 the rules become much stricter. Treat the switch as a long-term decision.
How to choose a Krankenkasse
All statutory funds must cover the same legal basic benefits. They differ in:
- The Zusatzbeitrag. The GKV-Spitzenverband publishes a list of all funds and their extra rates. A difference of 0.5 points on a 3,000-euro salary is 7.50 euros a month for you.
- Extra benefits (Satzungsleistungen): for example, extra check-ups, travel vaccinations or bonus programmes.
- Service: an app, English-language support, local offices.
- Region: some funds only operate in certain federal states.
Tell your employer which fund you chose; the employer registers you. After a switch you are normally bound to the new fund for 12 months. If your fund raises its Zusatzbeitrag, you can switch earlier. Since late July 2026, funds no longer have to write to you about an increase (parliament is discussing bringing this duty back), so check your rate every January.
Austria and Switzerland have their own systems.
Practise your German out loud with SipLingo, free to try on iPhone and Android:
Your Gesundheitskarte
After you join, the Krankenkasse sends you the elektronische Gesundheitskarte (eGK) with your Versichertennummer (insurance number). Bring it to every doctor and dentist; without it, the practice may bill you privately, so while you wait for the card, ask the fund for a temporary confirmation. Our guide on how to find a Hausarzt explains the first doctor visit. In a medical emergency, call 112 first; insurance questions can wait.
Vocabulary: German health insurance words
| German | English |
|---|---|
| die Krankenkasse | statutory health insurance fund |
| die Krankenversicherung | health insurance |
| gesetzlich / privat versichert | statutory / privately insured |
| der Beitrag, der Zusatzbeitrag | contribution, extra contribution |
| die Versicherungspflichtgrenze | income threshold for compulsory insurance |
| die Familienversicherung | free family cover |
| die Zuzahlung | co-payment |
| die Befreiung | exemption |
| die Gesundheitskarte | health insurance card |
| die Versichertennummer | insurance number |
| die Mitgliedsbescheinigung | membership certificate |
| die Adressänderung | change of address |
| der Antrag | application |
Calling your Krankenkasse: phrases
The three most common reasons to call are a membership certificate (Mitgliedsbescheinigung) for your employer or university, a new address, and a problem with the card.
- Guten Tag, mein Name ist Ana Ruiz. Meine Versichertennummer ist A123456789. Hello, my name is Ana Ruiz. My insurance number is A123456789.
- Ich brauche eine Mitgliedsbescheinigung für meinen Arbeitgeber. I need a membership certificate for my employer.
- Ich bin umgezogen und möchte meine Adresse ändern. I have moved and would like to change my address.
- Meine Gesundheitskarte ist noch nicht angekommen. My health insurance card has not arrived yet.
- Können Sie mir eine Ersatzbescheinigung schicken? Can you send me a replacement confirmation?
Model phone call
Krankenkasse: Guten Tag, Sie sprechen mit Herrn Becker. Was kann ich für Sie tun?
Sie: Guten Tag, mein Name ist Ana Ruiz. Ich brauche eine Mitgliedsbescheinigung für meinen neuen Arbeitgeber.
Krankenkasse: Gern. Wie ist Ihre Versichertennummer?
Sie: A123456789.
Krankenkasse: Und Ihr Geburtsdatum, bitte?
Sie: Der 4. März 1995.
Krankenkasse: Danke. Soll ich Ihnen die Bescheinigung per Post schicken oder ins Online-Postfach stellen?
Sie: Ins Online-Postfach, bitte. Dann kann ich sie sofort weiterleiten.
Krankenkasse: In Ordnung, Sie finden sie heute noch dort.
Translation: Hello, this is Mr Becker, how can I help? / Hello, my name is Ana Ruiz. I need a membership certificate for my new employer. / Of course. Your insurance number? / A123456789. / And your date of birth? / 4 March 1995. / Thanks. Shall I post the certificate or put it in your online mailbox? / The online mailbox, please, then I can forward it right away. / Fine, it will be there today.
The clerk speaks fast and asks for numbers. SipLingo lets you rehearse everyday calls and office conversations by voice and corrects your grammar and word order in your own language, so the dates and numbers come out right. Practise the call for free.
For more help with numbers and dates on the phone, see making a phone appointment in German.
Email template: address change and certificate
Betreff: Adressänderung und Mitgliedsbescheinigung – Versichertennummer A123456789
Sehr geehrte Damen und Herren,
ich bin am 1. Oktober 2026 umgezogen. Meine neue Adresse lautet:
Lindenstraße 12, 10115 Berlin.Bitte ändern Sie meine Adresse in Ihren Unterlagen. Außerdem bitte ich Sie um eine aktuelle Mitgliedsbescheinigung für meinen Arbeitgeber.
Vielen Dank im Voraus.
Mit freundlichen Grüßen
Ana Ruiz
Geburtsdatum: 04.03.1995
Translation: Subject: Change of address and membership certificate – insurance number A123456789. Dear Sir or Madam, I moved on 1 October 2026. My new address is Lindenstraße 12, 10115 Berlin. Please update my address in your records. I would also like a current membership certificate for my employer. Thank you in advance. Kind regards, Ana Ruiz, date of birth 04.03.1995.
Checked in October 2026 against the Federal Ministry of Health (contribution rates, thresholds, co-payment rules, the July 2026 savings law), the Bundesrat decision of 10 July 2026, Techniker Krankenkasse (family insurance limits and the 2027 reform summary) and the betanet guide to switching funds.
Related guides: German at the doctor: what to say · urgent doctor in Germany: 112 or 116117
Official sources
For the official details and the latest updates, see:
- Federal Ministry of Health (BMG): Statutory health insurance (SHI) explained – How SHI works: income-based contributions, family cover, compulsory insurance
- Make it in Germany (Federal Government): Health insurance for newcomers – Statutory vs private insurance, family cover, health card
Frequently asked questions
Can you explain the German health insurance system?
Everyone living in Germany must have health insurance. Most people are in the statutory system (GKV), paid as a share of income; some high earners, many self-employed people and civil servants are privately insured (PKV).
How much is German health insurance per month?
In the GKV you pay about half of 14.6% plus your fund’s extra contribution (average 2.9% in 2026). On a 3,000-euro gross salary that is about 262.50 euros a month for you; your employer pays the same.
Is healthcare 100% free in Germany?
Doctor visits with your Gesundheitskarte cost nothing, but there are co-payments, for example 5 to 10 euros per prescription and 10 euros per hospital day in 2026 (higher from 2027). A yearly cap of 2% of income (1% for the chronically ill) applies.
Which health insurance is better in Germany, public or private?
It depends on income, age, health and family. Public insurance is the usual choice for families and average incomes; private can be cheaper for young, healthy high earners, but returning to public insurance later is difficult.
What German do I need to call my Krankenkasse (Krankenkasse anrufen)?
Have your Versichertennummer ready and learn a few key sentences: Ich brauche eine Mitgliedsbescheinigung, Ich bin umgezogen, Meine Gesundheitskarte ist noch nicht angekommen. Ask Können Sie das bitte wiederholen? if they speak too fast.
Get confident on the phone with your Krankenkasse. SipLingo lets you practise real-life German calls by voice, with instant corrections in your own language.
