The Difficult Health Insurance Choice: Public or Private?

It’s one of the first choices you have to make when moving to Germany. By law, all legal residents must have health insurance coverage, and of course, there are a number of other insurances one may need to consider as well.

So, we’ve teamed up with James Meads, British expat and Founder of LiveWorkGermany, to look at the options that are available and to whom.

If you are self-employed, then you automatically have the option of whether to pay into the public health system (gesetzliche Krankenversicherung) or whether to opt out and take a private health insurance policy (Private Krankenversicherung).

Employees don’t automatically have this choice: It depends on how much you earn. In 2025, as an employee, you have to earn over €73,800 gross per annum to have the choice. Anyone earning below this threshold is automatically obliged to go with public insurance.

For employees, you will have to advise your employer during the first month on the job which health insurance you have taken (many expats go with the popular ones – Techniker Krankenkasse, Barmer, AOK, or DAK although you can also use a comparison tool to figure out which one is best for you and your situation) and produce a letter from your provider confirming your monthly bill. This is because regardless of which option you take, your employer is obliged to contribute to your healthcare costs and therefore needs to know how much to deduct or contribute to, your first payslip.

Are you only planning on staying in Germany for a limited number of months/years? You’re going to end up saving a lot more money and getting a lot better coverage with private insurance. Why? Many people don’t take private insurance because it’s difficult to switch back to public insurance when one starts to age. If you’re planning on only staying a few months or a few years in Germany, you don’t need to worry about the price increasing drastically, you can simply just reap the perks of private health insurance for a fraction of the price!

Choosing Public Health Insurance 

If you choose public insurance, this is calculated at 14.6% of your gross monthly salary. Your employer will contribute half of this sum and you will pay the other half, which is deducted directly from your salary and paid to the public insurance company, known in German as Gesetzliche Krankenkasse or GKV. You can figure out which public insurance provider may be best for you by using a comparison tool. Additionally, you have the option to purchase extras that are not covered under the normal policy, e.g. better private care in hospital and dental care, at an additional cost. This is voluntary and as such is not subsidized by the employer.

There are many gesetzliche Krankenkassen, each one with its specific advantages or disadvantages depending on what an individual is specifically looking for. As mentioned above, there are a few that are quite expat-friendly: 

• Techniker Krankenkasse – great for freelancers and English speakers and seems to approve a lot more treatments than other insurance providers 
• Barmer – great for English speakers with an excellent online platform in English
• AOK – popular among internationals of all languages
• DAK – has an English support system and some great travel perks

Don’t let these descriptions sell you on one or the other though, many public insurance providers offer the same packages, with a few tiny perks here and there. At the end of the day, it’ll just depend on how you enjoy interacting with their customer service support.

Going private means that the cost of the policy is determined by many factors about how risky you are perceived to be to insure. It could be considerably cheaper or more expensive than public insurance, depending on your individual circumstances.

Choosing Private Health Insurance

Opting for private insurance (PKV) means that your employer will contribute to your policy. You will receive the employer’s contribution (typically 50% of the monthly policy, with a few exceptions) directly on your payslip as part of your monthly salary. You are then directly responsible for paying for your health insurance costs.

So, if you have the choice available to you, should you go public or private?

While there are a number of different types of health insurance options in Germany, a younger person, single, in good health, with no pre-existing conditions, and with no dependent family members, is better off going private in most cases.

Ottonova is a very popular choice for expats and English speakers as their prices are very attractive and somehow still manage to provide better coverage than some of the top dollar insurance providers. Their services are also entirely in English.

Public insurance, calculated as a percentage of their income, would almost definitely be more expensive. This applies to both freelancers and employees. The only difference is employees don’t automatically have the choice.

If that same person were somewhat older, married with kids, and resided in Germany permanently, then a whole new set of factors come into play. A private health insurance company would consider them to be a higher risk. They also have kids who have to be insured on the policy. And they can’t just easily jump on a plane home if the costs become unaffordable in the same way that a single person could. In this case, public insurance would probably make more sense.

You cannot simply opt into the public system when a private insurance company jacks up the cost of the insurance policy. Otherwise, everyone smart enough would do it. There is a grace period but then after that, you can’t opt back in.

Since 2013, EU law states that insurers may not discriminate between male and female insurance policies. Therefore the two examples I used above are not gender-specific.