System Explorer

The Contribution Model

GKV follows a solidarity principle: everyone pays based on their income, regardless of health status. Your contribution is a fixed percentage of your gross salary.

• General rate: 14.6% of gross salary (split 50/50 between employer and employee)
• Additional rate (Zusatzbeitrag): varies by insurer (approx. 2.2%–4.4% in 2026), also split 50/50
• Assessment ceiling (Beitragsbemessungsgrenze): €5,812.50/month — contributions are capped at this income level
• Earning more than the ceiling? Your contribution stays the same — you pay the maximum rate

What GKV Covers

All GKV insurers must provide a standardized benefits package defined by law (SGB V). This includes doctor visits, hospital stays, prescriptions, and basic dental. There is no difference in medical benefits between GKV providers — only price and bonus programs differ.

Key Advantage

Free family coverage (Familienversicherung): Non-working spouses and children can be covered at no additional cost, provided certain income conditions are met. If the privately insured parent earns more than the GKV-insured parent and their income exceeds the JAEG threshold, children may need separate insurance.

Key Disadvantage

Higher earners pay more for the same coverage: If you earn €6,000/month, you pay roughly €640/month (employee share) for the same benefits as someone earning €3,000/month who pays ~€335.

The Premium Model

PKV premiums are income-independent. Your premium depends on three factors:

• Entry age — younger entry = lower lifetime premium
• Health status — pre-existing conditions may lead to surcharges or exclusions
• Tariff level — you choose your coverage level and deductible

A 32-year-old in good health pays the same premium whether they earn €5,000 or €15,000 per month.

Aging Reserves (Alterungsrückstellungen)

A portion of every PKV premium goes into Alterungsrückstellungen — a legally required savings reserve that cushions premium increases in old age. This is not a marketing feature; it's a regulated mechanism mandated by law (VAG / Kalkulationsverordnung).

What PKV Covers

Coverage depends on your tariff, but high-quality PKV typically includes: private hospital rooms, senior physician treatment, full dental (including implants), direct specialist access (no GP referral needed), and worldwide emergency coverage.

Key Advantage

Premium-quality medicine at lower cost for high earners: A healthy 32-year-old earning €6,000/month may pay €328/month (mid-tier, after employer subsidy) vs €642 in GKV — while receiving significantly better coverage.

Eligibility Rules (2026)

• Employed persons: Annual gross salary must be projected to exceed the Jahresarbeitsentgeltgrenze (JAEG) of €77,400/year (€6,450/month). For existing employees, this takes effect on January 1 of the following year
• Self-employed: Can freely choose PKV regardless of income — no threshold required
• Civil servants (Beamte): Receive Beihilfe (government subsidy) and typically use PKV
• Students: Can opt out of GKV at enrollment and choose PKV
• Not eligible: Employees below the JAEG threshold, retirees in mandatory GKV, persons over 55 who haven't been privately insured

The Opt-Out Window

Once you become versicherungsfrei (insurance-exempt) because your projected income exceeds the JAEG, you have a 3-month window to actively opt out of GKV and switch to PKV. If you don't act within this period, you remain voluntarily insured in GKV by default.

In GKV

Your employer pays exactly 50% of your total health insurance contribution (general rate + additional rate), plus 50% of long-term care insurance (excluding the childless surcharge). This is automatic and mandatory.

In PKV

Your employer pays 50% of your PKV premium, but capped at the maximum GKV employer share. In practice:

• Arbeitgeberzuschuss (AG-Zuschuss) = min(50% of PKV premium, max GKV employer share)
• The 2026 maximum employer share for health + LTC is approximately €613/month (health ~€509 + LTC ~€105)
• If your PKV premium is €656/month: employer pays 50% = €328 (below cap → full 50%)
• If your PKV premium is €1,400/month: employer pays €613 (the cap), not €700

Key Insight

For typical PKV premiums (€500–€750 range), the employer pays the full 50%. The cap only becomes relevant for very expensive tariffs or older entrants with high premiums.

GKV in Retirement (KVdR)

If you retire in GKV, you enter the Krankenversicherung der Rentner (KVdR). Your contributions are based on your pension income at a reduced rate. The pension provider (Deutsche Rentenversicherung) pays half of your health insurance contribution — similar to the employer's share during employment.

PKV in Retirement

• Your premium continues — but the 10% statutory surcharge is no longer charged from age 60, and the accumulated reserves begin to fund premium stabilization
• Aging reserves (Alterungsrückstellungen) accumulated over decades cushion premium increases
• You no longer have an employer subsidy — but you may receive a Zuschuss from Deutsche Rentenversicherung
• You can switch to a Basistarif (basic tariff) with GKV-equivalent benefits if needed

What This Means in Practice

PKV premiums in retirement are often lower than people fear — because the 10% surcharge has built additional reserves, and the Alterungsrückstellungen actively moderate cost increases. Good financial planning during working years (20–30 years of building reserves) ensures manageable premiums in old age.

Insurance Types

• GKV — Gesetzliche Krankenversicherung: statutory (public) health insurance
• PKV — Private Krankenversicherung: private health insurance
• PPV — Pflegepflichtversicherung: mandatory long-term care insurance
• KVdR — Krankenversicherung der Rentner: health insurance for retirees

Contribution Terms

• Beitragsbemessungsgrenze (BBG) — Assessment ceiling: maximum income used for calculating GKV contributions (€5,812.50/month in 2026)
• Jahresarbeitsentgeltgrenze (JAEG) — Annual earnings threshold: minimum income to opt out of mandatory GKV (€77,400/year in 2026)
• Zusatzbeitrag — Additional contribution: insurer-specific rate charged on top of the general 14.6%
• Arbeitgeberzuschuss — Employer subsidy: employer's share of your health insurance cost

PKV-Specific Terms

• Alterungsrückstellungen — Aging reserves: mandatory savings that cushion premium increases with age
• Selbstbeteiligung (SB) — Deductible: annual amount you pay before insurance covers costs
• Gesetzlicher Zuschlag (10%) — Statutory surcharge: required extra charge until age 60, builds additional reserves
• Krankentagegeld (KT) — Sick pay coverage: replaces income after 6 weeks of illness
• Beitragsrückerstattung (BRE) — Premium refund: money back for claim-free years
• Anwartschaft — Dormancy option: preserves your health status when pausing PKV (e.g., moving abroad)
• Basistarif — Basic tariff: PKV tariff with GKV-equivalent benefits at capped premiums (safety net)