Private Health Insurance in Germany (PKV) — Complete Expat Guide 2026

Germany has two parallel health insurance systems: GKV (gesetzliche Krankenversicherung, public insurance) and PKV (private Krankenversicherung, private insurance). Most people default into GKV automatically. But if you earn above a certain threshold or are self-employed, private insurance can offer better coverage at a significantly lower cost.

This guide covers everything an expat needs to know about PKV in 2026: the eligibility rules, how premiums work, what you actually get for your money, and how to find the right plan.

What is PKV (Private Health Insurance)?

PKV stands for private Krankenversicherung, Germany's private health insurance system. Unlike GKV, which is a statutory scheme administered by non-profit funds (Krankenkassen), PKV is provided by private insurance companies that compete on price, coverage, and service.

In PKV, your premium is calculated based on your age at entry, your health status, and the level of coverage you choose. It does not scale with your income. This is the fundamental difference from GKV, where contributions are a fixed percentage of your salary.

PKV typically offers: access to senior doctors (Chefarzt) rather than general ward doctors, private or semi-private hospital rooms, shorter waiting times for specialist appointments, broader dental coverage, and alternative medicine options. In exchange, you pay a predictable monthly premium that stays roughly fixed (with annual adjustments for medical cost inflation).

GKV vs PKV: Quick Comparison

Who Qualifies for PKV?

The main eligibility criterion for employees is the Jahresarbeitsentgeltgrenze (JAEG), commonly called the Versicherungspflichtgrenze. For 2026, this threshold is €77,400 gross annual income.

Employees who earn above this threshold for the current calendar year can opt out of GKV and choose PKV. There is an additional rule: you must have exceeded the threshold for the previous year as well (or be starting a new job above the threshold). This prevents people from briefly spiking their income to switch.

Three groups can always choose PKV regardless of income:

• Self-employed and freelancers: Anyone who is genuinely self-employed (gewerblich or freiberuflich) can choose PKV from day one, at any income level.
• Civil servants (Beamte): Entitled to Beihilfe (government subsidy covering 50-80% of medical costs), meaning PKV covers only the remainder at a reduced premium.
• Students: Can choose student PKV tariffs, though GKV student rates are often cheaper under age 25.

Full details: Who qualifies for PKV in Germany.

How PKV Works

Once insured with a private provider, you receive an insurance card (Versicherungskarte) or carry a paper certificate. When you visit a doctor, you are billed directly as a private patient. You pay the invoice, then submit it to your insurer for reimbursement, typically within two to three weeks. Some insurers offer direct billing with certain hospital groups.

Most plans include an annual deductible (Selbstbehalt), which you can set voluntarily to reduce your monthly premium. Common options range from €300 to €2,000 per year. If you claim nothing in a given year, many insurers refund one to three months of premiums, creating an incentive to cover minor costs yourself.

PKV plans are modular. You choose:

• Outpatient coverage level (e.g. 100% reimbursement vs 80%)
• Hospital coverage (private room, choice of doctor)
• Dental (routine vs full prosthetics)
• Supplementary riders (alternative medicine, glasses, daily sickness allowance)

What PKV Costs: Example Premiums 2026

PKV premiums vary significantly by age, health status, and plan level. The table below shows approximate monthly premiums for a healthy, non-smoking employee with no pre-existing conditions. These are indicative ranges; actual quotes depend on the insurer and your specific health history.

For self-employed people, there is no employer contribution, so you pay the full premium. However, even at full cost, PKV is often cheaper than GKV for freelancers, because GKV charges 14.6% + a supplementary rate (typically 1.5-2%) on your entire income with no employer sharing it.

Full breakdown: PKV costs and contributions in 2026.

Top PKV Providers for Expats

Germany has around 40 private health insurers. For expats, the most important factors are: English-speaking customer service, competitive rates, financial stability, and straightforward claims handling. The following are the most commonly recommended providers.

See all reviews: Top 10 PKV insurers for expats.

How to Apply for PKV

1. Check your eligibility: Confirm your income exceeds €77,400 or that you are self-employed. Use our eligibility quiz for a quick check.
2. Choose a broker: Working with a licensed §34d broker is strongly recommended. They have access to all insurers, compare quotes for your specific situation, and assist with the health questionnaire. This service is free to you.
3. Complete the health questionnaire: Every PKV application includes questions about pre-existing conditions. Answer honestly: non-disclosure can void your coverage. Minor conditions may lead to exclusions or small surcharges rather than outright rejection.
4. Compare quotes: Your broker will present options across multiple insurers. Compare not just the monthly premium but the coverage details, the insurer's track record on claims, and historical premium increases.
5. Apply and notify GKV: Once you have signed the PKV contract, notify your current GKV fund. Employees must give at least two months' notice, effective at end of month. If switching in the new year, notify by October 31.
6. Coverage begins: Your PKV coverage starts on the agreed date, typically January 1 if switching at year-end.

Ready to find out if PKV is right for you? Start with our 2-minute eligibility quiz or speak with a licensed broker who can compare your specific options.