GKV vs PKV — Choosing healthcare in Germany

€77,400 is the number that decides whether you have a decision at all. Below that regular gross salary an employee is in the statutory system by law, and no private tariff is available, however good the offer looked in the comparison portal. Above it, compulsory cover ends and the choice opens, in practice from the following January. It opens at the worst possible moment for the statutory side, because the Versicherungspflichtgrenze sits above the €69,750 Beitragsbemessungsgrenze. Everyone who is allowed to choose is already paying the maximum statutory contribution: €509 a month.

That single detail reframes the whole comparison. This is not a cheap public option standing next to an expensive private one. For the people who actually get the choice, the statutory contribution is at its ceiling from day one, which is exactly why a private premium looks attractive at 30 and frightening at 67.

Most German employees never face the question. On €45,000 of gross pay you are in the GKV by law, and the sensible moves are a cheaper Kasse and a dental top-up rather than a change of system. The decision belongs to four groups: the self-employed, who clear no threshold at all; Beamte; employees who just crossed the line; and anyone married to one of them.

The statutory contribution is capped, and that cuts both ways

The employee's share is 8.75% of gross pay: half of the 14.6% base rate plus half of the 2.9% average Zusatzbeitrag that the Bundesgesundheitsministerium set for 2026. Contributions stop at the Beitragsbemessungsgrenze of €5,812.50 a month, which puts the maximum at €509 and holds it there whether you earn €80,000 or €200,000.

For a high earner that is the best-value product in the German welfare state. Age, health and medical history never enter the calculation, and a bad year on the markets changes nothing. For the same person at 40, a private insurer will still undercut it. That is the trade on offer: a discount now, in exchange for a price you do not control later.

The cap runs the other way too, and this is the part that matters more. If the salary falls to €25,000, the contribution falls to roughly €182 a month. Nobody with a private tariff gets that phone call.

The private premium only moves in one direction

A PKV tariff is priced on your age and health at entry, then adjusted upward as the insured collective ages and treatment costs rise. Insurers do build an Alterungsrückstellung into every premium, and it is the reason a 70-year-old does not pay five times what a 30-year-old pays. It is not enough to hold the premium flat, and it is not a pot you can draw on: the reserve stays with the insurer, portable to another private insurer only within limits.

Read the shape rather than the endpoint. The private route is genuinely cheaper at the start: €420 against €509 is €89 a month, or €10,680 across the first decade. It becomes €51 a month more expensive in the forties, €231 more expensive in the fifties, and €441 more expensive between 60 and 67. Add those four numbers together and the private path costs €60,204 more over 37 years, having saved you real money for the first ten of them.

Retirement is where the two paths separate

The statutory contribution follows the pension. A €2,000 monthly pension in the Krankenversicherung der Rentner means the pensioner pays half of the 17.5% rate, which is €175, with the Rentenversicherung paying the other half. The private premium is €980 that year and stays there.

Two private policies at €1,960 a month come to 98% of a €2,000 pension. Nobody plans for that outcome. It is what happens when a couple insures privately, one partner never earns, and both reach 67 on a single pension.

Long-term care is separate in both systems and is left out of every figure here. It shifts the comparison by tens of euros a month, not by hundreds.

The routes back exist, and every one of them is narrow. Falling below the Versicherungspflichtgrenze restores compulsory statutory cover, and so does taking up insurable employment or claiming Arbeitslosengeld. After 55 that door closes for good, even in the cases that would otherwise qualify. The Basistarif guarantees that a private insurer cannot simply drop you, but its premium is capped at the statutory maximum contribution, a little over €1,000 a month in 2026. That is a guarantee of access, not of affordability.