Private health insurance — honestly calculated
Private cover (PKV) can cost less than the statutory system and deliver more at the same time. It can also become the most expensive decision of your life. Which of the two applies to you can be worked out — and that is exactly what we do before anything is signed.
Two questions, not one
Debate about PKV versus GKV almost always fixates on the premium. That is too narrow. There are two separate questions, and they can point in different directions.
1. The premium
In the statutory system your contribution follows your income. In the private system it follows entry age, health status and the cover you choose — income is irrelevant.
For well-paid, healthy people without dependants to insure, that comparison often favours the PKV. For single-earner families it usually reverses.
2. The cover
Statutory benefits are defined by law and broadly identical across funds. Private cover is defined in your contract — and is therefore contractually guaranteed.
Typical differences: free choice of specialist, markedly shorter waiting times for appointments, higher reimbursement for dental work, glasses and therapies.
Would private cover suit you? A quick check
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The check needs JavaScript. Alternatively we go through the questions in an initial call.
Private cover is not open to you at the moment
As an employee you may only switch once your gross income exceeds the compulsory insurance threshold of €77,400 a year (2026 figure). That is not an assessment but a statutory precondition.
The sensible route for you: targeted supplementary cover, above all dental and hospital options. It closes the most expensive gaps for a fraction of the cost and stays cancellable at any time.
Several things speak in favour
Yours is the kind of situation where a detailed comparison usually pays off. Whether it fits in the end depends on the specific tariff and your health assessment — that can only be settled with your real data.
It depends on the details
Points in your situation pull in both directions. That does not mean “no” — it means the calculation genuinely has to be done rather than estimated.
It rather speaks against
On these answers I would tend to advise against switching. I would rather tell you that here than after you have signed.
Worth examining instead: targeted supplementary cover — considerably cheaper, cancellable at any time and without the one-way street.
What shaped your result
- As a civil servant you receive Beihilfe. Private cover complements it and is almost always the cheaper solution in this constellation.
- As a self-employed person, private cover is open to you regardless of income.
- Your income is above the compulsory insurance threshold — switching is permitted.
- You have nobody to insure free of charge. This is exactly where the private system's price advantage sits.
- Your entry age is low. That lowers the premium permanently and lengthens the period for building ageing reserves.
- With one earner, every person pays their own premium privately. In the statutory system your partner would be covered at no extra cost.
- Children are covered free in the statutory system. Privately, each child costs its own premium.
- With concrete plans for children, the cost advantage often flips with the first one.
- An undecided family plan is a genuine risk in this calculation — the decision runs for decades.
- At your age the entry premium is higher and the period for building ageing reserves shorter.
- From 55 the route back into the statutory system is effectively closed. This decision would be final.
- Pre-existing conditions lead to surcharges, exclusions or rejection.
Orientation, not advice. This check does not replace an examination of your specific situation — in particular not the health assessment, on which acceptance and premium largely depend. Nobody can responsibly quote you a premium before those questions are settled.
Where the PKV is genuinely better
- Cover is contractually guaranteed. What your policy says cannot be removed by a change in the law.
- Shorter waiting times. The difference you notice most in everyday life.
- Dental work. Between the statutory fixed subsidy and good private reimbursement there are quickly four-figure sums.
- Premium refunds. Submit no claims for a year and many tariffs return several monthly premiums.
- Hospital options. Single or twin rooms and treatment by the senior consultant can be insured.
Where the PKV is the worse choice
No salesperson will tell you this, but it belongs on the table. In these situations I regularly advise against switching:
- Single-earner families. The statutory system covers a non-earning spouse and children at no extra cost. Privately, every person pays their own premium — which often reverses the price advantage entirely.
- Uncertain income. Your private premium stays the same even if your income falls. The statutory contribution falls with it.
- Pre-existing conditions. They lead to surcharges, exclusions or rejection. The statutory system takes everyone at the same rate.
- Premiums in old age. Ageing reserves dampen the rise but do not prevent it. If your retirement income will be tight, that matters.
- Going back is hard. From age 55 the route back into the statutory system is effectively closed. This decision spans decades.
If one of these applies to you, I will say so in the first call — even though I earn nothing from that. Anything else would also be a breach of my duty as a broker.
Already privately insured?
Then changing insurer is rarely the answer — your ageing reserves stay largely with the old company. The stronger lever sits inside your existing insurer. A tariff switch under § 204 VVG is your statutory right: it preserves your reserves in full and requires no new health assessment as long as cover does not increase.
Many people pay an outdated, expensive tariff for years while a modern one with equal or better cover exists in the same company. That is what I check for you.
The full background is in the guide article on private versus statutory health insurance.
PKV and GKV compared
Who is even allowed to take private health insurance?
Employees whose gross income exceeds the annual threshold (Jahresarbeitsentgeltgrenze), plus self-employed people and freelancers regardless of income, civil servants, and students under certain conditions. The threshold is €77,400 gross per year in 2026 and is adjusted annually.
Do private premiums rise sharply in old age?
They rise — that is not in dispute. The cause is medical progress and general healthcare cost inflation, not your personal age. The increase is dampened by ageing reserves you build up over the years and by the statutory surcharge that relieves premiums from age 65.
Serious advice plans for that rise instead of hiding it. If you could not carry the premium in retirement, you do not belong in the PKV.
What happens to my family?
There is no free family cover in the private system. Every person needs their own contract and premium. For employees the employer contributes to dependants' premiums within the statutory allowance.
Can I return to the statutory system later?
Until age 55 a return is possible under certain conditions — for instance if your income drops below the compulsory insurance threshold or you move into employment. From 55 the route is largely closed.
I am on a temporary contract or may leave Germany. Does that matter?
A great deal. Private cover is designed for the long term; ageing reserves only pay off over time. If your stay in Germany is open-ended or short, that argues strongly for staying statutory and adding supplementary cover instead.
Let's work through your case
With your real numbers — income, family situation, health. Free and non-binding. Even if the answer is: stay where you are.