This article was translated from the original human-written German version. While we strive for accuracy, we cannot guarantee it is error-free. We recommend consulting the German original for the most precise information. This content is for informational purposes only and does not constitute financial or legal advice. Always consult with a qualified professional before making insurance or financial decisions.
Private Health Insurance (PKV): Who can be insured and what are the requirements?
Introduction
The German health insurance system is characterized by two pillars: statutory health insurance (GKV) and private health insurance (PKV). While GKV is the norm for most citizens, PKV is only open to a specific group of people. This article examines the criteria for so-called exemption from insurance, which allows switching to PKV, and provides an overview of the relevant income limits and professional requirements.
1. Basics: Solidarity, Equivalence, and the Annual Income Threshold
Every citizen in Germany is subject to compulsory health insurance. The type of insurance depends on various factors.
Statutory Health Insurance (GKV): It is based on the solidarity principle (income-dependent contributions, needs-oriented benefits) and is the legally stipulated path for the majority of the population, especially for employees below a certain income limit. One feature is the contribution-free family insurance.
Private Health Insurance (PKV): It functions according to the equivalence principle (risk-based contributions, contractually agreed benefits). Admission to PKV generally requires exemption from insurance, meaning not being subject to compulsory insurance in the GKV.
The key figure for employees is the Annual Income Threshold (JAEG), also known as the compulsory insurance threshold. It determines from which gross income the GKV obligation ends.
General JAEG 2025: €73,800 annually (€6,150 monthly).
Special JAEG 2025: €66,600 annually. This lower limit applies to employees who were already privately insured on December 31, 2002.
2. In-depth: Requirements and Switching Options in Detail
The option to take out private insurance is subject to specific criteria.
Employees
For employees, exceeding the JAEG is the primary requirement.
With a salary increase: The GKV obligation ends at the end of the calendar year in which the JAEG is exceeded, provided that the salary also exceeds the limit for the following year. A switch is then possible on January 1st.
With a job change or career entry: If the new salary is above the JAEG from the start, you are immediately exempt from insurance and have the option to enter PKV.
Self-employed and freelancers
These professional groups are generally exempt from insurance and can opt for PKV from the beginning of their professional activity.
Civil servants, judges, and soldiers
These groups are also exempt from insurance. Due to the 'Beihilfe' (a subsidy from the employer towards health costs), PKV is often a financially suitable solution for them, as only the remaining costs need to be insured.
Students
Upon enrollment, the compulsory insurance in the student GKV (KVdS) typically begins. However, students can irrevocably opt out of this for the duration of their studies within three months of this obligation beginning, in order to take out private insurance.
Children and Families
GKV family insurance: Children can be co-insured free of charge under certain conditions. This is excluded if the PKV-insured parent earns more than the GKV-insured parent and their income is above the JAEG.
PKV for children: In PKV, each family member requires their own contract. However, newborns have a statutory right to be accepted without a health check under the tariff of a parent (child insurance). Contributions for children are significantly cheaper than for adults.
Health check
GKV must accept every applicant. PKV, on the other hand, conducts a health check and may reject applications or impose risk surcharges for pre-existing conditions.
System change
Returning from PKV to GKV is only possible under certain conditions (e.g., income dropping below the JAEG) and generally only up to the age of 55. When switching, the accumulated pension reserves are largely lost. However, within PKV, there is a legal right to switch tariffs.
3. Recommendations for Action
The decision for or against PKV depends on the individual situation.
Check your status: Determine whether you meet the requirements for exemption from insurance (income above JAEG, professional status).
Consider family planning: Compare the costs of contribution-free GKV family insurance with the model of individual contributions in PKV.
Consider your health: Take into account the health check as a potential hurdle for PKV access.
Think long-term: The decision is often a long-term one. Inform yourself about the different mechanisms for contribution development in old age (pay-as-you-go vs. funded).
4. Summary
The option to take out private insurance is not open to everyone in Germany. For employees, the Annual Income Threshold (JAEG) is the decisive threshold, while the self-employed and civil servants generally have a choice. The decision is linked to individual circumstances such as income, professional status, and health, and has far-reaching consequences for contribution structuring and family coverage.