Basics
GKV — plainly explained.
Who must join, how contributions are calculated, and what you get. A concise introduction to Germany’s statutory health insurance (GKV).
What is the GKV?
Germany’s statutory health insurance (GKV) covers about 73 million people and runs on the solidarity principle: higher earners pay more, but everyone receives the same legally defined care. Benefits are codified in the Social Code Book V (SGB V) — preventive check-ups, hospital treatment, prescriptions, rehab, and more. Unlike private insurance (PKV), there is no medical underwriting and no exclusion of pre-existing conditions; every fund must accept every applicant.
The GKV is run by 73 competing funds of various legal forms — from regional AOKs and substitute funds (TK, BARMER) to company, guild and agricultural funds. Despite this diversity the benefit catalogue is around 95 % identical: virtually every medically necessary treatment is covered, and the differences between funds lie mainly in bonus programs, optional tariffs, service quality and supplementary services such as osteopathy or extended preventive care.
The system is financed through paritetic contributions: employer and employee pay half each, and a federal subsidy of currently €14.5 billion covers non-insurance benefits like free family coverage. Unlike many other countries there are neither co-payments at routine doctor visits nor waiting lists for standard treatments — making Germany one of the most densely supplied healthcare systems in the world.
History and principles
Germany’s social insurance system has roughly 140 years of history: Bismarck introduced the first compulsory health insurance for workers in 1883 — the world’s first system of its kind. Out of this idea grew four pillars: the solidarity principle (contributions by ability, care by need), the benefits-in-kind principle (you receive treatment, not money), the self-administration principle (insured and employers shape the funds), and the economic-efficiency requirement (treatment must be sufficient, appropriate and necessary). These pillars still define the system and clearly distinguish it from purely private models.
Important reforms shape the recent past: 1993’s Health Structure Act introduced free choice of fund — before then members were assigned by region or occupation. 2004’s GKV Modernisation Act brought the practice fee (since abolished) and co-payments. 2009 unified contributions through the central health fund, requiring all funds to apply the same general rate. 2015 introduced the income-based supplementary contribution, which has been the main lever for rate adjustments ever since.
Internationally, the German GKV combines premium-level care with moderate contributions — the share of GDP is around 11 %, similar to France and below the US level of 17 %. The split between GKV and PKV is unusual, however: most European countries operate a single public system with private supplemental insurance. Reform debates around a citizens’ insurance target precisely this unification — without majority support so far.
Mandatory vs. voluntary coverage
Employees earning below the annual income threshold (2026: €77,400 gross, or €6,450/month) are automatically GKV-insured. Only once your projected income exceeds this limit may you switch to private (PKV) — self-employed and civil servants can choose regardless of income. Students, retirees, Bürgergeld recipients, and family members each follow their own rules. If you’re unsure whether you qualify, our PKV comparison page walks through the eligibility test step by step.
Voluntary GKV is a special form: it’s open to insured people who exceed the compulsory threshold but consciously choose to stay in or return to the GKV — for example after a long stay abroad or after family coverage ends. Contributions here are levied not just on employment income but on all contributable income (including rental income, capital gains above the saver’s allowance, pensions). The self-employed in voluntary GKV also face a minimum contribution of around €230/month (2026).
The choice between compulsory and voluntary insurance is often more consequential than expected. Compulsory members pay only on employment income; voluntary members on other income too. Anyone who rents out a flat or receives dividends should run the numbers before voluntarily joining — sometimes GKV family coverage via a spouse is cheaper, sometimes a high-earner with capital income is better off in PKV. A consultation with an independent broker or consumer protection agency clears up the picture.
Who is co-insured for free?
Spouses and children can be co-insured at no extra cost as long as their own income stays below €505/month (or €556 for a mini-job). Children are always covered until age 18, until 23 if not working, and until 25 while in school or university — with no age limit for disabilities. Both parents must be in the GKV; if one parent is in the PKV and earns more, the child cannot join family coverage. This typically saves families €2,000–4,000 per year.
Registered civil partners have been fully equal to spouses since 2001. Stepchildren, foster children and grandchildren taken into the household can also be added if the legal requirements are met. Family coverage automatically ends when income exceeds the threshold, when Bürgergeld receipt ends, or when the child reaches the age limit — the fund must be actively notified, otherwise back-dated contributions can apply. Practically it’s sensible to send an annual confirmation of status to the fund.
A critical constellation: if one parent is in the PKV, earns more than the GKV compulsory threshold and regularly supports the other parent, the children are excluded from GKV family coverage. They must then be privately insured themselves — with several children this can make PKV unattractive. Family planning and insurance choice should therefore be looked at together, ideally before any PKV switch.
How are contributions calculated?
The GKV contribution is a 14.6 % general rate plus a fund-specific supplement (averaging around 2.9 % in 2026). Both apply to gross income up to the contribution ceiling (2026: €5,175/month, or €62,100/year) and are split equally between you and your employer. On a €4,500 gross salary you personally pay roughly €394/month — and the gap between the cheapest and most expensive fund easily reaches €300–500 per year. Our fund calculator on the “Switch provider" page shows your exact figure.
In addition to health insurance, long-term care insurance is levied — formally separate but in the same payroll deduction. It sits at 3.6 % of gross income in 2026; childless members aged 23 and over pay a 0.6 percentage point surcharge (4.2 % total). Employer and employee split this contribution too, with special rules in Saxony where the employee share is slightly higher. Care insurance follows the chosen health fund — switching brings your care insurance with you automatically.
Important to know: contributable income is not simply taxed but subject to allowances and special rules. For pension income (e.g. occupational pensions), contributions only kick in above €187.25/month (2026). For lump-sum payouts from direct pension contracts the amount is spread over ten years. The self-employed pay the full rate themselves and may choose whether to include sick pay — without it the reduced rate of 14.0 % applies instead of 14.6 %.
What benefits does GKV cover?
The legal benefits catalogue is broad and codified in § 11 SGB V. It covers medical and dental treatment, prescribed medication, therapeutic and assistive devices (eyeglasses only in special cases), hospital stays, rehabilitation, home nursing, hospice care, pregnancy and childbirth, preventive and screening exams, and STIKO-recommended vaccinations. Psychotherapy is also included — though waiting times of 3–6 months are common. Funeral allowances were removed from the catalogue in 2004 and must be covered privately.
Gaps appear mainly in dental prosthetics, outpatient eyeglasses for adults, alternative practitioner services, single hospital rooms, senior-doctor treatment and private travel vaccinations. These are reimbursed only partially or not at all — that’s where private supplemental policies come in. For dental prosthetics, for example, the GKV covers only 60–75 % of the standard solution; the rest is on the insured. Alternative methods like osteopathy, homeopathy and acupuncture (outside migraine and chronic pain) are also limited in the catalogue.
Some funds offer extended statutory benefits beyond the legal minimum — additional preventive exams, travel vaccinations, osteopathy sessions or expanded mother-and-child programs. These extras differ between funds and are an important comparison factor. Anyone who regularly uses certain services (e.g. osteopathy for back pain) can save several hundred euros a year just by picking the right fund — without taking out supplementary insurance.
GKV vs. PKV at a glance
The key differences in brief: the GKV calculates contributions by income (max around €1,000/month employee share), the PKV by entry age, health and tariff. The GKV offers free family coverage; the PKV requires its own contribution for every dependent. The GKV runs a unified benefits catalogue with the benefits-in-kind principle; the PKV has individually agreed benefits and the cost-reimbursement principle — you pay first and submit invoices. In old age the GKV often becomes cheaper, the PKV often more expensive. Returning to the GKV after age 55 is virtually impossible.
For employees below the compulsory threshold the question doesn’t arise — they are GKV-insured. Only above the threshold (€77,400 in 2026) does the option open up. Rule of thumb: young, healthy single high-earners with strong career prospects often benefit from PKV; families, those with pre-existing conditions and people with uncertain income outlook are better served by the GKV. Civil servants are a special case: they receive subsidies (Beihilfe) from their employer and only need a PKV residual policy — for them PKV is almost always cheaper.
A decision should never be made on short-term contribution advantages, but on a 30+ year life plan. Anyone switching to PKV at 35 will likely pay three to four times the entry premium at age 70 — and can’t go back. The GKV offers fewer comfort benefits but predictability, family coverage and a safety net for every life phase. Anyone leaning toward PKV should compare at least three tariffs with an independent advisor and never pick the cheapest entry tariff, which is often weighted with high deductibles or sub-limits.
Choice of fund and right to switch
Free choice of fund has applied in Germany since 1996: every statutorily insured person can choose any fund open in their state — generally at least 50 of the 73 existing funds. After 12 months of membership you can cancel any time, with two months’ notice. If contributions rise, the special right of termination kicks in: you can cancel within one month of the notice, even before the 12 months are up. The new fund handles deregistration with the old — you’re not uninsured for a single day.
Four factors matter when choosing: the fund-specific supplementary rate (2026 between 0.9 % and 3.5 %), the bonus program (up to €600 a year cashback), optional tariffs (GP-only, deductible, premium refund) and service quality (app, online consultation, hotline wait times). Stiftung Warentest and Finanztest publish regular tests — the annual fund ranking is a good starting point. Don’t just look at the rate: a slightly more expensive fund with a strong bonus program can be cheaper overall.
Practical tip: schedule a yearly review in January or February. That’s exactly when the supplementary rates for the year are published and you have a one-month special termination window. With a 15-minute online comparison plus an online application at the new fund, you complete the switch in under half an hour — and often save several hundred euros a year. A detailed step-by-step guide is on our switching page.