GKV or PKV for expats in Germany, and why it is hard to undo.

Employees may only choose PKV above a yearly gross threshold — €77,400 in 2026, verified against the federal government's published figures — which is reviewed annually. Below it, GKV is mandatory for employees; the self-employed and civil servants sit outside the threshold logic entirely. Check the current figure rather than any article, ours included: it moves every January.

Non-earning spouses and children can be covered without extra contributions under Familienversicherung, subject to an income test on the dependant: €565 a month in 2026, or €603 where the income is Minijob earnings. PKV has no equivalent: every person is a separate contract with a separate premium. For single-income families this one difference decides the whole comparison more often than any perk does.

Decide, do not just cancel. If PKV: ask about dormancy (Anwartschaft) before you leave — it can preserve your entry age and health status for a return. If GKV: your membership history matters if you come back later in life. Ten minutes before the flight beats an impossible conversation at 56.

Yes, for every resident, as a standing legal obligation rather than a visa condition. The practical question is never whether to hold cover but which system you are in — and, if you have a choice, whether to exercise it.

We will not answer that in the abstract, and be wary of anyone who does. It turns on your income, your age, whether you have dependants who do not earn, and how long you intend to stay. What we will say plainly is that the two options are not symmetrical: one of them is difficult to leave, and that asymmetry belongs in the decision.

Only in specific circumstances, and the older you are the narrower they get. The rules are deliberately restrictive — they exist to stop people holding private cover while young and healthy and rejoining the shared system when they are neither. §6 Abs. 3a SGB V sets two conditions together, not one: no statutory cover in the five years before compulsory insurance would begin, AND at least half of those five years spent exempt, insurance-free or self-employed. Marriage to someone who meets that test imports it. Treat the move into private cover as difficult to undo, because for most people it is.

No. Employees may only opt out above the Jahresarbeitsentgeltgrenze — €77,400 a year, €6,450 a month, in 2026 — and the self-employed and civil servants sit under different rules. Two things the comparison sites get wrong. Clearing the threshold does not let you switch that month: under §6 Abs. 4 SGB V compulsory insurance ends at the close of the calendar year, and only if your pay will also clear the NEXT year's higher figure. And a separate, lower threshold of €69,750 applies to people already privately insured on 31 December 2002. The figure moves every January, so check the year on any number you are quoted.

That question belongs at the beginning, not the end. Both systems are built around residence in Germany, and neither travels well. If Germany is one chapter of a longer international life, that changes what you should hold on day one — and it is exactly the situation a domestic intermediary is least equipped to price.

Comparable international private medical insurance in Germany costs about $7,307 a year on average, which ranks Germany 34th of the 50 countries in the SIP Health Cost Index 2025 (data as at August 2025). That is an average across 7 international insurers and three standard profiles — a 24-year-old, a 35-year-old and a 50-year-old — so it describes what the country costs rather than what you would pay. Malaysia prices higher and Azerbaijan lower. Your own premium depends on your age, your health history, whether you are insuring a family, your deductible, and whether you need cover in the United States.