If you have read part 1 of our series, you have learned that we have two very different systems that arose for historical reasons. These historical reasons are still incredibly relevant because they determine who is allowed to / has to join public health insurance (aka GKV, for the German “Gesetzliche Krankenversicherung) and who gets the option / is forced to join Private Health Insurance (aka PKV, for the German “ Private Krankenversicherung”).
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Before we start, it is important to note that there is an obligation to health insurance in Germany, meaning by law you have to have health insurance, whether you want one or not. Not complying can lead to severe fines.

Having said that, you need to know that there are three different kinds of memberships in GKV:

• Compulsory membership
• Voluntary membership
• Family membership

All give you the same coverage but very different rules apply as to who gets to join.

Compulsory membership in GKV

The biggest group of people that are in the public system are in it whether they like it or not, they HAVE to be in GKV. Here are the most important groups that trigger GKV:

• Employees with a gross income higher than 520 € / month but lower than 69.300 € / year (that is the number for the “Jahresarbeitsentgeltgrenze” in 2024, it changes regularly and is tied to a range of other important numbers set by the government).
• Recipients of unemployment benefit I and “Unterhaltsgeld” (and, under certain conditions, recipients of unemployment benefit II).
• People without any other entitlement to coverage in the event of illness who were last covered by statutory health insurance or are assigned to the GKV.

The vast majority join through the very first point: if you are an employee in Germany (and you do not earn more than 5750 € / month) you have to join GKV.

Voluntary membership in GKV

Often but not always, a voluntary memberships requires previous compulsory membership, but generally speaking the following groups of people are eligible to become a voluntary member of GKV:

• Employees that earn above the income threshold of 69.000 € / year or who within two months of returning from abroad, resume employment that does not result in compulsory insurance.
• Self-employed and freelancers that are no longer compulsorily / family insured due to having taken up their self-employment / freelancer activities. To make it simple: if you were in GKV and then turned self-employed / freelancer, you can stay in GKV.
• Severely disabled persons, under certain circumstances.
• Former temporary soldiers, under certain circumstances.
• Pensioners.
• Students above the age of 30.
• People who are unemployed.

Family membership in GKV

The last group are for members that are family of compulsory or voluntarily insured members:

• Spouses that do not earn more than 485 € / month on average.
• Children up to the age of 18 – or up to the age of 23, if they do not earn more than 485 € / month – or up to the age of 25, if they are in school / apprenticeship and / or are involved in recognized volunteering work.

The big advantage of a family membership is that those members can join their spouses / parents plan for free. When determining whether a child can be covered by family insurance, it is relevant how the parents are insured, whether they are married and how much they earn. If one parent has private health insurance, it is necessary to check whether non-contributory insurance is possible for the child, regardless of the factors listed above.

There is another specialized way to join GKV, namely through the “Künstlersozialkasse” (KSK). This is an organization that was founded to give artists and publicists a way into the social security system, as these people are usually not employed and would otherwise never have the chance to join GKV. If you want to know more about the KSK, stay tuned, we will write a post about it in the upcoming weeks.

All in all, around 90 % of people living in Germany are in the GKV system, through any of the above ways.

Eligibility for private health insurance

The other 10 %, roughly 9 million people, are in PKV. Some of those went into PKV voluntarily and some did not really have a choice because they do not belong to any of the groups above. We could make our lives easy now and write “if you do not belong to any groups above, you can go into PKV”.

Voluntary PKV membership

But let’s take a closer look, these are the people that are allowed to join PKV:

• Employees that have a gross income that is higher 69.300 € / year. If you belong to this group, you have the choice: To stay in GKV on a voluntary basis (you no longer HAVE to stay) – or to join PKV.

• All self-employed and freelancers independent of income. If you arrive in Germany as a self-employed / freelancer and you have not previously been in any EU public health insurance system, you even HAVE to join PKV.
• Anybody without their own income / an income below 520 € / month per month, e.g. housewives and househusbands.
• Children, provided their income is less than 520 € / month
• “Beamte”, i.e. people employed by the regional or federal government.
• All persons who are not employed but are not dependent on the unemployment benefit system, e.g. retirees.

Compulsory membership in PKV

There even are a range of people that have to be in PKV:

• Self-employed and freelancers that arrive in Germany as a self-employed / freelancer and have not previously been in any EU public health insurance system.
• People that were in PKV but who currently have no insurance cover despite the obligation to take out insurance.
• Employees from abroad over 55 years

As you can see, the vast majority of people that join PKV do so happily and voluntarily because it makes sense in their situation. We will mention this many times during our series but since it is such an important point, we never tire to stress this: whether it makes sense to join PKV almost always depends on your individual situation and all pros and cons should be assessed carefully.

More on those pros and cons will follow on our blog, so stay tuned!