Private health insurance (PKV) — explained simply

Private health insurance (PKV) follows the principle of individual insurance: you sign a personal contract where contribution and benefits depend on your entry age, your health at the time of application and the chosen tariff — not on your income. The benefits are clearly defined and contractually guaranteed for life.

Waiting periods

In principle PKV has a 3-month general waiting period and an 8-month special waiting period. In practice these are often waived, so you have full cover from day one. Important: "no waiting period" does not cover treatments that were already planned, recommended or known before you applied.

Prepayment principle

Doctor's and hospital bills are paid by you first. You then submit them to your PKV and get reimbursed fully or partially depending on your tariff.

Old-age reserves

To cushion the rising health costs of old age, the insurer builds so-called Altersrückstellungen from day one. Combined with the statutory Vorsorgezuschlag, these are two built-in mechanisms designed to stabilise your contribution later in life.

Mandatory building blocks

Alongside your PKV tariff you must take out a private Pflegepflichtversicherung (long-term care). A Krankentagegeldversicherung (daily sickness benefit) is not legally required, but every employee and self-employed person should have one.

Health and age drive your premium

Because health status and age directly affect the premium, PKV is most attractive for people who are young, healthy and earn well — and who want to stay that way through strong preventive care.

Civil servants (Beamte)

As a Beamter you can freely choose between PKV and GKV. Your employer pays a Beihilfe of at least 50% of your medical costs, so you only need to insure the remainder through a private Restkostenversicherung. For most civil servants without serious health issues, PKV is clearly the better deal — lower cost, better benefits. The PKV Öffnungsklausel guarantees access for every Beamter.

Employees (Angestellte)

Employees must earn above the Jahresarbeitsentgeltgrenze (JAEG) to be allowed to switch. In 2026 the threshold is €77,400 per year — roughly €6,450 per month including regular bonuses like Urlaubsgeld and Weihnachtsgeld. You must exceed this threshold for at least one year. Once in PKV, you receive an Arbeitgeberzuschuss capped at half the maximum GKV contribution (€508.59 in 2026).

Self-employed (Selbstständige)

Self-employed people can join PKV regardless of income — but they don't have to; voluntary statutory insurance is also an option. An exception applies to artists and journalists, who may fall under the Künstlersozialkasse.

Students

At the start of your studies you can opt for PKV, but you're then locked in for the rest of your higher education. Dedicated student tariffs are cheaper because no old-age reserves are built. Once you take up your first main job (below the JAEG), you can return to the GKV. PKV is especially attractive for children of civil servants, who receive 80% Beihilfe.

The big advantage of PKV is simple: the best possible medical care, assuming a good tariff. That includes faster appointments, broader treatment options and access to medication and therapies that the GKV doesn't even list. The GKV gives you what is medically necessary and sufficient — the PKV gives you what is medically best.

No Fallpauschalen at the doctor

GKV patients are billed via Fallpauschalen — flat-rate fees per case. Once that budget is used up, the doctor is treating you at a loss. Privately insured patients are billed for what is actually done, which is exactly why you get appointments faster and feel less rushed in the practice. Inside public hospitals, Fallpauschalen still apply, but private clinics (accessible to PKV patients) bill differently.

Other typical benefits

• • Single or double room in hospital
• • Chefarztbehandlung (treatment by the head physician)
• • Free choice of hospital and doctor
• • Faster specialist appointments
• • Beitragsrückerstattung if you don't submit any bills
• • Much stronger benefits for Heilmittel, Zahnersatz and Reha

Tax savings

PKV contributions are tax-deductible, and pre-paying contributions for future years can create significant tax savings — especially for higher earners.

A good PKV is not cheap

People often switch because they think they'll save money in their young years — and that's exactly how cheap tariffs are sold. It's a trap. A solid tariff costs real money, and skimping today usually means very expensive contributions in old age.

No free family coverage

Unlike in the GKV, your spouse and children are not covered for free. Each family member has their own contract. There is no free coverage during maternity or parental leave either — you keep paying, and the employer subsidy stops, which makes Elternzeit financially heavy.

Excess (Selbstbeteiligung)

Many PKV tariffs include a yearly excess. The cheaper the tariff, the higher the typical excess. Below that amount you pay everything yourself before the insurer reimburses anything.

Switching back to GKV is hard

Going from PKV back to GKV is full of hurdles, and the rules differ between employees and self-employed. From age 55 onwards, returning to GKV is essentially closed off.

The seemingly small details inside a PKV tariff are what separate a good contract from a painful one. That includes how the insurer calculates contributions, how transparent its history of premium increases is, the quality of its Altersrückstellungen, the wording around outpatient and inpatient care, and the clauses that let you adjust your tariff later without new health questions.

Two things matter most for long-term stability: choose an insurer with a clean history of moderate premium adjustments, and build a strategy for old age from day one — for example via a Beitragsentlastungstarif or a Rürup pension that cross-subsidises your PKV contribution later in life.

There is no universal answer. PKV is worth it when you value the best medical care and you have the financial discipline to keep your contribution affordable for life. GKV is the better fit if you want a simple system, family coverage and you don't want to think about reimbursements.

Key inputs to the decision: your income trajectory, your family planning, your health, your risk appetite — and how long you intend to stay in Germany. None of these can be answered by a comparison portal.

Billing

In the GKV you simply show your insurance card and the doctor settles directly with the statutory fund. In the PKV the doctor invoices you personally — you pay first and submit the bill to the insurer to be reimbursed (Kostenerstattungsprinzip). Modern scan apps make this almost frictionless. For inpatient hospital stays the PKV also offers a card so the hospital can bill the insurer directly.

Application

Anyone meeting the formal requirements is accepted in the GKV — health status doesn't matter (Kontrahierungszwang). In the PKV the insurer performs a health check and can decline you, apply a Risikozuschlag or exclude specific conditions. False statements on the health questionnaire can be held against you for 5 to 10 years. For self-employed applicants the insurer also looks at your financial situation.

You will hear over and over again that "you can't afford PKV as a pensioner". The truth is more nuanced. Contributions only spiral out of control when people pick poor tariffs, ignore the right safeguards during the active years, and skip the legal tools designed to stabilise contributions in old age.

Used properly, the combination of Altersrückstellungen, statutory Vorsorgezuschlag, a Beitragsentlastungstarif, a Rürup pension as a cross-subsidy and the official Zuschuss der Deutschen Rentenversicherung for privately insured pensioners keeps PKV affordable far into retirement. Returning to GKV is also possible under specific circumstances — the catchphrase "once private, always private" is simply not accurate.

Basistarif

The Basistarif is a safety net for anyone who can no longer afford a regular PKV tariff. Benefits are similar to the GKV and the contribution is capped at the GKV maximum. Every PKV insurer must offer it, and for anyone who joined PKV after 1 January 2009 there are no further requirements to switch into it.

Standardtarif

The Standardtarif is also capped at the GKV maximum and tends to be cheaper than the Basistarif. It is only available to people who joined PKV before 1 January 2009, and only under specific age/income conditions (e.g. age 65+, or age 55+ with income below the special JAEG of €69,750 in 2026).

Before switching to either, always check whether a regular but cheaper tariff inside your existing insurer is possible — that is usually the better option.

Most of the strong opinions you hear about PKV — at the Stammtisch, in talk shows, in pop-up ads — are simply wrong. They are loud, not informed. The real problem isn't whether PKV or GKV is better; the real problem is that many people took out a PKV who never should have, because they were sold on the wrong motive: "Switch now and save on contributions."

That motive collapses over time. You can't buy the Mercedes of health insurance and expect to pay Fiat prices forever. The only motive that holds up long-term is the best possible medical care for you and your family.

PKV is a genuinely complex product. The right contract depends on your health, your goals, your family situation, your career path and your long-term financial plan. A few clicks on a comparison portal will not get you there.

Work with an independent broker you trust — ideally one who walks you through the health questions carefully, runs anonymous Risikovoranfragen before any real application, and is willing to say "no, PKV isn't right for you" when that's the honest answer. Our principle has always been simple: first understand, then insure.