GKV or PKV: the German healthcare choice you can only get right once
Whoever goes to work in Germany is automatically publicly insured (GKV) — family covered free. Whoever earns above the wage threshold may go private (PKV), and that tempts with low entry premiums. But the way back is legally sealed off, and above 55 it is virtually locked.
5 min read
Written and checked by Auke on , against the sources at the bottom. Is something no longer right? Report it below and I'll fix it.
As a Dutch emigrant you usually don't have to choose yourself: the law chooses for you, and that choice turns out well. Whoever works as an employee is compulsorily insured in the public system. Whoever earns above the wage threshold may go private, but the way back is legally sealed off.
Germany has those two healthcare systems side by side:
- the GKV (Gesetzliche Krankenversicherung), the public health insurance
- the PKV (Private Krankenversicherung), the private health insurance
Which system you enter is no detail. It is a decision with consequences lasting decades.
What happens when you take a job?
Whoever works in Germany as an employee is compulsorily insured by law in the public Gesetzliche Krankenversicherung. You choose a Krankenkasse yourself, a public health insurer: AOK, TK, BARMER or one of the dozens of others. After that you're tied to it for at least twelve months. You pass your choice on to your employer, and the cover runs from the first working day. If you don't pass on a choice within two weeks, your employer registers you with your previous kasse. If you had none, it picks a kasse for you.
The premium depends on your income. It is 14.6% plus a Zusatzbeitrag, a surcharge that differs per kasse. Together that is around 17-18%, and your employer pays half. On top of that comes the Pflegeversicherung, the long-term care insurance, also shared. Above the Beitragsbemessungsgrenze, the ceiling for the premium, the excess doesn't count.
The big trump card for families is called Familienversicherung. Your spouse or registered partner with at most a small income of their own and your children are free co-insured: the children up to age 18, up to 23 without work, up to 25 while studying. If you live together unmarried, that does not apply to your partner: they need insurance of their own. Children moreover pay no co-payments anywhere. For single-earner families that is downright favourable.
| Amount or threshold | 2026 |
|---|---|
| General GKV premium | 14.6% plus Zusatzbeitrag, on average 2.9% |
| Pflegeversicherung | 3.6%; childless people from age 23 4.2% |
| Beitragsbemessungsgrenze | € 5,812.50 per month, € 69,750 per year |
| Jahresarbeitsentgeltgrenze (above it PKV is allowed) | € 77,400 |
| Employer's contribution to a PKV premium | up to € 471.32 per month |
| Minimum premium voluntary member, health only | € 222.80 per month |
| Partner co-insured free up to | € 565 per month, € 603 with a minijob |
| Co-payment on prescriptions | 10%, minimum € 5, maximum € 10; annual ceiling 2% (chronically ill 1%) |
| Festzuschuss for dentures | 60%, 70% or 75% |
| Country-of-residence factor Germany (CAK) | 1.000 |
What do you pay at the counter?
GP and hospital cost nothing extra. Prescriptions carry a co-payment of 10% per medicine, with the minimum, maximum and annual ceiling from the table.
The dentist is the real difference from the Netherlands. Crowns and dentures are reimbursed by the GKV through fixed subsidies of 60%. These grow to 70% and 75% for whoever goes for a check-up every calendar year after turning eighteen and has that stamped in the Bonusheft, a stamp booklet. The 75% requires ten years without interruption. So start that booklet in your first year; it's literally worth money.
Why is the PKV a trap?
If you earn more than the Jahresarbeitsentgeltgrenze (€ 77,400 in 2026), the wage threshold for compulsory insurance, you may go to the private PKV. Compulsory insurance then ends at the end of the calendar year in which you exceed it. The PKV tempts with premiums below the GKV price and faster appointments, and your employer contributes.
Two things you then have to know:
- In the PKV every family member pays their own premium. The free Familienversicherung doesn't exist there, and the premium rises with the years.
- The way back is legally sealed off. Returning to the GKV is only possible by becoming compulsorily insured again, for instance with a job below the wage threshold. Whoever is then older than 55 and was not in the GKV in the last five years stays exempt from it by law.
For a family going for the long term, the GKV is almost always the sensible default.
What if you are self-employed or not (yet) working?
The self-employed fall outside the compulsory GKV. Joining voluntarily is possible if you can show an insurance history. EU insurance time generally counts towards that. Whether your Dutch basic insurance qualifies is something you have confirmed in black and white before departure by the Krankenkasse of your choice. As a voluntary member, count on a minimum premium of € 222.80 per month (2026) for health cover, plus the Pflegeversicherung.
If the GKV doesn't work out, there is a safety net. Every private insurer is obliged to accept you in the Basistarif, a basic policy without risk surcharges.
How does it work if you retire to Germany?
If you move with AOW (the Dutch state pension) or a pension without working there, your healthcare runs via the familiar treaty route. You register with the CAK, which passes your entitlement on to a German Krankenkasse with an S1 form. That is the European form with which your right to healthcare moves with you. You get full German healthcare and pay a treaty contribution to the Netherlands, with country-of-residence factor 1.000: German healthcare is priced the same as Dutch. You can register up to five months before your departure or retirement date. The CAK replies within four weeks, with the S1 form attached to the letter.
If you leave before your AOW age, watch the date. The CAK route is expected to be open from 1 November 2026 only to new applicants with a statutory benefit: AOW, Anw, WAO, WIA or Wajong. Whoever brings only an early-retirement pension, RVU payment or occupational pension taken early then falls outside it. They arrange healthcare until AOW age themselves. In Germany that means the voluntary GKV or the Basistarif above. Whoever is already a CAK customer keeps their rights. What exactly changes, and what you can do now.
In Vertrekklaar this is phase 1 of 5 of the journey, step 1.2: the same steps, but for your situation — in your order, tickable, and with the deadlines watched. See the whole journey to Germany or go straight to step 1.2 in the open plan.
What this rests on
The facts in this article come from these official pages. Rules change. When in doubt, go by the source, not this article.
- SGB V §5 — who is compulsorily insured — gesetze-im-internet.de
- Bundesgesundheitsministerium — premiums and amounts — bundesgesundheitsministerium.de
- SGB V §10 — the free Familienversicherung — gesetze-im-internet.de
- SGB V §6 — the over-55 rule on returning — gesetze-im-internet.de
- CAK — regeling buitenland (pensioners) — hetcak.nl
- CAK — emigrating with early retirement, the expected change per 1 November 2026 — hetcak.nl
- SGB V §175 — choosing the Krankenkasse, two weeks, bound for twelve months — gesetze-im-internet.de
- SGB V §61 and §62 — co-payment on prescriptions and the 2% and 1% ceiling — gesetze-im-internet.de
- SGB V §55 — Festzuschuss of 60, 70 and 75% for dentures — gesetze-im-internet.de
- Bundesgesundheitsministerium — Pflegeversicherung premium 3.6% and the surcharge for the childless — bundesgesundheitsministerium.de
- CAK — country-of-residence factors per country (Germany 1.000) — hetcak.nl
- CAK — registering, up to five months ahead, reply within four weeks — hetcak.nl
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