GKV or PKV: the German healthcare choice you can only get right once

Germany has two healthcare systems side by side, and which one you enter is no detail but a decision with consequences lasting decades. The good news: for most Dutch emigrants the law simply chooses for you, and that choice turns out well.

In employment: automatically GKV, family covered free

Whoever works in Germany as an employee is compulsorily insured by law in the public Gesetzliche Krankenversicherung. You choose one of the more than ninety Krankenkassen yourself (AOK, TK, BARMER and dozens of others — after that you're tied to it for at least twelve months), pass it on to your employer, and the cover runs from the first working day. If you don't choose within two weeks, your employer chooses for you.

The premium is income-related: 14.6% plus a Zusatzbeitrag that differs per kasse (on average 2.9% in 2026), together around 17-18% — of which your employer pays half. On top of that comes the Pflegeversicherung (3.6%, also shared; childless people over 23 pay 0.6 points extra). There is a ceiling: above a monthly wage of € 5,812.50 the excess doesn't count.

The big trump card for families is called Familienversicherung: your partner without income of their own (up to € 565 per month, € 603 with a minijob) and your children are free co-insured — up to 18, up to 23 without work, up to 25 in study. Children moreover pay no co-payments anywhere. Compare that with two Dutch premiums plus children's premiums, and the German system is downright favourable for single-earner families.

What the GKV costs at the counter

GP and hospital cost nothing extra. Prescriptions carry a co-payment of 10% with a minimum of € 5 and a maximum of € 10 per medicine, with an annual ceiling of 2% of your gross income (1% for the chronically ill). The dentist is the real difference from the Netherlands: crowns and dentures are reimbursed by the GKV through fixed subsidies of 60% — which grow to 70% and 75% for whoever goes for an annual check-up and has that stamped in the Bonusheft. So start that booklet in your first year; it's literally worth money.

The PKV temptation — and the trap behind it

If you earn more than the Jahresarbeitsentgeltgrenze (€ 77,400 in 2026), you may go to the private PKV. It tempts young, healthy high earners with premiums below the GKV price and faster appointments. Two things you then have to know. One: in the PKV every family member pays their own premium — the free Familienversicherung doesn't exist there, and the premium rises with the years. Two: the way back is legally sealed off. Returning to the GKV is only possible by becoming compulsorily insured again (for instance a job below the wage threshold), and whoever is older than 55 virtually never gets back in according to the law. So the PKV is not a subscription you cancel, but a door that falls shut behind you. For a family going to Germany for the long term, the GKV is in almost all cases the sensible default.

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, but whether your Dutch basic insurance qualifies is something you have confirmed in black and white before departure by the Krankenkasse of your choice; this is exactly the point where newcomers fall between two stools. As a non-working voluntary member count on a minimum premium of around € 267 per month. If the GKV doesn't work out, there is a safety net: every private insurer is obliged to accept you in the Basistarif, without risk surcharges.

Retired 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: register with the CAK, which passes your entitlement on to a German Krankenkasse with an S1 form. You get full German healthcare and pay a treaty contribution to the Netherlands — with the country-of-residence factor for Germany, and in 2026 that stands at exactly 1.000: German healthcare is priced in this system the same as Dutch. Start three months before departure; the CAK application is completed within four weeks.

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 and arranges healthcare until AOW age themselves — in Germany that means the voluntary GKV or the Basistarif above, from around € 267 per month. Whoever is already a CAK customer keeps their rights. What exactly changes, and what you can do now.