Are children covered for free in public health insurance?

The Familienversicherung is one of those quietly important features of the German public system that often tips the public-vs-private calculation. It allows children — and a non-working spouse with very low income — to be insured under the GKV contract of one parent at no extra contribution.

Children are typically covered until age 18, until age 23 if they are not in employment, and until age 25 if they are still in school, training or higher education; longer in special cases such as disability. The child must stay below a small income threshold of their own. If both parents are GKV-insured, family coverage simply attaches to one of them.

Where it gets trickier is the mixed-system family: one parent in PKV, one in GKV. Depending on the income split between the two, GKV can actually decline family coverage for the children, sending them into PKV instead. This is one of the genuinely unpleasant surprises that a private decision can create for families and is often missed at the point of signing.

In private insurance, by contrast, every child needs their own contract with their own premium. For a family with two or three children, that difference can be substantial — sometimes enough on its own to shift the long-term maths firmly in favour of staying public.

If you are weighing PKV with children currently or potentially in the picture, this is one of the points that deserves to be modelled out properly before signing anything.