When is private health insurance worthwhile for expats?

Private health insurance (PKV) becomes accessible to employees once their gross income exceeds the annual threshold (Versicherungspflichtgrenze), and to self-employed people regardless of income. The entry premium for a young, healthy, high-earning single can genuinely be lower than what they would pay into GKV.

The picture changes when you model the contract over decades. PKV premiums are calculated individually and tend to rise as you age, even though insurers build up Alterungsrückstellungen (ageing reserves) to dampen the increase. If your income later drops — parental leave, sabbatical, career change, returning to study — you cannot easily switch back to public insurance once you are over 55, and the PKV premium still has to be paid. Each child and any non-working spouse needs their own contract too, which often surprises expats coming from systems where family cover is automatic.

PKV makes the most sense in a fairly specific shape: settled high income, low likelihood of leaving Germany short-term, no plans for several children on a single salary, and a willingness to actively manage the contract over decades.

For everything in between, the right question is rarely "is PKV cheaper than GKV now?" but "does PKV still make sense for me at age 55, 65, and 75?". The honest answer to that question only comes from a long-term model that includes family scenarios, career interruptions and retirement — not from a single first-year quote.