Who must insure where — and why the PKV door mostly locks behind you.
Health insurance is mandatory — for everyone, from day oneEvery resident of Germany must hold health insurance. Employees under the income threshold are compulsorily insured in GKV; gaps in coverage generate back-payments (Beitragsschulden) that follow you for years.
The legal rules for entering and leaving private insuranceOnly employees above the annual income threshold, the self-employed, and civil servants may choose PKV. The law makes returning to GKV deliberately difficult — a decision at 30 shapes your costs at 70.Health insurance when no employer pays halfThe self-employed choose between voluntary GKV membership (income-based, with a minimum assumed income) and PKV. Students get a heavily discounted GKV rate — but only up to age 30.
The mandatory care insurance attached to your health coverPflegeversicherung is a compulsory add-on to every health insurance, funding long-term care needs. Childless members over 23 pay a legal surcharge, and benefits are organised in five care grades (Pflegegrade).