Public Insurance (GKV): 2026 Rules & Rates in German

Public health insurance (Gesetzliche Krankenversicherung – GKV) is the backbone of the German healthcare system, covering approximately 90% of the population.

It operates on the “solidarity principle,” where contributions are based on your income rather than your individual health risk or age. 

2026 Key Thresholds and Costs

In 2026, several financial limits for public insurance have increased:

• Compulsory Insurance Threshold (JAEG): €77,400 per year (€6,450 per month). If your gross annual salary is below this, you must be publicly insured.
• Contribution Assessment Ceiling: €69,750 per year (€5,812.50 per month). This is the maximum income used to calculate your premiums; any earnings above this amount are not taxed for health insurance.
• Standard Rate: The base rate remains 14.6% of your gross income, split equally (7.3% each) between you and your employer.
• Additional Contribution: Each provider charges an individual “extra” fee. The average for 2026 is expected to exceed 3% (up from previous years). 

Eligibility and Enrollment

• Mandatory for: Employees earning under €77,400, students under age 30, and individuals receiving state benefits.
• Voluntary for: High earners (above €77,400), freelancers, and some students over age 30 can choose to stay in the public system voluntarily.
• Free Family Coverage: One of the biggest advantages is that non-working spouses and children can often be insured for free under your primary policy. 

What is Covered?

Public insurance provides a standardized package of benefits defined by law: 

• Outpatient Care: Visits to general practitioners (GPs) and specialists.
• Inpatient Care: Hospital stays and surgeries (typically in shared rooms).
• Medications: Prescription drugs are covered, usually requiring a small co-payment of €5 to €10.
• Preventive Care: Routine screenings, cancer checks, and vaccinations.
• Sick Pay (Krankengeld): If you are ill for more than 6 weeks, the insurer pays roughly 70% of your gross salary for up to 78 weeks. 

Accessing Care

Once enrolled, you receive an Electronic Health Card (eGK). You must present this at every medical visit so the doctor can bill the insurer directly. You generally do not have to pay upfront or file claims for standard treatments. The back of your card also serves as the European Health Insurance Card (EHIC), providing emergency coverage within the EU/EEA and Switzerland.