Is private health insurance worth it? Who it suits and who it does not

Whether private health insurance makes sense is not decided by the current premium alone. The long-term premium development in old age, the scope of benefits and your personal life planning matter just as much. We recommend that people interested in switching ask directly in the initial consultation whether private and statutory insurance are both options in their case. A differentiated answer is a sign of quality. Also note that a return from private to statutory insurance is usually ruled out from age 55 (§ 6 SGB V).

The basic requirement is an income above the Jahresarbeitsentgeltgrenze (i) of €77,400 gross per year (2026). Once you exceed it, you become eligible to switch.

The economic logic is simple. High earners pay the maximum contribution of €1,226.44 per month in statutory health insurance, including long-term care insurance. The employer contribution is at most €508.59 for health insurance and €104.63 for long-term care insurance per month (2026). From 2027 it is expected to be €557.81 and €114.75, according to the cabinet decision. Private premiums for healthy employees who join between the ages of 30 and 40 are typically €400 to €700 per month.

The risk lies in old age. Private premiums rise over time. Without ageing reserves built up through an early entry, they can exceed the contributions in statutory insurance in retirement. Long-term premium stability is therefore a central criterion for the decision.

For civil servants, private health insurance is an economic advantage in most cases, because the Beihilfe (i) system lowers the cost of insurance by design.

The public employer pays 50 to 70 percent of medical costs through Beihilfe (i). The civil servant only insures the remaining share of 30 to 50 percent. Private premiums for civil servants are typically €200 to €400 per month.

Statutory insurance is possible for civil servants, but often an economic disadvantage, because the full contribution is due and Beihilfe (i) is not offset against it. In practice it is therefore rarely the cheaper choice. Exceptions apply to civil servants with serious pre-existing conditions that would lead to high risk surcharges in private health insurance.

Not everyone who could switch should switch. In certain situations we expressly advise against it.

People in family insurance: If you are covered through a partner's statutory health insurance and have no income or only a small income of your own (limit in 2026: €565 per month), you pay no contribution of your own. Private health insurance would cause premiums of your own here, without any economic advantage.

Low earners: For self-employed people with a low income, the minimum contribution in statutory health insurance is a flat €270 to €278 per month. Private premiums are usually higher and offer no family insurance in this situation.

Older people without ageing reserves: If you switch to private health insurance late, you do not build up sufficient ageing reserves. In retirement, premiums can then be well above the contributions in statutory insurance. The decision has to be calculated over a long time horizon.

Over 5,000 applications with health questions lead to a clear observation. The question of whether private health insurance makes sense is often asked too late. Many employees wait one to two years after exceeding the Jahresarbeitsentgeltgrenze (i) before they look for advice. Every year of delay raises the starting premium.

We recommend checking the question of suitability at the latest in the first year after you exceed the threshold. The first years after that are often the most economical time to join, because age at entry largely determines the premium.

Even with an income above the threshold, staying in statutory insurance can make sense if pre-existing conditions would lead to high risk surcharges or benefit exclusions in private health insurance. An anonymous risk enquiry clarifies this before any decision.

If you plan a family with a partner who has no high income of their own, a combination of private and statutory insurance is often a good idea: the main earner in private health insurance, the partner in statutory health insurance and the children in free family insurance there. In many situations this saves a lot compared with comprehensive health insurance for all family members in private health insurance. For married parents there is one restriction: if the privately insured parent earns more than the partner and their income is above the Jahresarbeitsentgeltgrenze (i), the children are not covered by family insurance (§ 10 Abs. 3 SGB V).

There is no general age limit. Whether it pays off depends on your health status, the plan, your family planning and your planned retirement. As a guide, a later entry means a higher premium. From age 50, the economics should be calculated especially carefully over your whole lifetime.

Comprehensive health insurance fully replaces statutory health insurance and covers all medical costs. Supplementary insurance adds to statutory cover, for example for dental treatment, a chief physician or a single room, without ending your membership. Employees with a high income who switch typically take out comprehensive health insurance.

No, private health insurance is not compulsory for the self-employed. You can stay in statutory insurance voluntarily or switch to private health insurance. Because self-employed people receive no employer contribution, the decision is weighed differently than for employees.