Compulsory health insurance in Germany: who must be insured and how?

Compulsory membership under § 5 SGB V automatically covers employees below the Jahresarbeitsentgeltgrenze. They have no choice and cannot switch to private health insurance on their own.

The general duty to have health insurance under § 193 VVG applies to everyone who is not a compulsory member of statutory health insurance. They must either stay voluntarily insured in statutory health insurance or take out full private health insurance cover. Gaps are not allowed.

If your salary rises above the Jahresarbeitsentgeltgrenze (i)JAEG · JahresarbeitsentgeltgrenzeThe annual income threshold in Germany. Employees who earn more than this per year may leave statutory health insurance and switch to private health insurance.More about JAEG →, a window opens to switch to private health insurance. This window applies if your income exceeded the limit in the previous year and will probably also exceed it in the current year. Exceeding it once is not enough. You should check the relevant value for the current year in advance.

Self-employed people and freelancers are not compulsory members of statutory health insurance. They can switch to private health insurance as soon as they start their self-employed work, regardless of income. Civil servants also have a free choice. Because they are entitled to Beihilfe (i)BeihilfeThe state healthcare allowance for civil servants. The Beihilfestelle pays a fixed share of medical costs, the Beihilfesatz, and private insurance covers the rest.More about Beihilfe →, they usually choose private health insurance with a Restkostenversicherung (i)Restkostenversicherung · RestkostentarifA private plan that covers the share of medical costs that Beihilfe does not pay. Together with Beihilfe it gives civil servants full cover.More about Restkostentarif →.

We recommend that you check right away whether you are above the Versicherungspflichtgrenze (i) when your salary jumps or when you become self-employed. The window to switch to private health insurance is limited in time. An early check gives you clarity about your options.