Requirements for private health insurance: who may switch

The requirements for private health insurance differ by occupational group. Four groups of people can take out private health insurance in Germany: employees, self-employed people and freelancers, civil servants, and students. Each group has its own eligibility logic. Employees are bound to the income threshold, the other three groups are not.

The Jahresarbeitsentgeltgrenze (JAEG) of €77,400 is the central threshold for employees in 2026.

If you earn more than €77,400 gross a year as an employee (that is €6,450 a month), you become exempt from compulsory health insurance and may choose: statutory insurance or private health insurance. A second, lower JAEG (i) of €69,750 only applies to people who already had comprehensive private health insurance on December 31, 2002.

Under § 6 SGB V, what counts is not the previous year's pay but the expected regular annual pay for the coming year. If you receive a monthly salary, twelve times the salary last set in your contract applies.

The employer pays 50% of the premiums up to a maximum of €508.59 a month for health insurance and €104.63 for long-term care insurance. From 2027, the maximum amounts are expected to rise to €557.81 and €114.75 according to a cabinet decision.

Besides your base salary, annual pay includes everything that is very likely to be paid regularly. If you receive a monthly salary, twelve times the salary last set in your contract applies.

Other components that count toward annual pay:

• the taxable benefit of a company car
• holiday pay
• Christmas bonus
• capital-forming payments
• regular profit shares, if they are paid with certainty
• contractual claims to minimum amounts for variable components
• pay for on-call duty and supplements for shift work or work under difficult conditions
• overtime pay only if it is paid as a flat rate
• performance-based pay only with the guaranteed minimum amount

The exemption from compulsory insurance depends on whether your income reaches this threshold after a job change or after a pay rise.

For a new job: if you start a new job and your salary for the following 12 months is above the current Jahresarbeitsentgeltgrenze (i), you are classed as exempt from compulsory insurance. This rule applies regardless of the start date of the new job. You can therefore switch to private health insurance from the start of the new employment.

For a pay rise: if your employer raises your salary during the year so that it exceeds the Jahresarbeitsentgeltgrenze (i), you are treated as an exempt employee from January 1 of the following year. The threshold of the next year is decisive, not that of the current year.

An example: if your salary is raised to €79,000 a year in August 2026, exemption depends on the then higher Jahresarbeitsentgeltgrenze (i) of the following year. If your income is still below it, you initially remain compulsorily insured and cannot leave statutory health insurance.

Self-employed people and freelancers can as a rule take out private health insurance regardless of income, as long as there is no statutory obligation to be insured.

If you move from employment into self-employment, clarify your health insurance status right at the start. In many cases, your previous statutory health insurance continues automatically as a voluntary membership. If you want to switch to private health insurance instead, leaving, proof of other cover and the deadlines must be checked carefully.

The three-month period under § 9 SGB V matters above all if you have to actively declare voluntary membership in statutory health insurance. If a statutory membership already exists, mandatory follow-on insurance can apply instead.

Artists and journalists are a special case: they may be assigned to the Artists' Social Insurance Fund, which changes the obligation to be insured. If in doubt, it pays to check before any decision for private health insurance.

Civil servants may join private health insurance regardless of income. Through Beihilfe, the public employer pays part of the medical costs, and the rest is covered by a private 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 →. At federal level, the Beihilfesatz (i) is 50% (with no child or one child), 70% (from two children and for retired civil servants) and 80% for the children themselves.

Beihilfe (i) is a matter for the federal states: the federal values serve as a guide here, and the actual rates depend on the public employer. Trainee civil servants and retired civil servants also have an entitlement to Beihilfe, though partly with different rates. The responsible Beihilfe office answers detailed questions.

Students can be exempted from compulsory statutory insurance within the first three months after the start of their studies. This exemption applies for the entire course of study and cannot be revoked.

Family insurance through the parents usually ends on the 25th birthday. If you are considering private health insurance, weigh the low premiums of student plans against the long-term consequences.

Eligibility is the first hurdle, not the decision criterion. Three rules of thumb help with the question of suitability:

In our advice we often see this: if you just exceed the JAEG (i) at 25 or 30, first check whether your income will stay stable for several years, and do not switch by reflex just because you may.

A comparison makes this concrete: a healthy insured person aged 30 pays around €430 a month in private health insurance as a guide value, while the maximum contribution to statutory health insurance including long-term care insurance is €1,226.44 in 2026. These premiums are guide values. The actual premium depends on age, health, choice of plan and insurer.

If you meet the requirements, you must also pass the health questions with the insurer. Three results are possible:

• acceptance on standard terms
• acceptance with a risk surcharge or a benefit exclusion
• rejection

An anonymous risk enquiry with several insurers checks your chances of acceptance in advance, without a rejected application being stored by the insurer.

The requirements for private health insurance can change. If your income as an employee falls below the Jahresarbeitsentgeltgrenze (i) again, you generally become compulsorily insured in statutory health insurance again. This can happen with part-time work, a job change or a pay cut, for example.

Self-employed people can also return to statutory health insurance if they give up self-employment and take up employment subject to social insurance. What always counts is your specific insurance status.

In legal terms, private health insurance is therefore not a one-way street. But the way back to statutory health insurance is tied to clear requirements and becomes much harder from age 55 if you had no statutory insurance in the last five years and the other requirements of § 6 (3a) SGB V are met. That is why a switch to private health insurance should always be planned for the long term.