GKV or PKV in Germany: what changes in 2027 and 2028

GKV and PKV work on different principles

GKV contributions are primarily income-based and are calculated up to the contribution assessment ceiling. In 2026, that ceiling is 69,750 euros per year.

PKV contributions follow a different logic. They depend, among other things, on age at entry, health at the time of underwriting and the level of cover selected. Income is not the basis for the premium.

Family circumstances also matter. Under GKV, a spouse with little or no income and children may be covered without an additional individual contribution if the requirements for family insurance are met. Under PKV, each insured person has an individual contract.

The threshold for choosing PKV rises sharply in 2027

For employees, the annual earnings threshold known as the JAEG determines when compulsory GKV membership can end. In 2026, it is 77,400 euros.

In 2027, the normal wage-linked adjustment is supplemented by an exceptional increase of 3,600 euros per year.

The official draft published by the BMAS on 21 September 2026 gives a figure of 84,150 euros per year, or 7,012.50 euros per month. The regulation has not yet completed the approval process.

For an employee earning 80,000, 82,000 or 83,000 euros in regular annual pay, this can remove a choice that still exists in 2026.

A protection rule applies to some employees already in PKV

The reform provides a separate threshold for employees who, on 31 December 2026, are already exempt from compulsory GKV because they exceed the existing JAEG and are insured under substitutive private health insurance.

The 2027 draft sets this protected threshold at 80,550 euros.

An employee earning 82,000 euros may therefore be treated differently depending on whether the precise protection conditions are met.

The GKV contribution ceiling also rises

The health insurance contribution assessment ceiling is 69,750 euros in 2026. The draft figure for 2027 is 76,500 euros.

For higher earners, a larger share of salary will therefore be subject to contributions. The Federal Ministry of Health estimates that the exceptional part of this increase can add up to around 26 euros per month to the employee’s own contribution.

Co-payments and dental cover also change

From 2027, several statutory GKV co-payments rise by 50 per cent. For affected prescription medicines, the range increases from 5-10 euros to 7.50-15 euros.

The annual caps remain in place: 1 per cent of gross household income for recognised chronically ill patients and 2 per cent for other insured people.

For standard dental prostheses, the basic fixed subsidy falls from 60 to 50 per cent. With a regular bonus record, the planned subsidy is 60 per cent after five years and 65 per cent after ten years. Hardship protection for low incomes remains.

Family insurance changes for some couples in 2028

From 2028, some spouses or registered partners who are currently covered free of charge will face an additional contribution equal to 2.5 per cent of the contribution-liable income of the working partner.

Children can continue to be covered free of charge where the normal conditions are met. Parents living with a child under 12 are exempt from the new surcharge, and further exemptions apply in certain care, disability and retirement situations.

A simple family example

Consider an employee earning 90,000 euros gross per year, with a non-working partner and two children aged 13 and 14.

Today, family insurance can represent a substantial financial advantage if all conditions are met.

In 2028, the children may still be covered free of charge. The exemption linked to having a child under 12 no longer applies in this example, so the new contribution for the partner may become relevant.

That does not make PKV automatically cheaper. A private solution has to include the individual premiums for those who need cover, as well as age, health and the selected benefits.

Look at the household over several years

Income, family structure, children’s ages, part-time work, parental leave, professional status, health and retirement can all change the result. For people with links to France, a future return or another international move also matters.

The 2027 and 2028 reforms move several of these parameters at the same time. Anyone who has not compared the systems for several years therefore has a good reason to revisit the calculation.