Can one switch back from private health insurance to statutory health insurance?

Yes, but under strict conditions. Usually, you need your annual income to drop below the compulsory insurance threshold and take up employment. After 55, returning to the GKV is almost impossible - the law closes this path to stop people switching back to the public system just for retirement.

Can I be refused private health insurance (PKV)?

Yes. Unlike GKV, private insurance checks health and is entitled to refuse or raise the premium due to chronic conditions and a serious medical history. Therefore, inquiries to insurance companies are usually made anonymously, before submitting an official application.

Switching from private to state health insurance in Germany, and vice versa

Q: Who can switch from GKV to PKV?

Self-employed people and freelancers, civil servants (Beamte), students under certain conditions, and employees with an income above the annual compulsory insurance threshold (Versicherungspflichtgrenze) can switch to private health insurance (PKV). In 2026, this threshold is around 77,400 euros gross per year.

Q: How can a student switch from private health insurance (PKV) to public health insurance (GKV)?

If you have enrolled in higher education or vocational training, are over 18 but under 30 years old, you can return to the state system. A transition is also possible upon starting paid employment that is subject to compulsory insurance.

21 October 2024

In Germany there are two insurance systems: public and private. Their names are often shortened to GKV and PKV.

Statutory Health Insurance - state medical insurance.
private health insurance — private medical insurance.

Both systems have their advantages and disadvantages. And having chosen one of them, over time it may turn out that the other suits you better. This happens due to changes in your life, income, marital status or state of health. And here the question arises: «Can I switch from private insurance to public?» Or «How do I switch from public insurance to private?».

This is possible if you meet certain criteria set by insurance companies. In this article, we will explain who is eligible to change their insurance system and under what conditions it will not be possible to do so.

In short: how to change your insurance system

You cannot freely switch between private (PKV) and public (GKV) health insurance in Germany — moving in either direction is subject to strict conditions. You can leave the GKV for the PKV if your income exceeds the annual threshold (around €77,400 gross in 2026), or if you are self-employed, a freelancer or a civil servant. Moving back from the PKV to the GKV is more difficult: as a rule, your income needs to drop below the threshold, and after the age of 55 a return is virtually impossible. Therefore, the decision to opt for PKV should be carefully considered in advance.

All articles about private health insurance in Germany:

Switching from private to state insurance

Your health insurance decision should be well thought through from the very beginning. Because changes at a later date are only possible under certain conditions. Changes in your life or income may prompt you to decide to switch your insurance system in Germany.

When and how is it possible to switch from private health insurance (PKV) to statutory health insurance (GKV)?

In the law the reasons for switching from private to public insurance are clearly laid out:

Change from PKV to GKV for the self-employed
To switch to GKV, you must reduce your self-employment from full-time to part-time or stop it altogether and transition to an employment relationship that is subject to compulsory health insurance. Your new salary must be at least €603 per month (as of 2026) and must not exceed the compulsory insurance threshold or the annual earnings limit (€77,400 per year or €6,450 per month according to 2026 figures).

Switching from private to public health insurance for employees
Your income has decreased and does not exceed the annual salary limit of €77,400 (as of 2026) and is not lower than €603 per month.
You have started receiving unemployment benefit (Arbeitslosengeld I). If you have been covered by private health insurance for more than 5 years, you are entitled to remain with that provider, and the Arbeitsagentur will also cover 50% the cost of your premiums, but no more than it would have paid under the GKV.

To fit within the annual earnings threshold, you can reduce your working hours, switch to part-time employment, or take leave. These measures will lower your income and reduce your annual salary. However, to be able to switch from private health insurance (PKV) to public health insurance (GKV), you must not only earn below the annual earnings threshold, but this income must also be considered permanent. Health insurance funds are critical of short-term income reductions aimed at switching to GKV. And although the law does not regulate the minimum duration for earning below the threshold, the reduction in income must not be considered temporary.

If you meet one of these criteria, you are eligible to cancel your private insurance and switch to public health insurance.

You can find out more about state medical insurance, compare tariffs and arrange insurance via the link:

More details

When it is impossible to switch from PKV to GKV

If you are over 55* И For the past five years, you have not had compulsory health insurance or you have been self-employed full-time.
You are a highly-paid specialist, with an income exceeding €77,400 per year (2026).
An employee whose income has fallen, but who has spent more than 50% of their time at PKV.
Civil servant or self-employed person who was previously continuously insured with a private insurance company throughout their working life.

Source

*Exemptions for people over 55 years of age
After exceeding this age, switching to the GKV is only possible if very specific conditions are met.
If you lived in another EU country until the age of 55 and were insured there in the statutory health insurance system, you can provide proof of this when moving to Germany and take out German public health insurance.
If your spouse has statutory health insurance, you can also switch to the GKV. To do this, you must give up your professional activity or self-employment and not exceed a monthly income of 505 euros or have earnings from a mini-job of no more than 538 euros.

If switching from private to state insurance is no longer an option for you, there are ways to reduce your PKV contributions:
Optimising and reviewing tariffs is an effective strategy for reducing monthly premiums without having to give up necessary insurance cover. This is effective if you want to reduce your monthly increasing premiums and adapt your insurance cover to your current life situation.
Increasing the excess can significantly reduce monthly premiums. This is particularly suitable for those who rarely use medical services.
Reviewing the additional services included in your policy. You might find that a single room and treatment specifically by the chief physician are not actually necessary for you. Adjusting these items could lead to cheaper premiums.
There is also Basic tariff. Since 1st January 2009, private insurance companies have been obliged to offer a basic tariff. It provides basic medical protection and is comparable to the GKV. Its purpose is to provide affordable health insurance for those who cannot afford more expensive tariffs. You cannot be refused it. And, if you cannot return to state healthcare, this tariff will be useful to you. The contribution to the basic tariff cannot exceed 1,017.19 euros in 2026, and there will also be additional payments for Pflegeversicherung. Furthermore, in the event of the insured person requiring care, it can be halved.

Switching from GKV (statutory health insurance) to PKV (private)

Switching from state to private insurance can result in you receiving a better range of medical services for less money. This is precisely what happens when you choose the right tariff based on your needs and suited to your life circumstances. However, mistakes or underestimating the future can lead to an unmanageable financial burden in the long term.

The option to switch from mandatory to private insurance is not available to everyone.

Who can switch from GKV to PKV

Employees whose annual salary threshold exceeds €77,400 (2026)*. Those who earn a high income and consequently pay a lot into statutory health insurance can often secure a cheaper rate with better service conditions in private health insurance. Since the amount of statutory insurance contributions depends on the level of income, private health insurance can be financially more attractive for such people.
Full-time self-employed workers can choose private insurance regardless of their income level.
Civil servants are free to choose between state or private health insurance when entering the service.
Students may opt for private health insurance at the start of their studies. Indeed, private health insurance may be a more attractive option for them if their parents work in the civil service. In this case, a government subsidy may cover up to 80% of the insurance cost.

However, private insurance companies most often require proof of income and enter into contracts for incomes starting at 30,000 to 40,000 euros a year.

**If you are a freelancer in the arts or journalism (artist, musician, performer, journalist), you can choose either private insurance or state insurance, which will be paid for under 50%** Artists' Social Security Fund. Half of the GKV contribution is paid by you and half by the KSK. The amount of the contribution depends on your earned income. The minimum income is €3,900 per year. This is a great opportunity for creative people to take out health insurance without having an annual income like high earners or successful entrepreneurs.

Reasons why you might be refused a private medical insurance policy

Before taking out private medical insurance, all applicants must complete a health questionnaire. It needs to be filled out as truthfully and in as much detail as possible. Based on this questionnaire, the insurer may approve or deny your insurance.

Some aspects of your health may require a price adjustment and a risk surcharge, but will allow you to obtain an insurance policy.

However, there are conditions for which private insurance companies refuse coverage to clients.

Pre-existing conditions that frequently lead to refusal:
Alzheimer's disease
Asthma (chronic)
Epilepsy
Diabetes
Mental illness
Oncology
Leukaemia
Multiple sclerosis
Parkinson's disease
Stroke
Dependencies
AIDS
Down's syndrome
Musculoskeletal conditions

Comparison of transition directions

Direction of transition	Who has access	Key condition	Important limitation
private health insurance to public health insurance	Employees, students aged 18–30, in the event of a drop in income	Income below the compulsory insurance threshold	After 55 years the return is almost closed
statutory health insurance to private health insurance	Self-employed people, freelancers, civil servants, and employees whose income exceeds the threshold	Income above ~€77,400 (2026)	Health check, possible rejection

You can find out more about private medical insurance and submit an application for selection and arrangement of insurance via the link:

More details

We are independent specialists in insurance and finance, and offer free advice on selecting the insurance products best suited to your needs. If you’re finding it difficult to decide which type of insurance – state or private – to choose in Germany, please get in touch with us in whatever way is most convenient for you. We’ll assess your personal circumstances, take your plans and future prospects into account, and select a policy and insurance company that fully meet your needs and preferences.