Private or state health insurance for entrepreneurs: complete 2026 guide

It depends on age and health.

Examples (mid-range, good tariff):

• 30 years old, healthy: €480-580/month
• 35 years old, healthy: €500-650/month
• 40 years old, healthy: €580-750/month
• 45 years old, healthy: €680–880/month
• 50 years old, healthy: €750-980/month

With loadings (chronic illnesses): +10-50%

With exclusions (for example, psychotherapy): the cost is lower, but a part is not covered

21.1 % of income (14.6 % basic rate + 2.9 % average supplementary contribution under § 242a SGB V + 3.6 % Pflege). For childless people aged 23 and over Pflege is 4.2 %, giving 21.7 % 

Examples:

• Income €2,000/month: €422/month, €434 for childless people
• Income €3,000/month: €633/month, €651 for childless people
• Income €4,000/month: €844/month, €868 for childless people
• Income of €5,812.50/month and above: €1,226/month with children, €1,261 for childless people

Minimum: €270/month (with an income of €1318/month)

Formula:

For a single person:

• If income > €60,000/year → Private health insurance is more cost-effective (saving €200-700/month)
• If income < €40,000/year → GKV is better value

For the family (spouse + children):

• Almost always GKV is more cost-effective (family for free; from 2028, +2.5 % of income for the spouse unless there is a child under 12 in the household)
• Exception: your spouse has their own well-paid job

Almost impossible.

Exceptions (fewer than 2% of cases):

• Moving to another EU country + returning with employment (very difficult)
• Marriage to an EU citizen + family insurance

Altersrückstellungen are a mandatory part of your Private Health Insurance (PKV) contributions that are set aside to lower contributions in old age.

Example:

• You pay €600/month into private health insurance
• ~€60 (10%) goes into the Altersrückstellungen
• After 15 years, it has accumulated: €60 × 12 months × 15 years = €10,800

Upon exiting the PKV:

• You will lose these €10,800 (they won’t be refunded!)
• In retirement, GKV will cost more than PKV could with accumulated savings

Exception:
If you move to another PKV (change company), Altersrückstellungen are transferred (partially).

But upon switching to GKV – you lose them completely.

Beitragsentlastung im Alter – an additional option in PKV to reduce contributions in retirement. You can partially increase contributions when you are younger in order to subsequently receive a reduction in contributions after reaching a certain age (e.g., 60–67 years).

This option is not compulsory, but it is one of the few ways to reduce PKV contributions in old age.

Yes.

Rule: If you are in PKV, your family cannot be in the free GKV family insurance (Familienversicherung).

Options:

• The whole family has private health insurance (expensive: everyone pays separately)
• You are in private health insurance (PKV), your wife is working – she has her own statutory health insurance (GKV) (children can be insured with her under the family insurance scheme (Familienversicherung) if your income does not exceed hers)
• The whole family has statutory health insurance (family insurance is free, but you pay based on income; from 2028, another 2.5 % of income for the spouse, except in families with a child under 12) if your spouse does not work. If your spouse works, you pay for yourself and your spouse pays for their own GKV

PKV contributions do not decrease when income falls!

Example:

• You are in private health insurance (PKV), paying €650/month
• Income dropped from €60,000 to €25,000/year (crisis)
• The contribution remains €650/month (independent of income!)

What to do:

• Ask your PKV for the Notlagentarif (emergency tariff):
  • Minimum service package
  • Reduction of the contribution to ~€200-300/month
  • But quality = like GKV
• OR return to the GKV (if under 55 and subject to compulsory insurance)

In the GKV: the contribution falls automatically to 21.1 % of the new income (21.7 % for childless people), but never below the minimum.

It depends on the tariff.

Typical conditions:

• Good tariffs: 30-50 sessions a year, sometimes up to 100
• Average tariffs: 20–30 sessions
• Cheap tariffs: 10-20 sessions OR excluded entirely

Important:

• Check which methods are covered:
  • Verhaltenstherapie (behavioural therapy) – usually yes
  • Tiefenpsychologie (depth psychology) — usually yes
  • Psychoanalyse (psychoanalysis) — sometimes limited
  • Paartherapie (couples therapy) — usually no

Tip: If psychotherapy is important to you → choose a plan with a minimum of 40-50 sessions.

Possible, but difficult.

Conditions (section 10 SGB V):

• Children can remain in the statutory health insurance (GKV) family insurance if:
  • The other parent also works and is covered by statutory health insurance
  • And their income is higher than yours (the PKV parent’s)

If you haven’t seen a doctor for a whole year → PKV refunds part of your contributions!

Typical conditions:

• 1 year without claims: 1-2 monthly premiums back
• 2 years in a row: 2-3 monthly contributions
• 3 consecutive years: up to 4 monthly contributions

Example:

• Contribution: €550/month
• Haven’t been ill for 2 years in a row
• Refund: 3 × €550 = €1,650

BUT:

• If you make a claim even once (even for a cold), your refund resets to zero
• Is it worth enduring illness for a refund? No! Health is more important.

Lifehack:

• Pay minor expenses (up to €500/year) yourself and do not submit the bills
• Major ones (operations, etc.) – you apply for reimbursement and thus keep the contribution refund

Versicherungspflichtgrenze = the income limit up to which employees are compulsorily insured in the GKV.

In 2026: €77,400 per year (€6,450 per month gross)

How it works:

• Salary below €77,400 → must be in the GKV (compulsory insurance)
• Salary higher than €77,400 → you can switch to PKV

For entrepreneurs:

• Does not apply! (you are free to choose GKV or PKV at any time)

BUT: This threshold is important for a return to the GKV:
If you get a job with a salary below €77,400 – you return to the GKV

Yes, but only if:

• Your salary is above €77,400/year
• You were already in PKV before starting the job

If the salary is lower:

• You must return to the GKV (compulsory health insurance)

For entrepreneurs:

• You can combine a Gewerbe (registered business) and salaried employment
• If employment is your main income + salary < €77,400 → you must be in the GKV
• If business is your main income → you can stay in PKV

The employer pays for PKV:

• Half of the contribution (maximum €508.59/month in 2026) and Pflege €104.63/month, you pay the rest yourself

You have 4 options:

1. Tarifwechsel (switching tariffs within PKV)

• • Switch to a cheaper tariff with the same company
  • No new medical check! (legal right under section 204 VVG)
  • You keep your Altersrückstellungen
  • Downside: fewer benefits (e.g. psychotherapy excluded)

2. Switching to another private health insurance (PKV)

• • Compare quotes from other insurers
  • With a new medical check (they might refuse you or charge more due to age/illnesses)
  • Altersrückstellungen are partly transferred (approximately 60–80%)

    Minus: You will lose part of your savings

3. Standardtarif (standard tariff) or Basistarif (basic tariff)

• • Statutory minimum tariff (similar in services to the GKV)
  • Standardtarif: for those who were in PKV before 2009 and are over 55
  • Basistarif: for everyone else
  • Cost: at most GKV (~€1226/month in 2026)

    Minus: Quality = like GKV (lost the advantages of PKV)

4. Return to statutory health insurance

• • If under 55 – see the section “Can one switch back from private health insurance to statutory health insurance?”
  • If over 55 – practically impossible

Tip: First try Tarifwechsel (without loss).

It depends on your situation.

YES, if ALL of these apply:

• You are up to 40-45 years old
• Excellent health (no chronic illnesses)
• Single OR your spouse has their own job (no children OR the children will be insured with your spouse in the GKV)
• Income consistently €50,000+/year
• You understand: this is for good (returning after 55 is almost impossible)
• Ready to build up a pension pot of €500,000+

NO, if at least one applies:

• You are 45+ years old (contributions are rising rapidly)
• You have a chronic illness (they will refuse or make it expensive)
• Non-working spouse and/or children (you will lose free family insurance)
• Income unstable (PKV contributions do not fall when income decreases!)
• Not 100% sure (it’s better to stay in the GKV with the option to return)