Number of Public Health Insurance Companies in Germany [1992 to 2025]

Key Takeaways

• The number of public health insurance companies in Germany reduced from 1,223 in 1992 to 94 in 2025.
• The sharpest drop in the number of public health insurance funds occurred in 1995, when 318 statutory health insurance companies were lost. 
• In 2024, “company health insurance funds (BKKs)” had 70 companies but insured only 11.4 million individuals or 15.2% of the GKV-insured population.
• “Substitute funds (Ersatzkassen or vdek)” had the largest insured population (38.5%) of 28.7 million persons despite having only 6 companies in 2024.
• The main reasons for the decline in the number of public health insurance companies are the increasing premiums, mergers between companies, and individuals shifting to private health insurance.

This is how you do it

• Use our "Health Insurance Finder" tool to check which health insurance is best for you.
• We find TK the best public health insurance provider for expats. Its website, mobile app, and customer service are in English. You can register with TK online.
• We recommend getting private health insurance via an insurance broker. They are experts and can help you find the best plan for your needs. You can book a call with an expert we recommend here.

Table of Contents

How did the number of public health insurance companies in Germany change between 1992 and 2025

In 1992, Germany had 1223 public health insurance funds. From 1992 to 1996, Germany lost almost half of its public health insurance companies.

The most drastic decline occurred in 1995, when 318 statutory health insurance funds merged into existing ones. 

This downward trend continued steadily over the following decades, leaving Germany with 94 public health insurance companies as of 2025.

87.6% of the German population is insured under public health insurance. In other words, 94 public health insurance companies offer medical coverage to 87.6% of the population. 

We find TK the best public health insurance provider for expats. It offers its website, mobile app, and customer support in English.

You can register with TK online for free in 2 minutes using our “TK registration service.“

What are the types of public health insurance companies in Germany?

There are various types of public health insurance companies in Germany. One main distinction between these companies is their scope and target membership. 

• Nationwide coverage. Companies that offer insurance to everyone in Germany.
• Specific coverage. Companies that offer insurance to certain areas or professional groups (e.g., doctors, miners, engineers) only.

As of 2025, the 94 public health insurance companies in Germany are divided into various types, which include

• General local health insurance funds (Allgemeine Ortskrankenkassen or AOK) originally provided insurance for workers in certain local areas. Over time, AOKs have consolidated into larger health insurance companies, with one AOK now serving each federal state or region (e.g., AOK Bayern, AOK Baden-Württemberg).
• Company health insurance funds (Betriebskrankenkassen or BKK) are set up by individual companies or industries to insure their employees.
• Substitute funds (Ersatzkassen or vdek) are alternatives to AOKs offered to white-collar workers. They now provide insurance on a national level and are highly competitive, offering additional services (e.g., bonus programs and alternative medicine coverage).
• Trade association sickness funds (Innungskrankenkassen or IKK) are initially established by craftsmen’s guilds (Innungen) to insure their members (e.g., carpenters, bakers, artisans).
• Other insurances (Sonstige) include specialized funds like the Knappschaft (for miners) and the Landwirtschaftliche Krankenkasse (LKK, for farmers).

Public health insurance category	Number of public health insurance companies in each category
Company health insurance funds (BKK)	69
Substitute funds (vdek)	6
General local health insurance funds (AOK)	11
Trade association sickness funds (IKK)	6
Other	2
TOTAL	94

Breakdown of the number of public health insurance companies in Germany (2024)

Public health insurance company	Number of companies	Number of people insured
		(In millions)	(In percentage)
Company health insurance funds (BKK)	70	11.4 mil.	15.2
Substitute funds (vdek)	6	28.7 mil.	38.5
General local health insurance funds (AOK)	11	27.5 mil.	36.9
Trade association sickness funds (IKK)	6	5.1 mil.	6.8
KBS	1	1.3 mil.	1.8
LKK	1	0.5 mil.	0.7
TOTAL	95	74.56 mil.

In 2024,  an analysis of public health insurance companies in Germany revealed an interesting contrast between the number of individual companies under each type of public health insurance and their respective coverage of insured individuals.

Company health insurance funds (BKKs) have 70 individual companies, representing the largest number among the group. However, they covered a comparatively smaller proportion of the GKV-insured population, providing insurance to 15.2% or 11.4 million individuals.

Conversely, substitute funds (Ersatzkassen or vdek), despite consisting of only 6 companies, had the highest number of insured persons with 28.7 million individuals or 38.5% of the GKV-insured population.

General local health insurance funds (AOKs) held the second-largest share in terms of coverage, providing public health insurance to 27.5 million individuals or 36.9% of all GKV-insured persons in 2024.

Factors for the decline in the number of public health insurance companies in Germany

The number of public health companies drastically declined from 1,223 in 1992 to only 94 in 2025. Here are the major factors that are responsible for this decline.

Increasing public health insurance premiums

The public health insurance premium comprises “basic contribution” and “additional contribution.” The German government froze the basic contribution rate to 14.6% for all public health insurance companies.

Thus, if the health insurer doesn’t have enough funds to cover its expenses, it increases the additional contribution rate. 

Suppose an insurance company increases its additional contribution rate. This gives its members a special right to terminate the health insurance contract.

As 95% of the medical coverage offered by all public health insurance companies is the same, people move to cheaper insurance providers. This leads to a loss of insured members. 

Ultimately, the insurance company has no choice but to shut down or merge with an existing health insurer.

In 2024, the Germany-wide average additional contribution was 1.7%. This increased to 2.5% in 2025.

We find TK the best public health insurance provider for expats. It offers its website, mobile app, and customer support in English.

You can register with TK online for free in 2 minutes using our “TK registration service.“

Increasing number of mergers between public health insurance companies

A primary factor contributing to the decline in the number of public health insurance companies is the ongoing consolidation through mergers. 

Companies facing financial challenges and membership losses often seek mergers with larger entities to remain competitive. 

These mergers can also occur across different fund types, such as smaller Betriebskrankenkassen (BKKs) joining forces with larger BKKs.

Increasing desirability for private health insurance

A growing number of individuals, particularly those with higher incomes, are opting for private health insurance. 

This shift is influenced by the

• increasing public health insurance premiums
• better medical coverage in private health insurance.

The private insurance system offers

• faster access to specialists
• more treatment options
• lower premiums, and more

This makes private health insurance increasingly desirable for those who can get it. 

We recommend getting private health insurance via an insurance broker. They are experts and can help you find the best plan for your needs. You can book a call with an expert we recommend here.

Five biggest public health insurance companies in Germany

The table below shows the five biggest public health insurance companies in Germany, ranked by the number of people insured.

Public Health Insurance Company	Total Insured (Versichert)	Family members insured for free	Paying members (Mitglieder)	Insured for free (%)	As of
Techniker Krankenkasse (TK)	11,804,078	2,638,412	9,165,666	22.35%	Jan 2025
BARMER	8,683,320	1,557,950	7,125,370	17.94%	Jan 2024
DAK Gesundheit	5,528,159	992,078	4,536,081	17.94%	Jan 2024
AOK Bayern	4,659,900	1,009,251	3,650,685	21.65%	Dec 2024
AOK Baden-Württemberg	4,552,637	1,079,185	3,473,452	23.7%	Jan 2023

Techniker Krankenkasse (TK) is Germany’s biggest public health insurance provider based on the number of insured members. TK has 11.8 million members as of 2025.

Barmer is the second largest public health insurance company after TK, with 8.68 million members.

AOK is a group of independent regional health insurance companies. When you combine all the AOK regional health insurance providers, AOK has 27 million insured members in Germany, which is almost one-third of the German population.

Different public health insurance companies have different insurance premiums. However, 95% of their medical coverage/services are the same. Thus, the locals keep an eye on the premium development and switch to a cheaper public health insurer.

You can calculate how much you pay to your current insurer and savings potential by switching to a cheaper insurer using our public health insurance premium calculator.

We find TK the best public health insurance provider for expats. It offers its website, mobile app, and customer support in English.

You can register with TK online for free in 2 minutes using our “TK registration service.“

References

• https://www.sozialpolitik-aktuell.de/files/sozialpolitik-aktuell/_Politikfelder/Gesundheitswesen/Datensammlung/PDF-Dateien/abbVI21b.pdf
• https://www.vdek.com/presse/daten/b_versicherte.html