Switch From Private to Public Health Insurance in Germany [2025 English Guide]

A detailed guide on how to switch from private health insurance to public health insurance in Germany. Tips and tricks for employed, self-employed, and old people to return to the German public healthcare system.

Key takeaways

• In certain cases, you can return from private to public health insurance (Gesetzliche Krankenversicherung (GKV) in German).
• Employed people with a gross income below 69,300 € as of 2024 or 73,800 € as of 2025 can switch from private health insurance to public.
• Self-employed individuals must switch to an employment relationship or shut down their business to return to public health insurance.
• Your chances to change from private to public health insurance diminish with age. It’s almost impossible for people older than 55 to move to public health insurance.

This is how you do it

• The easiest way to move back to the public German health insurance system is by reducing your income. There are various options to reduce your salary. For example, working part-time, paying into a company pension scheme, etc.
• If your spouse has statutory health insurance, they can get you back into the public system via a family health insurance scheme.
• The last resort is registering as unemployed or taking out health insurance in another European country.
• If none of the methods work for you, consider changing your private health insurance provider and plan. Your insurance broker, who helped you find the plan, can provide support.

Table of contents

Many expats move to private health insurance when young and healthy because it’s cheap and offers better services. However, they often don’t consider the long-term view, such as family, income, etc.

As your life situation changes, private health insurance may no longer be affordable. For example, you may have married, and your spouse no longer works, or you may have decided to have children.

In such situations, the monthly private health insurance contribution sometimes becomes too high that people try to return to the public system.

However, leaving private health insurance is tough and possible only in certain cases.

What can you do if the private health insurance no longer fits your situation?

You have three options if private insurance is not affordable anymore.

1. Cancel your private health insurance contract within 14 days of receiving it.
2. Reduce the cost of your private health insurance by
   • Moving to a cheaper private health insurance tariff.
   • Changing your private health insurance provider (not recommended).
3. Switch to public health insurance.

The first option is usually not relevant because of the two reasons

• The cost of private health insurance increases after a few years. According to the PKV Association, the monthly contributions of privately insured individuals increased by 3.2 percent annually between 2014 and 2024.
• Your life situation won’t change in 14 days but after a few years.

This guide will focus on switching from a private insurance plan to public health insurance. If you want to learn how to reduce your private health insurance costs, read our guide here.

There are different ways to return to public health insurance, depending on whether you are an employee or self-employed. But first, let’s check how employees can switch to public insurance.

How can employees switch from private to public health insurance in Germany?

The best way for employees to return to public insurance is to reduce their salary below the annual limit (Jahres­arbeits­entgelt­grenze in Germany) of 69,300 € in 2024 and 73,800 € in 2025.

As soon as you earn below the annual limit, you are required to take the health insurance again. This is your chance to switch to public health insurance.

The annual limit is even lower for people who opted for a private health insurance plan before 31 December 2002, at 62,100 € (as of 2024).

Things to keep in mind while moving to the German public health system

• The reduction in your salary should not be “of short duration.” How long the “short duration” is – is not specified under German law. However, your earnings should remain below the annual limit for over three months.
• You should switch to public health insurance within two weeks after starting to earn below the annual limit.
• You can choose any public health insurance. We find TK to be the best public health insurance provider for expats in Germany.

Things to know after you moved to public health insurance

• Once you switch to a public health insurer, you can remain in the German public health insurance system even if your salary rises above the annual income limit again.
• The rule that you must be a member of public health insurance for twelve months during your low salary does not exist anymore (§ 188 Para. 4 SGB V.) Hence, you can opt for public health insurance even if your salary increases before twelve months.

How to reduce your salary to switch from private health insurance to public health insurance in Germany?

Reducing your annual income is the easiest way to return to public health insurance in Germany.

I will share with you three ways you can reduce your income.

#1 Reduce income temporarily

You can reduce your annual income by

• working part-time
• taking a sabbatical
• using a work-time account.

What is a work-time account?

Many companies offer work-time accounts. The work-time account adds part of your working hours to a separate account.

You don’t get paid for these hours. Instead, you can use these hours afterward to take long paid leave.

With reduced numbers of paid hours, your annual income also reduces.

Once your salary goes below the annual limit of 69,300 € (as of 2024) and 73,800 in 2025, you can enroll in German public health insurance.

#2 Reduce income by using “bridge part-time” work.

A good way of returning to the statutory health insurance scheme is to use “bridge part-time” work (Brückenteilzeit in German).

In 2019, German regulators introduced a law allowing workers to reduce their working hours for a period. Once the period is over, they can return to their original working hours.

For example, Suppose you have a 40 hours/week contract, and your salary is above the annual limit. In this case, you can reduce your working time to 30 hours/week for one year to bring your salary below the annual limit.

After one year, you have the right to return to your earlier working time, i.e., 40 hours/week.

So, the option to reduce your hours and the right to return to your original hours is “bridge part-time” work.

Prerequisites

You must fulfill the following conditions to qualify for “bridge-part time” work.

• You are working for a company with more than 45 employees.
• You have been working in this company for at least six months.

Things to keep in mind

• You must apply for “bridge part-time” work (Brückenteilzeit in German) for at least one year.
• The closer your salary is to the annual limit of 69,300 € (as of 2024), the more worthwhile it is to use “bridge part-time” work.
• However, the higher the income, the more difficult it is to say whether this step will pay off, given the drop in salary. Thus, a tariff change might make more sense for high earners.

#3 Reduce income by contributing to the company’s pension scheme

Anyone who earns less than 72,926 euros gross in 2024 or 77,664 euros gross in 2025 can switch to a public health insurer via company pension schemes (Betrieblicher Altersvorsorge in German (bAV)).

Every employee in Germany has a legal entitlement to the so-called deferred compensation.

You can pay up to 3,636 euros per year (as of 2024) or 3.864 € per year (as of 2025) from your gross income into a company pension scheme free of social security contributions.

Contributing to the company’s pension scheme reduces the annual income that is relevant for health insurance. Hence, getting your salary below the yearly limit of 69,300 € (as of 2024) and 73,800 € (as of 2025).

And the best part is the rest of your income is not lost but, instead, saved for your older self.

You can calculate the amount you must save by using the below formula:

Amount that you should pay into the company pension scheme = Annual gross income – Annual limit (69,300 euros as of 2024)

You only have to contribute to the company pension scheme for one year. After returning to public insurance, you can reduce or suspend the contribution.

Example

A 35-year-old employee, Sarah earns EUR 70,000 gross per year. She wants public health insurance again.

So, instead of giving up income through temporary part-time work, Sarah pays a one-time payment of 1,500 euros from her Christmas bonus into the company’s pension scheme.

As a result, Sarah’s gross income drops from 70,000 euros to 68,500 euros. Thus, her employer issues a written confirmation that she is subject to compulsory public insurance.

With written confirmation from the employer, Sarah can terminate the private health insurance without notice and register with a public health insurance provider.

NOTE: To cancel private health insurance, you must first have the public health insurance contract.

How can you stay with private health insurance even if you earn below the income threshold?

Suppose you want to stay with private health insurance even if you earn below the income threshold. In this case, you can apply for an exemption to compulsory public health insurance.

You can apply for an exemption via any public health insurer. Here is the exemption form from TK.

NOTE: If you apply for an exemption you can no longer return to public health insurance even if you take on a new job subject to compulsory public health insurance coverage.

You can return to the public system only if the insurance obligation occurs for a reason other than earning below the income threshold in a job.

What can you do if you are exempt from the compulsory German health insurance system?

Suppose you applied for an exemption to compulsory public health insurance in the past. However, now you want to switch to public health insurance.

In this case, you can return to the public system only if the insurance obligation occurs for reasons other than what you gave when applying for the exemption.

Examples:

• Sarah switched jobs and earned below the income threshold in 2022. However, she wanted to stay with private health insurance and applied for an exemption in 2022. In 2025, she decided to return to public insurance. In this case, Sarah’s lower income won’t allow her to make the switch. Sarah can, however, return to private health insurance if she becomes unemployed for at least one month and is entitled to “unemployment benefit I.”
• Adam became unemployed in 2023. He was eligible to return to the public system. However, he opted to stay in private health insurance. In 2025, Adam wants to switch to public health insurance. In this case, Adam cannot use his unemployment status to return to public insurance. He can, however, get a job with a salary lower than the income threshold to return to the public system.

NOTE: Pensioners exempt from the compulsory state insurance scheme cannot return to the public healthcare system for the rest of their lives.

How can a self-employed switch from a private to public health insurance provider?

The switch from private to public health insurance is more difficult for the self-employed. The problem is that you can’t just lower your income to enter the public healthcare system.

But you have the following options:

#1 You get a full-time job

Changing from being self-employed to being an employee in a company is the easiest way for the self-employed to return to public health insurance.

Things to keep in mind

• Your earnings in the new job must be more than the mini-job limit (i.e., 538€ per month (as of 2024) and 556€ per month (as of 2025).
• Your income must not exceed the annual limit of 69,300 € (as of 2024) or (73,800 € in 2025).

Benefits of opting for this method

• You don’t have to give up your self-employment to be employed elsewhere.
• You can continue to do your business part-time alongside your full-time employment.

Conditions to continue your business with your job

• You should be working more than 20 hours per week on the job.
• The gross income from your job should be more than half the reference value for social security. The reference value for social security is 3535€ in the old federal states and 3465€ in the new federal states as of 2024. So, your income should be higher than 1767.50 € (3535 / 2) in the old federal states and 1732.50€ (3465 / 2) in the new federal states

NOTE: The public health insurers check whether the employment is genuine. Hence, it is not sufficient to appear to be employed by relatives.

#2 Business Abandonment and Family Insurance

Another option is to shut down your business and enroll in your spouse’s public health insurance plan for free.

However, you can opt for free family health insurance if you earn less than 505 euros (2024) per month in a job subject to social security contributions. For income from a mini-job, the limit is 538 euros per month (as of 2024).

State long-term care insurance

Suppose you switch to public health insurance via family insurance. In that case, you automatically become a member of statutory long-term care insurance.

However, you are eligible for benefits from long-term care insurance after a pre-insurance period of two years.

But the good news is, since January 2019, public insurers have considered the time you were part of private insurance ( § 33 Para. 3 SGB XI ) in the pre-insurance period. As a result, most insured persons are continually covered by long-term care insurance.

Two options to return to public health insurance in emergencies

If none of the above methods work for you to switch from private insurance to public, you still have two options.

Both employed and self-employed can take advantage of these options.

#1 You register as unemployed

Anyone who receives unemployment benefit-I can take out public insurance again (§ 5 Para. 1.2 SGB V). But unfortunately, people aged 55 years or older still cannot switch to state health insurance.

As per German law, it’s enough to draw unemployment benefit-I for one month to enter the public healthcare system.

Once you are part of German health insurance, you can stay in it even if you get a well-paid job afterward (§ 188 Para . 4 SGB V).

#2 You insure yourself in another European country

The second emergency solution is to take out public health insurance in another European country. Countries other than Germany that have health insurance obligations are the Netherlands, Sweden, and Switzerland.

So, you have to move to one of these countries or take a job there to get into public insurance.

Good to know

• You must be part of public insurance in these countries for at least twelve months. Hence, you must cancel your private health insurance in good time.
• If you return to Germany, you can become a member of public insurance within three months ( § 9 Para. 2 No. 1 SGB V ).

NOTE: You must check with a consumer advice center or independent patient advice service about the regulations that apply in your case.

How can students return to public health insurance in Germany?

Here are the options for students to return to public health insurance.

1. If you recently signed a private health insurance contract, you can cancel it within 14 days of signing up.
2. You can return to the public healthcare system when you get full-time employment for the first time after graduation.
3. Suppose you become self-employed immediately after graduating. Then, you must remain privately insured. How much you earn doesn’t matter in this situation.
4. You have a special right to terminate your private health insurance contract if your insurer increases the monthly premiums. Learn more about it in our guide on canceling private health insurance in Germany.
5. You should consult your university’s student help center, fee-based broker, or consumer advice centers (Verbraucherzentrale in German) for personalized advice.

Anyone older than 55 years can hardly switch to public health insurance in Germany

People who have private health insurance and are 55 or older find it difficult to insure themselves with a public insurer.

The legislature restricted older people’s options to switch from private to public insurance.

Even if they enter an employment relationship that subjects them to compulsory state insurance, they cannot return to the public healthcare system.

Why is it tough for older people to return to the public healthcare system?

The German government wanted to prevent citizens from benefiting from the low premiums of private health insurance when they were young and returning to the public system when they were old.

Hence, the German legislature put this restriction in place to avoid burdening the public healthcare system, with many people moving into it during their old age.

Thus, the only option is to stay with your existing insurer and change the insurance plan or switch to a different health insurance provider.

The insurance broker who helped you get the private insurance can support you here.

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.

3 ways older people can switch from private insurance to public insurance

Option 1

You can switch if you had compulsory public health insurance for at least two and a half years in the previous five years.

Unfortunately, that is a very rare case.

Option 2

You can move to public health insurance via family insurance. But, you must fulfill certain requirements (§ 10 SGB V).

• Your spouse or life partner must be insured by law.
• Your income from a job subject to social security contributions may not exceed 505 € (as of 2024). If you do mini-jobs, the limit is 538€ as of 2024.

Option 3

You can switch from private healthcare to public if you become at least 50 percent severely disabled.

The deadline to apply for public health insurance is three months after doctors determine the disability.

In this case also, you or your spouse or one of your parents must fulfill certain pre-insurance periods (§ 9 Para. 1 No. 4 SGB V).

Unfortunately, in practice, the probability of switching from private insurance to public is very low.

Health insurance companies have the right to limit the maximum age for admission. And most insurers set the age limit at 45 years.

What to do if public health insurance providers reject your application?

First things first, never cheat your way back into statutory health insurance.

Suppose the health insurance company finds out you have intentionally given false information. In that case, they can revoke your health insurance retrospectively.

Here is what you can do if you think the health insurance company wrongly refused your admission application.

• You can object to the refusal in writing within one month.
• If the insurance company rejects the objection, you can file a complaint in the social court.

NOTE: Under Section 44 of Social Security Code X, you can file an objection even after the objection period.

We recommend seeking advice before taking any legal action. You can contact one of the following for advice.

• Consumer advice center
• A lawyer with a specialization in Social law
• Independent patient advice service (UPD)

Sometimes, it also helps to file a complaint to the Federal Social Security Office.

Convert private health insurance into supplementary insurance

When you switch from private to public health insurance, you can convert your private health insurance contract into private supplementary health insurance.

It has the following advantages:

• You can use your saved retirement provisions to pay for the supplementary insurance. This way, you don’t lose your retirement provisions.
• You get the benefits of private health insurance, such as getting treatment in private hospitals, dental care, etc., while being insured by public insurance.

Moreover, taking out supplementary health insurance is quick and easy. You do not need a health check and have no waiting period before you can claim benefits.

References

• https://www.bundesregierung.de/breg-de/aktuelles/beitragsbemessungsgrenzen-2024-2229320
• https://www.finanztip.de/pkv/pkv-rueckkehr-gkv/
• https://www.deutsche-rentenversicherung.de/DRV/DE/Experten/Arbeitgeber-und-Steuerberater/summa-summarum/Lexikon/B/bezugsgroesse.html