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 (GLKV) in German).
• Employed people with a gross income below 66,600 euros (as of 2023) or (69,300 € in 2024) can switch from private health insurance to public.
• Self-employed individuals must switch to an employment relationship to return to public health insurance.
• Your chances to change from private to public health insurance diminish with age.
• People older than 55 cannot move to public health insurance. One way to get into public health insurance is by getting family insurance through your spouse.

This is how you do it

• To get back into the public German health insurance system, you must have a gross salary lower than 66,600 € in 2023 or (69,300 € in 2024). If you have a higher salary, you have to reduce it. 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. You can compare private health insurance plans on the comparison portal, Check24*. You can also check private insurance plans from Feather*. Feather offers services in English.

Table of contents

Many health insurance brokers recommend young Expats move to private health insurance providers as they are cheap and offer better services.

However, the monthly contribution to the private insurance scheme increases as you age. So, increased private health insurance prices during retirement make things even worse.

The monthly contribution sometimes becomes too high that people try to return to the public system.

But 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?

In Germany, you can cancel your contract within 14 days after you have received it. Thus, if you recently took out private health insurance and didn’t like it, you can cancel it within 14 days.

But unfortunately, the disadvantages of private health insurance only become apparent after a few years.

For example, an increase in monthly contributions, high health insurance costs to cover your children, etc.

According to the PKV Association, the monthly contributions of privately insured individuals increased by 3 percent annually over the past ten years.

So, if the private health insurance costs are too high, you can either switch to public health insurance or reduce the cost of your private health insurance.

This guide will focus on switching from a private insurance plan to public health insurance.

But you can always change your private health insurance tariff with the same insurer to reduce costs.

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?

Under German law, every resident in Germany must have health insurance.

Thus, for low earners who cannot afford private health insurance, the German government offers cheaper public health insurance plans.

And the low earners must sign a contract with one of the public health insurers.

Reduce your salary below the annual limit to switch from private insurance to public insurance.

So, one way to return to public insurance in Germany is to reduce your salary below the annual limit (Jahres­arbeits­entgelt­grenze in Germany) of 66,600 euros (as of 2023) and 69,300 € in 2024.

This way, you claim that you cannot afford private insurance and must return to public insurance. In short, you take advantage of the loophole in the law by reducing your salary.

For people who opted for a private health insurance plan before 31 December 2002, the annual limit is even lower, i.e., 58,050 €.

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.
• Reduced salary during parental leave or care leave does not apply.

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 mandatory insurance law no longer applies when your salary exceeds the annual income limit. Hence, you must voluntarily take out public health insurance.
• 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 leave.

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

Once your salary goes below the annual limit of 66,600 € (as of 2023) or 69,300 € in 2024, 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, you have a 40 hours/week contract, and your salary is above the annual limit of 66,600 € (as of 2023) or (69,300 € in 2024).

So, you decided to 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 66,600 euros (as of 2023) or (69,300 € in 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 70,104 euros gross in 2023 or 72,926 euros gross in 2024 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 3,504 euros per year (as of 2023) or 3,636 € per year (as of 2024) 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 66,600 euros (as of 2023) or 69,300 € (as of 2024).

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 – 69,300 euros

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 40-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.

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

Suppose the German health insurance company exempted you from compulsory state health insurance.

In that case, you cannot easily return to the public healthcare system, even if your income is below the annual income limit.

Unfortunately, the exemption continues to apply even if you take on a new job subject to compulsory public health insurance coverage.

How can you return to public health insurance?

Returning to state health insurance is only possible if the health insurance obligation occurs for another reason.

For example, if an exempt employee becomes unemployed for at least one month and is entitled to “unemployment benefit I.”

Then, the employee can apply to return to the public healthcare system. Moreover, they can continue the public health insurance plan even if their income exceeds the annual income limit.

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 insurer is more difficult for the self-employed.

The problem is you can’t just lower your income to get into 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 538 euros per month, i.e., above the mini-job limit.
• Your income must not exceed the annual limit of 66,600 € (as of 2023) or (69,300 € in 2024).

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 should be more than half the reference value for social security.

The reference value for social security is 1767.50 € in the old federal states and 1732.50 € in the new federal states as of 2024.

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

In case you go out of business, you can enroll in your spouse’s public health insurance plan as a dependent for free.

However, you can opt for free family health insurance if you earn less than 505 euros (2024) per month. 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 state long-term care insurance member.

But 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).

It even applies to privately insured persons exempted from compulsory public insurance.

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.

Private health insurance tends to be more expensive than public insurance for older people.

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.

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 620 € per month (as of 2023) or 649 € (as of 2024). If you do mini-jobs, the limit is 520€ since October 2022.

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 centers
• 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.

Thus, you can get the benefits of private health insurance relatively cheaply as a member of the public health system.

For example, getting treatment in private hospitals, dental care, etc.

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.