Trends in Public Health Insurance Membership [2000-2025]

Key takeaways

• The number of people insured under public health insurance (GKV) has increased from 71.3 million in 2000 to 74.26 million in 2025, making up approximately 87.6% of the population in Germany.
• After reaching a low of 69.6 million in 2011, membership in public health insurance has steadily increased.
• The number of compulsorily insured members in public health insurance has increased from 29.2 million in 2000 to 35.2 million in 2025. This category represents the largest group in the public health system.
• The number of family members insured under free family insurance has steadily decreased from 20.2 million in 2000 to 15.72 million in 2025. This is likely caused by the declining birthrate and more women joining the workforce.
• The number of pensioners (Rentner) has remained fairly stable from 2000 to 2025, with a sudden increase in 2024. The number of pensioners in statutory health insurance will continue to rise till 2050 due to aging population.

This is how you do it

• Based on current situation, experts predict that public health insurance won’t be able to offer adequate coverage at an affordable price in the near future. Thus, people who are eligible for private health insurance should consider making the switch.
• 95% of the coverage offered by all public health insurance companies is the same. Thus, you should move to a public insurer that has lower premiums. 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.
• Use our "Health Insurance Finder" tool to check which health insurance is best for you.
• 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.
• In our comparison and test, we found Haellesche, Allianz, and Signal Iduna’s private health insurance plans to be the best.

Table of Contents

How many people are insured in public health insurance in Germany?

Public health insurance categorizes its members into four broad categories.

• Compulsorily insured
• Voluntarily insured
• Insurance for pensioners (KVdR)
• Free family insurance

Here’s a breakdown of the number of people insured in the different categories of the statutory health system.

	Number of people insured (in millions)	Number of people insured (in percentage)
Compulsory insurance	35.21	47.4%
Insurance for pensioners (KvdR)	17.65	23.8%
Free family insurance	15.1	20.3%
Voluntary public health insurance	6.29	8.5%
TOTAL	74.26

Read our guide on the number of people insured in public and public health insurance in Germany to learn more.

How did the number of people insured in Germany’s public health insurance change from 2000 to 2025?

In 2000, 71.3 million people were insured under public health insurance in Germany. The number of people with public health insurance declined between 2000 and 2011, reaching a low of 69.6 million in 2011. 

However, from 2012 onwards, the number of people insured in public health insurance increased on average by 0.6% annually. 

The number of people insured under public health insurance reached 74.26 million (as of 2025). This is approximately  87.6% of the population (84.74 million in 2025) in Germany.

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.“

What does the Shift in Public Health Insurance Numbers Reveal?

Overall, the number of people insured in state health insurance has increased. When we look closely at the data, we find many interesting changes in Germany’s overall demography.

Change in people compulsorily insured in public health insurance

“Compulsorily insured members (Pflichtmitglieder)” made up the majority (>41.0%) of people insured under public health insurance. Moreover, an average of 0.26 million people per year have been added to this category since 2000. This is an average increase of 0.88% per annum.

As of 2025, 35.2 million people are compulsorily insured in public health insurance. This is 47.4%  of the total people insured in statutory health insurance.

The two main reasons for the increase in the compulsorily insured members are

• Declining birth rate in Germany.
• The number of housewives insured for free in family insurance is decreasing. This is because more and more women are employed and insured compulsorily under statutory health insurance. 

How did the number of people insured for free in family insurance change between 2000 and 2025?

The number of family members insured under public health insurance has steadily decreased from 20.2 million in 2000 to 15.72 million in 2025. This decline is primarily due to

• The birth rate is declining. This means that fewer family members can be insured under free family insurance.
• The number of women entering the workforce and reaching the income threshold has been increasing. Wives initially insured under free family insurance are becoming compulsorily insured through employment.

Germany’s public health system is struggling with an increase in medical expenditures and had a deficit of 6.3 billion euros in the first half of 2024. Thus, decreasing the number of members insured in “free family insurance” is healthy for the state healthcare system.

Increase in the number of pensioners insured in public health insurance

The number of pensioners has remained fairly stable (16.7 million) between 2000 and 2023, with a sudden increase in 2024 (17.65 million). This sudden increase is because of the growth in Germany’s aging population.

Considering the increase in Germany’s aging population, the number of pensioners will increase steadily from 2025 onwards. This will add additional strain to the already stressed public healthcare system.

The aging population is one of the major reasons why many experts believe that it would be difficult for public insurers to offer adequate medical coverage at an affordable price. This has prompted people to move to private health insurance, as evidenced by the increase in the percentage of the German population insured in private health insurance.

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.

Decline in percentage of people voluntarily insured in public health insurance between 2000 and 2025

“Voluntary insured members (Freiwillig Versicherte)” represent the smallest group within the public insurance system. This group represented 9.2% of the people insured in public health insurance in 2000 and has decreased to 8.5% in 2025.

As mentioned previously, the main reasons for the decline are

• People are losing trust in the ability of the public healthcare system to offer good coverage at an affordable price.
• Increasing attractiveness of private health insurance (PKV) for higher-income individuals.

How confident are Germans in their health insurance policy?

As per the survey of Rober Bosch Stiftung, 60% of the Germans have lost confidence in the German healthcare system. Three years ago, it was only 30% of the people. 

It’s a big and justified drop. The German healthcare system is struggling due to increased expenses and reduced income. 

The healthcare expenditure was 497.7 billion euros in 2022 and is increasing consistently each year.

The factors contributing to the rising healthcare expenditure are

• Germany’s aging population. More old people (60 and above) mean more medical expenses. 31% of the German population is 60 or above as of 2024. The situation will worsen as one-third of the German population will be 60 or above by 2050. [4]

• Inflation is increasing the cost of medical treatments, medicines, etc.
• Medical science progress: Innovations in the medical field offer patients better and more treatment options. This leads to increased medical spending.
• Longer life expectancy: Life expectancy in Germany is around 81 years [5]. Statistically, each year costs the health system about twice as much as the previous one.

To cover these healthcare costs, Germany needs more young earners to contribute to the public healthcare system. However, the population of young professionals is decreasing.

All these factors make people lose their trust in the German healthcare system. People fear that the German public healthcare system will no longer be able to offer high-quality service at an affordable price.

Moreover, experts predict that health insurance premiums will increase drastically in the future.

References

• https://www.bundesgesundheitsministerium.de/themen/krankenversicherung/zahlen-und-fakten-zur-krankenversicherung/mitglieder-und-versicherte.html
• https://www.bundesgesundheitsministerium.de/presse/pressemitteilungen/finanzentwicklung-der-gkv-im-1-halbjahr-2024-pm-06-09-2024.html