Statutory or private? Who actually gets to choose in Germany

Last checked against the official sources: 29 August 2026

The question everyone asks — “statutory or private?” — rests on a false premise: that a choice exists. Under German law compulsion is the rule and choice is a narrow exception open to a handful of groups. And the sharpest edge is not the monthly maths but an age rule that shuts the door back into statutory cover after 55 — however completely your circumstances change afterwards.

The annual income threshold: the number that decides whether you have a choice

For most employees this is the only line that matters. § 6(1) no. 1 says that anyone whose regular annual pay exceeds this threshold becomes “free of insurance” — they leave compulsory cover and three roads open up: stay in the statutory system voluntarily, move to private cover, or combine the two.

But the figure itself is not in the statute, and this is where sources copied from older articles go wrong. § 6(6) gives the mechanism, not the number: the legal base is €45,900 for 2003, and the threshold then changes on 1 January each year in the same ratio as gross wages and salaries per employee moved in the previous calendar year against the year before, rounded up to the next multiple of 450, and set by the federal government in a regulation.

Worse, there is more than one threshold. § 6(7) keeps a second, lower line for a defined group: those who on 31 December 2002 were free of insurance because they exceeded the threshold then and were covered by a private substitutive policy. Their base is €41,400 for 2003, moving by the same mechanism. Two people on identical salaries can therefore sit on opposite sides of the line for a reason that dates back twenty years.

Crossed the threshold? You are not out tomorrow

§ 6(4) lays down three rules that are widely missed.

First, if your pay exceeds the threshold, compulsory insurance does not end immediately but at the end of the calendar year in which it was exceeded. You stay compulsorily insured for the rest of that year however high your income climbs.

Second — and this is the decisive one — it does not end at all if your pay does not exceed the threshold applying from the start of the next year. Because the threshold rises every January, a single good year may never push you out of statutory cover: the new threshold simply catches up with you.

Third, retroactive pay increases are attributed to the calendar year in which the entitlement to the increased pay arose, not the year they are paid out. A late bonus cannot be used to push you out of a year that has already closed.

The door that shuts at 55

§ 6(3a) is the sharpest provision in the whole file, because it does not reverse.

People who become subject to compulsory insurance after completing their 55th year of life remain “free of insurance” — that is, barred from entering statutory cover — if they were not covered by statutory insurance in the five years before that compulsion arose. On top of that they must have spent at least half of that period free of insurance, exempt from it, or outside it because of main-occupation self-employment.

Sentence 3 adds a second lock: if the exemption, the freedom from insurance or the main self-employment falls away after 55, that status is treated as continuing for the purposes of this test. Shedding it late does not open the door.

And there is an extension few people expect: sentence 4 puts marriage or a registered partnership with a person in that position on exactly the same footing. The door can close on you because of your partner’s insurance history, not your own.

The one exception: those compulsorily insured under no. 13 — people with no cover at all — are not caught by this lock.

§ 5(11): the rule that applies to non-EU residents alone

§ 5(1) no. 13 is the safety net of the German system: anyone without any other health cover becomes compulsorily insured. But § 5(11) pulls that net out from under one specific group.

Foreigners who are not nationals of an EU member state, an EEA contracting state or Switzerland are caught by no. 13 only where two conditions hold together:

• they hold a settlement permit or a residence permit limited to more than twelve months under the Residence Act, and
• the grant of that permit was not subject to a duty to secure their own livelihood within the meaning of § 5(1) no. 1 of the Residence Act.

The practical consequence surprises almost everyone who meets it: study permits and many work permits are granted precisely on condition that the holder secures their own livelihood — so the holder sits outside the residual compulsion and cannot invoke no. 13 to force a fund to take them. Cover is their own responsibility, and it is usually a condition of renewing the permit in the first place.

The final sentence closes a different question cleanly: for people entitled under the Asylum Seekers Benefits Act, cover is deemed to exist as soon as an entitlement to benefits for illness, pregnancy and childbirth exists in principle under § 4 of that Act — so they do not fall under no. 13 either.

How to decide in practice

1. Start with § 5, not with the offers. Work out which paragraph applies to you. Compulsion comes first, and comparing providers is pointless if you were never free to choose.
2. Compare your pay against this year’s threshold. Not last year’s, and not a figure quoted in an older article. It changes every 1 January by regulation.
3. If you cross it, do not rush. Your exit is deferred to the end of the year — and may not happen at all if next year’s threshold catches up with you.
4. If you are a non-EU national, read both limbs of § 5(11) together. Failing either one puts you entirely outside the residual compulsion.
5. Count your age before any move to private cover. If you are approaching 55, the move is close to final — read § 6(3a) in the original before you sign.
6. If you want to join voluntarily, start counting on day one. Three months from the end of the previous membership, from starting work, or from returning to Germany, depending on your case — and the period cannot be revived.

Frequently asked questions

Can I switch to private insurance whenever I like?

No. The choice only opens once you are outside compulsory insurance — by exceeding the annual income threshold, by an employment status such as civil servant, or by self-employment as your main occupation. Anyone covered by § 5 has no choice at all.

My salary went over the threshold this month — am I out of statutory cover?

No. Compulsory insurance ends at the end of the calendar year, and does not end at all if your pay does not exceed the threshold applying from the start of the next year.

Can I move back from private to statutory cover after 55?

As a rule, no. Anyone who becomes subject to compulsory insurance after completing their 55th year stays barred from statutory cover if they were not statutorily insured in the preceding five years and spent at least half of that time free of or exempt from insurance. The only exception is compulsion under no. 13.

I am an international student — am I covered automatically?

Enrolled students are compulsorily insured until they turn 30 under no. 9. The no. 13 safety net, however, does not reach you if your permit was granted on condition that you secure your own livelihood — which is normally the case for a study permit.

What is the deadline for joining voluntarily?

Three months, within which the fund must be notified. The clock starts differently depending on your case: from the end of the previous membership, from the birth of a child, from starting your first job in Germany, or from returning to the country.

What does health insurance cost?

The statutory contribution is calculated as a percentage of income, not a fixed amount, while private premiums are priced by age, health status and the scope of cover. Rates and extra services differ between funds — check with yours directly.