Child health insurance: private or statutory – the optimal choice for family health meetings
10.04.25
12
Minutes
Katrin Straub
Managing Director at nextsure
Your child’s health is a top priority. Which health insurance, private or statutory, offers the best protection and suits your family? This article examines both options so that you can make an informed decision about health insurance for your child.
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The topic in brief and concise terms
The decision between private or statutory health insurance for a child depends largely on the parents’ income, occupational status and desired benefits; the statutory health insurance scheme (GKV) often offers free family cover, while private health insurance (PKV) provides enhanced benefits in return for an individual premium.
Private health insurance contributions for children start at around €110 per month, but can be significantly lower for children of civil servants thanks to supplementary cover (from around €35), while statutory health insurance family cover is usually free of charge.
Differences in benefits are evident, among other things, in consultant-led treatment, single rooms, alternative therapies and subsidies for visual aids or orthodontics, which are often more comprehensive in private health insurance.
Understanding the Basics: Clearly Distinguishing Statutory and Private Options for Children
Statutory health insurance (GKV) often allows children to be covered free of charge. This so-called family insurance applies when one parent is a member of the GKV. The income threshold for free cover is €535 per month in 2025. For mini-job workers, the limit is €556.
Private health insurance (PKV) requires a separate contract for each child. A newborn can often be admitted without a medical examination. This applies if the application is submitted within two months of birth. One decisive advantage of PKV can be its often broader range of benefits. The statutory health insurance provides solid basic coverage. Understanding these basics is the first step towards making the right decision.
Analyse Costs: Present Contributions and Long-Term Expenses Transparently
In the statutory health insurance scheme (GKV), children are usually covered as part of the family at no additional contribution. For many families, this represents savings of over €100 per month. A voluntary statutory insurance policy for a child would otherwise cost around €220. The PKV contributions for children are calculated individually and often start at around €110 per month. Tariffs without an excess start at around €160.
For children of civil servants, PKV can be particularly affordable. Thanks to entitlement to state aid of often 80 per cent, contributions from €35 are possible. Long term, however, PKV contributions can rise more sharply than GKV additional contributions. A precise calculation of the costs of private health insurance is essential. The financial burden over many years must be considered before comparing benefit details.
Compare the scope of benefits: defining the optimal health protection for your child
Statutory health insurance (GKV) covers medically necessary basic care for children. This includes standard vaccinations and preventive check-ups such as U-examinations. Private health insurance (PKV) often offers more extensive benefits. Examples include treatment by the head consultant or a single room in hospital, which can support recovery. Alternative therapies are also reimbursed more often, up to 100 per cent depending on the tariff.
Additional benefits such as supplementary insurance for children's glasses or orthodontics are often better covered by PKV. GKV only reimburses glasses up to the age of 18. The following points illustrate typical differences in benefits:
Free choice of doctor and hospital: usually more extensive in PKV.
Reimbursement for alternative practitioners: rare in GKV, in PKV often up to 80 per cent depending on the tariff.
Coverage for over-the-counter medicines: more common in PKV.
Faster appointments with specialists: a frequently cited advantage for private patients.
Rooming-in costs: coverage for one parent staying in the child's hospital room.
The choice of system largely determines the quality and extent of care. A private supplementary insurance policy can close gaps in GKV coverage. These differences in benefits have a direct impact on access to medical care.
Optimising Access and Flexibility: Assessing the Impact on Everyday Medical Practice
Privately insured children often benefit from greater freedom in choosing a doctor. They can usually consult specialists without a referral. In the statutory health insurance scheme (GKV), access to specialists is sometimes associated with longer waiting times, sometimes several weeks. Private health insurance (PKV) advertises shorter waiting times, which can make a difference of days in acute cases. This is particularly relevant when insuring a child after birth.
A switch from private health insurance (PKV) back to the statutory health insurance scheme (GKV) is only possible for children under certain conditions. For example, when starting vocational training subject to social insurance contributions. The choice of system therefore has long-term consequences for flexibility. The decision should take the whole of childhood and adolescence into account. Let us now take a closer look at the legal framework.
Applying Expert Knowledge: Mastering Legal Frameworks and Specific Family Arrangements
Family cover in statutory health insurance (GKV) is regulated in Section 10 of Book V of the Social Code (SGB V). Children are co-insured until they reach the age of 18. This age limit can be extended to the age of 25 if they are in school or vocational training. An important condition is that the child has no own income above 535 euros (2025).
A child may, in some circumstances, need private insurance even if one parent is covered by statutory health insurance. This is the case if the privately insured parent is the main earner. Their income must also exceed the annual earnings threshold of 73,800 euros (2025). For unmarried parents, there is often freedom of choice. Our expert tip: check early on whether an option insurance policy is available in order to keep later options open. The question of whether you must have health insurance in Germany can be answered with a clear yes, as our article on insurance obligation explains. These legal details are crucial for long-term planning.
Developing Long-Term Perspectives: Ensuring Insurance Coverage During the Transition to Adulthood
When training begins or a degree course starts, family cover often ends. Young people then become liable for compulsory insurance in statutory health insurance (GKV) themselves. The premium is then around 120 euros for students. Children insured privately can often be exempted from the GKV obligation. They then remain in private health insurance (PKV), but must pay the premiums themselves.
Premiums for private health insurance (PKV) are recalculated for young adults. They then also include ageing provisions, which can lead to an increase of up to 100 percent. An early decision in favour of private health insurance can offer advantages through special youth tariffs. The Premiums for civil servants and their children often remain comparatively stable. These transitions require forward-looking planning.
The choice between GKV and PKV for your child depends on many factors. Consider your income, your employment status and the level of cover you want. GKV offers solid basic cover, often with no additional costs for the child. PKV can score points with more extensive benefits and shorter waiting times, but costs extra per child, for example 150 euros per month.
You should include the following aspects in your decision:
Current and future insurance status of both parents.
Number of children for whom contributions would be payable (PKV).
Desired scope of benefits (e.g. consultant treatment, alternative medicine, orthodontics).
Long-term financial predictability of the contributions.
Flexibility in choosing doctors and treatment methods.
Importance of waiting times for doctor’s appointments.
There is no blanket recommendation; the individual situation is decisive. Our expert tip: professional advice from nextsure can help you find the best solution for your family, especially for the question of whether your child should have private or statutory health insurance. We analyse your situation and identify potential optimisation opportunities. It is helpful to know the basics of health insurance. This will help you make a sustainable decision for your child’s health.
Request an individual risk analysis now: Have your insurance situation checked free of charge and receive specific optimisation suggestions.
More useful links
Wikipedia provides a comprehensive overview of health insurance in Germany.
Federal Ministry of Health provides information on statutory health insurance.
Gesundheitsinformation.de provides general information on health insurance in Germany.
Federal Statistical Office (Destatis) provides statistical data on health insurance, based on the microcensus.
Federal Ministry of Health presents figures and facts on members and insured persons of health insurance.
Scientific Institute of Private Health Insurance offers a comparison of private and statutory health insurance for children.
Wikipedia explains the basics of private health insurance.
Federal Ministry of Health provides information on early detection examinations for children.
Federal Ministry of Health provides key figures, data and announcements on health insurance.
FAQ
Can my child also be covered by private health insurance if both parents are covered by statutory health insurance?
Yes, even if both parents are insured under statutory health insurance and the child is therefore entitled to free family cover, you can take out private health insurance for your child. This can make sense if you want more comprehensive cover.
What happens to the child’s health insurance in the event of separation or divorce?
In the event of separation or divorce, the child’s insurance depends on various factors, including custody and the parents’ insurance status. If the child lives with the parent insured under the statutory health insurance scheme, it is usually covered there as a dependent. If the parent providing care is privately insured, the child often needs its own private health insurance, the cost of which must be borne by the parent liable for maintenance.
Is there a health assessment for children in private health insurance?
For newborns, private health insurance often offers an easier admission without a health check (child follow-on cover), if the application is submitted within two months of birth and one parent has already been privately insured with the same insurer for at least three months. The insurance cover may not be higher than that of the parent. Otherwise, a health check is customary.
What is the income threshold for contribution-free family insurance in statutory health insurance in 2025?
The general income threshold for non-contributory family insurance in statutory health insurance (GKV) is €535 per month in 2025. For children who have a mini-job, the threshold is €556 per month.
What role does government assistance play in the private health insurance costs of civil servants’ children?
The employer's subsidy significantly reduces the cost of private health insurance for civil servants' children. As the subsidy often covers 80 per cent of medical expenses, the private health insurance only has to cover the remaining 20 per cent, which can lead to very low monthly premiums.
Can I take out private supplementary insurance for my child covered by statutory health insurance?
Yes, for children insured under the statutory health insurance scheme, private supplementary insurance policies can be taken out to extend the scope of benefits. Popular options include dental supplementary insurance, spectacles insurance, or hospital supplementary insurance for treatment by the chief physician and a single room.
