If you start working in nursing after a degree programme, you have two questions to answer at the same time: what will I earn, and how am I insured? This guide explains where the figures come from, what health insurance usually looks like after you qualify, and which cover matters most in nursing. Starting a nursing career with a degree is more straightforward than it may seem at first.
Short answer: Pay in nursing with a degree follows the collective agreement or employment guidelines of your employer, not one fixed national figure. Employees usually earn less than the 2026 compulsory insurance threshold of 6,450 euros per month (as of January 2026) and stay in the statutory health insurance. Long-term care insurance is 3.6 percent in 2026, plus the childless surcharge if it applies. Last updated: October 2026.
The most important points at a glance
- Your pay follows the collective agreement of your employer. Without one, your employment contract is the reference.
- If your salary stays below the compulsory insurance threshold of 6,450 euros per month (2026), you remain in the statutory health insurance as an employee.
- You usually share health, long-term care and pension contributions equally with your employer. The childless surcharge is paid by you alone.
- Disability insurance becomes harder and more expensive to get the longer you wait. All health questions must be answered completely.
- Pay figures from forums are not collective agreement values. Rely on the pay table that applies to your post.
How much do you earn after a nursing degree?
There is no uniform starting salary in nursing. Three factors decide: the employer, the collective agreement and your grade. At a municipal hospital the pay table is usually set by the TVöD (the collective agreement for public service employees in municipalities), at university hospitals run by a federal state often by the TV-L. Church-run providers such as Caritas or Diakonie use their own employment guidelines (AVR), while private providers often have an in-house agreement.
| Employer | Basis | Where to find the table |
|---|---|---|
| Municipal hospital | TVöD (nursing) | HR department or the employers association (VKA) |
| University hospital of a federal state | TV-L or in-house agreement | HR department, collective agreement of the state |
| Caritas or Diakonie | Employment guidelines (AVR) | Employer, published AVR |
| Private care provider | In-house agreement or none | Employment contract and job advertisement |
The pay table shows the monthly salary for each pay grade and step. A reliable figure for 2026 cannot be given without the table of your own agreement, because grade and step depend on training, duties and experience. Ask your employer for the classification in writing.
What is left net?
Income tax and allowances depend on your tax class and personal situation. For the net figure, use the income tax calculator of the German Federal Ministry of Finance (bmf-steuerrechner.de). Social contributions are easier to follow. Example (assumption): gross salary 4,000 euros per month, no children, statutory health insurance, average additional contribution 2026 of 2.9 percent.
| Contribution | Total rate | Your share | Amount at 4,000 euros |
|---|---|---|---|
| Health insurance (14.6 percent plus 2.9 percent additional contribution) | 17.5 % | 8.75 % | 350.00 euros |
| Long-term care insurance (3.6 percent) plus childless surcharge (0.6 points) | 4.2 % | 2.4 % | 96.00 euros |
| Pension insurance | 18.6 % | 9.3 % | 372.00 euros |
| Total | 818.00 euros |
Unemployment insurance and income tax are not included. The contribution ceiling for health and long-term care insurance in 2026 is 5,812.50 euros per month (as of January 2026). Below that ceiling, contributions are calculated on your full gross salary.
Health insurance after qualifying: statutory or private?
With an employment contract you are generally compulsorily insured as an employee. If you have a contract with pay during a dual degree programme, section 5 (4a) of Book V of the Social Code (SGB V) puts you on the same footing as employees. Your health insurer checks the details based on your contract.
Private health insurance only becomes an option once your regular annual income is above the compulsory insurance threshold, which was 77,400 euros a year in 2026. Nursing salaries are normally well below it. For a comparison of the two systems, read our guide on private insurance at career start (in German).
Which cover matters in nursing
Nursing is physically demanding, so disability insurance deserves a close look. Under section 172 of the German Insurance Contract Act (VVG), a disability policy pays when the occupational disability begins after the policy starts. At application you must answer health questions completely and correctly under section 19 VVG. Omissions can cause problems when you claim.
| Cover | Purpose | What to check |
|---|---|---|
| Disability insurance | Income if illness ends your working life | Job description, health questions, referral clause |
| Statutory earnings-related disability pension | Basic cover through the pension insurance | Insurance periods, application with the German pension insurance (section 43 SGB VI) |
| Professional liability | Damage to patients or residents | Whether your employer covers it and to what extent |
If you are unsure about disability insurance, you can get personal advice: how we work at Academycon.
Frequently asked questions
Do I get pay during a dual nursing degree?
That depends on your contract. For dual programmes with a contract and pay, section 5 (4a) SGB V puts you on the same footing as employees. Whether you receive pay, and how much, is stated in your training or employment contract. Have practical placements and study periods explained to you before you sign.
Do I have to switch to private health insurance after graduating?
No. Below the compulsory insurance threshold you stay in the statutory system. Exemption under section 6 SGB V only applies above that threshold. Whether a switch makes sense depends on your age, health and tariff.
How does the childless surcharge affect me?
The surcharge of 0.6 percentage points has applied since 1 July 2023 to people without children from the month after their 23rd birthday, and it is paid by the insured person alone (as of 2026). A further increase of 0.1 points for 2027 is planned in the draft care reform law. That law is not yet in force, so the current rate applies.
What happens between two jobs?
A gap in cover can arise between the end of your studies and your first contract. Our guide on the gap between study and work (in German) explains how to avoid it. Plan the transition with your health insurer before a contract ends.
What to do now
- Check your contract for pay, collective agreement and pay grade.
- Ask HR for the pay table for the current year and your step.
- Confirm with your health insurer that your membership continues without a gap and which contributions apply.
- Review your disability cover before pre-existing conditions make an application harder.
Related guides
- Health insurance after study: statutory, private, family and transition
- Compulsory insurance threshold 2027
- Understanding your first payslip: gross, net, deductions
- Disability insurance for students: costs and start (in German)
Sources: Section 5 SGB V, compulsory insurance (as of October 2026) · Section 6 SGB V, exemption from compulsory insurance (as of October 2026) · Section 172 VVG, disability (as of October 2026) · GKV-Spitzenverband, fact sheet on 2026 reference values (as of January 2026) · German Federal Ministry of Health, childless surcharge (as of 2026).
Last updated: October 2026. This guide is general information, not individual advice.
