This article was translated from the original human-written German version. While we strive for accuracy, we cannot guarantee it is error-free. We recommend consulting the German original for the most precise information. This content is for informational purposes only and does not constitute financial or legal advice. Always consult with a qualified professional before making insurance or financial decisions.

PKV Premium Increase: Causes and Frequency in Focus

A. Introduction

Healthcare costs are a constant topic in Germany, affecting both the Statutory Health Insurance (GKV) and Private Health Insurance (PKV). But how exactly do premium adjustments arise, especially in the PKV, and what factors influence the stability of premiums for the years 2025 and 2026? This article examines the complex causes and mechanisms of premium adjustments in the PKV, contextualizes them with the GKV, and addresses frequently asked questions.

B. Basics of Premium Calculation

The financing of healthcare in Germany is based on two different systems:

Statutory Health Insurance (GKV): The GKV is based on the solidarity principle. Contributions are based on income up to the contribution assessment ceiling (BBG). In the pay-as-you-go system, current revenues are used directly to finance current healthcare expenses; no individual contingency reserves are formed.
Private Health Insurance (PKV): The PKV is based on the equivalence principle. Contributions are based on individual risk (entry age, health status) and the chosen tariff. In the funded system, a portion of the premium is saved as contingency reserves to stabilize premiums in old age.

C. Causes and Mechanisms of Premium Adjustments

Premium adjustments are necessary in both systems to ensure the long-term financing of healthcare services. However, the reasons and the nature of the adjustments differ.

1. Causes of Premium Adjustments in the PKV

The main causes for premium adjustments in the PKV are the general cost increases in healthcare. These include:

Medical-technical progress: New diagnostic and treatment methods, as well as innovative medications, lead to higher costs.
Increased utilization of medical services.
Rising costs in hospitals.
A higher life expectancy of people.
The interest rate environment, which influences the returns on accumulated contingency reserves.

2. Mechanism of Premium Adjustment in the PKV

Premium adjustment is strictly regulated by law. An adjustment is only permissible if the actual benefit expenditures deviate from the original calculation by a legally defined percentage. The adjustment requires the approval of an independent trustee. Aging alone is legally excluded as a reason for a premium increase.

3. Causes and Mechanisms of Premium Adjustments in the GKV

The development of contributions in the GKV is significantly influenced by demographic and economic developments. The contribution burden increases due to:

Direct premium increases: This includes the adjustment of the fund-specific additional contribution and the annual increase of the contribution assessment ceiling (BBG).
Indirect premium increases: Every salary increase below the BBG automatically leads to a higher absolute contribution.

GKV financing is also supported by federal subsidies.

4. Frequency and Development of Premiums in Comparison

Premiums are rising in both systems. Statistical comparisons by industry associations show that the percentage increase in contribution income per capita in the GKV has been slightly higher in recent decades than that of premium income in the PKV.

The GKV maximum contribution (including nursing care insurance) for childless individuals will be approximately €1,218 in 2025 and will approach the mark of around €1,250 in 2026, based on the projected increase in the BBG.

D. Premium Stabilization and Relief in Old Age

1. Mechanisms in the PKV

In the PKV, there are several factors that contribute to premium stabilization in old age:

Contingency reserves: The accumulated capital stock (end of 2023: €328 billion) is used to dampen premiums in old age.
Statutory 10% surcharge: This is additionally saved from ages 21 to 60 and then ceases, which reduces the premium.
Abolition of premiums in old age: Upon retirement, the premium for daily sickness allowance usually ceases.
Premium relief tariffs: Insured individuals can voluntarily make additional provisions to specifically reduce their premiums in old age.
Tariff change law (§ 204 VVG): Insured individuals have a legal right to switch to another tariff of their insurer, taking their contingency reserves with them.
Basic tariff: As a social safety net, the basic tariff offers GKV-like benefits. The premium is capped at the GKV maximum contribution.
Subsidy from pension insurance: Pensioners insured in the PKV also receive a subsidy towards their premium from the statutory pension insurance. For 2025, this amounts to 8.55% of the statutory pension.

2. Aspects of Premium Development in the GKV in Old Age

In the GKV, pensioners pay contributions on their statutory pension and other income such as company pensions. Since no individual contingency reserves are formed, premiums for pensioners are also dependent on general cost and demographic developments.

E. Recommendations for Action for Insured Individuals

To actively react to premium adjustments, insured individuals can consider the following points:

Understand premium calculation: Familiarize yourself with the basics of premium calculation in your system.
Know options for premium reduction: Inform yourself about options such as premium relief tariffs or statutory tariff change possibilities in the PKV.
Plan early: Consider automatic premium reliefs in old age, such as the abolition of the 10% surcharge in the PKV.

F. Summary

Premium adjustments in both health insurance systems are a consequence of general cost developments in healthcare. The funded system of the PKV, with its contingency reserves, aims to stabilize premiums in the long term and cushion the impact of demographic change, in contrast to the pay-as-you-go system of the GKV. Further premium developments are to be expected in both systems for 2025 and the following years. Through conscious tariff choice, planning, and knowledge of legal options, insured individuals can proactively contribute to stabilizing their premiums in old age.

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