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.

Costs of Private Health Insurance (PKV) Depending on Age: Examples and Premium Development

The concern about the development of healthcare costs in old age is widespread. In particular, premiums for Private Health Insurance (PKV) are often the subject of discussion. This article examines the different premium calculations of the Statutory Health Insurance (GKV) and the PKV, explains the role of age in PKV premiums, and shows how costs can develop over time. The goal is to provide a well-founded, neutral basis for personal decision-making.

Fundamentals of Premium Calculation: GKV vs. PKV

The premium calculation in German health insurance differs fundamentally between the GKV and the PKV.

In the GKV, premiums are levied income-dependent up to the contribution assessment ceiling (BBG). The system works on a pay-as-you-go basis, where current income finances current healthcare expenses. No individual longevity reserves are formed.
In the PKV, the calculation is based on the funded system. Premiums depend on the chosen tariff, the age of entry, and the state of health. A key feature is the formation of longevity reserves, which serve as provisions for age-related increasing healthcare costs.

Premium Development in the PKV: Age and Long-Term Stability

Premium calculation in the PKV is designed to keep premiums as stable as possible over the entire contract duration by taking age-related cost development into account from the outset.

How PKV Premiums are Calculated

The premium in the PKV consists of several components:

Risk premium: This covers the statistically recorded benefit needs in the individual age groups.
Savings component (longevity reserves): To enable stable premiums in the long term, insured individuals pay a premium in their younger years that is higher than the pure risk costs. The surplus is invested with interest as longevity reserves to offset higher costs in old age.
Statutory 10% surcharge: From age 21 to 60, a surcharge is levied, which also serves to stabilize premiums from the age of 65.

Reasons for Premium Adjustments

Premium adjustments (BAP) in the PKV are not arbitrary increases. They are strictly regulated by law and do not occur solely due to aging. The main reasons are:

General cost increases in healthcare (e.g., due to medical progress).
A higher life expectancy than originally calculated.
Changes in the capital market (interest rate level).

Adjustments must be reviewed by an independent trustee.

Premium Development in Comparison: PKV and GKV

Long-term premium development is often discussed. Statistical comparisons by industry associations show that the percentage increase in contribution income per capita in the GKV has been slightly higher than that of premium income in the PKV in recent decades.

GKV premiums increase due to several factors:

Every salary increase below the contribution assessment ceiling (BBG) leads to a higher absolute premium.
The annual increase in the BBG increases premiums for high earners. The GKV maximum premium (including nursing care insurance) will be approx. €1,218 (childless) in 2025 and is expected to rise to approx. €1,250 in 2026.
Health insurance funds charge individual additional contributions, the average of which is forecast for 2025 at 2.5% and for 2026 at 2.7% to 2.9%.

Tax Advantages and Relief in Old Age

The Citizen Relief Act allows contributions to basic coverage in health and nursing care insurance in both systems to be claimed for tax purposes.

In addition, the PKV offers various mechanisms for premium reduction in old age:

The statutory 10% surcharge is waived from the age of 61.
Upon retirement, the premium for daily sickness allowance is usually waived.
Premium relief tariffs allow for additional, voluntary provision.
The tariff change law according to § 204 VVG allows insured individuals to switch within their company to a tariff with a different scope of benefits or a higher deductible in order to reduce premiums.

Case Studies on Premium Development in the PKV

The age of entry is a crucial factor for the premium amount. An earlier entry allows for a longer savings phase for longevity reserves, which tends to have a positive impact on long-term premium stability. A later entry leads to higher initial premiums, as the same reserves must be built up in a shorter time. Individual contract developments always depend on the chosen tariff, the state of health, and general cost developments.

Recommendations for Action: Making the Right Decision

The choice between GKV and PKV should be made carefully, taking into account individual life circumstances and long-term financial planning.

When is a switch to the PKV possible?

The choice is primarily available to:

Employees whose income exceeds the annual income limit (JAEG).
- JAEG 2025: €73,800
- JAEG 2026 (Forecast): approx. €76,800
Self-employed and freelancers.
Civil servants.

Important Factors for Your Decision

Scope of benefits: Is statutory defined care (GKV) sufficient for me, or do I want contractually guaranteed, individualizable benefits (PKV)?
Premium amount and stability: Does an income-dependent premium (GKV) or a risk-based premium with retirement provision (PKV) better suit my financial planning?
Family planning: How does the contribution-free family insurance of the GKV affect my overall costs compared to individual premiums in the PKV?

Conclusion and Outlook

The cost development of the PKV by age is a complex topic. The system, through the funded system and the formation of longevity reserves, is designed to stabilize premiums in the long term. Premium adjustments are possible but follow clear rules and are cushioned by various relief mechanisms in old age. In comparison, the GKV, with its pay-as-you-go system, is more dependent on demographic developments. Choosing the right system requires a well-founded assessment of the personal situation.

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Costs of Private Health Insurance (PKV) Depending on Age: Examples and Premium Development