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Contributions in Private Health Insurance (PKV): How Your Contribution is Calculated and What Influences the Costs
The monthly contributions to Private Health Insurance (PKV) are a central topic for many insured individuals and often a cause for questions and discussions. Unlike statutory health insurance (GKV), whose contributions depend primarily on income, contribution calculation in the PKV is based on a more complex system. But what factors actually determine the amount of these contributions, and how does PKV ensure that they remain affordable in old age? Understanding these mechanisms is essential for being able to assess the functioning of PKV and one's own coverage in the long term.
In this article, we will shed light on the legal bases and mathematical models underlying PKV contribution calculation. We will break down the individual components of the contribution, identify the decisive influencing factors, and explain the role of age reserves in detail. Furthermore, we will discuss the reasons for contribution adjustments and outline which tax aspects are relevant when considering contributions. The goal is to provide you with a transparent and objective picture of the PKV contribution system.
Fundamentals: PKV Contribution Calculation in System Comparison
The German health insurance system fundamentally differs in its financing and contribution principles between statutory health insurance (GKV) and private health insurance (PKV). Both systems fulfill the insurance obligation valid in Germany.
Principles of Contribution Calculation
Statutory Health Insurance (GKV): Operates according to the solidarity principle. Contributions are based on the economic capacity of the insured, i.e., on income, up to the respective contribution assessment ceiling (BBG). For voluntarily GKV-insured individuals, other income such as rental, interest, and rental income can also be used for contribution calculation. Age reserves are generally not formed in the GKV. Instead, revenues are immediately used to finance current benefit expenses, which is known as the pay-as-you-go system. Contribution rates and additional contributions can also be influenced by tax subsidies.
Private Health Insurance (PKV): Is based on the equivalence principle. Here, the contribution is based on the contractually agreed benefits and the individual risk of the insured. Decisive factors are the entry age and health status at the time of contract conclusion, as well as the chosen tariff. A significant component of the PKV contribution is the formation of age reserves. These reserves are intended to cushion rising health costs in old age and prevent contributions from increasing solely due to aging. Financing is provided without tax subsidies.
Capital Funding System and Age Reserves
The capital funding system is the foundation of PKV financing. Part of the contribution is used from the beginning as a savings component for age reserves. These reserves are accumulated over the entire insurance period and invested with interest. They serve to cover the higher health costs that arise in old age. The entire PKV industry formed age reserves totaling EUR 328 billion in 2023 for 8.7 million privately insured individuals, averaging nearly €38,000 per insured person. This contrasts with the GKV, which does not form such reserves and is therefore more directly affected by demographic changes. Continuous contributions to age reserves are a core feature of PKV.
In-depth: Components of the PKV Contribution and Their Influencing Factors
Contribution calculation in PKV is an actuarial model that considers various components to ensure long-term stable and risk-appropriate calculations.
Structure of the Contribution
The PKV contribution consists of several elements based on the legal framework of the Insurance Supervision Act (VAG).
Risk Contribution (Per Capita Claim): This contribution covers age-dependent insurance benefits. It is statistically recorded per tariff and considers the benefit needs in different age groups. The risk contribution generally increases with age, as healthcare costs and thus insurance benefits rise with age.
Net Contribution: To comply with the principle of consistently stable contributions over time (without considering the increase in healthcare costs), the net contribution is calculated as the average risk contribution over the probable insurance period. This means that insured individuals pay a higher contribution in their younger years than would be necessary to cover their current health risk. This