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.
Will my premiums increase if I get seriously ill?
The question of whether a serious illness drives up health insurance premiums is a central concern for many insured individuals in Germany. Both statutory health insurance (GKV) and private health insurance (PKV) have different approaches to handling the costs of illnesses and how this affects premiums. It is important to understand the underlying principles of both systems to answer this question objectively.
Fundamentals of Premium Calculation and Financing
Statutory Health Insurance (GKV)
The GKV is based on the principle of solidarity and the pay-as-you-go system. Current premium income finances the ongoing benefit expenses of the entire community of insured individuals. Premiums are income-dependent. No funded pension reserves are formed. The scope of benefits is uniformly defined for everyone in the SGB V and is based on the requirement for adequate, appropriate, and economical care.
Private Health Insurance (PKV)
The PKV operates according to the principle of equivalence and uses a funded system. The premium amount is based on the chosen tariff, age at entry, and health status at the time of contract initiation. Part of the premium is used to build up pension reserves. The agreed scope of benefits is contractually guaranteed and cannot be unilaterally reduced by the insurer.
Do PKV Premiums Remain Stable in Case of Illness?
For private full-coverage health insurance, termination by the insurer due to an illness that has occurred is legally excluded. Likewise, individual premium increases for individual policyholders due to new illnesses are not permissible.
Premium adjustments are not arbitrary but apply to an entire tariff collective. Triggering factors include general developments such as rising treatment costs or increased life expectancy. Additionally, the following factors influence the premium amount in old age:
Statutory Surcharge: A 10% surcharge is levied until the age of 60. Upon reaching this age limit, it is waived, which reduces the premium.
Waiver of Daily Sickness Allowance: Upon retirement, the premium for the daily sickness allowance is discontinued.
Premium Reduction Tariffs (BEK): Insured individuals can voluntarily provide for a guaranteed reduction in their premiums in old age.
Tariff Change Right: There is a legal right to switch to a different tariff within the insurance, with pension reserves being credited.
Basic Tariff: For financial emergencies, there is the basic tariff, whose premium is limited to the GKV maximum premium and can be reduced or waived in cases of need.
How Does the GKV Handle Costs in Case of Illness?
In the GKV, an individual illness does not lead to an increase in the income-dependent premium. According to the principle of solidarity, the costs are borne by the community of insured individuals.
The absolute premium amount for the individual depends on the politically determined contribution rate and the amount of assessable income. As the contribution assessment ceiling (BBG) is adjusted annually to wage developments, the absolutely payable premium increases continuously with corresponding income.
Recommendations for Action
The choice of the appropriate health insurance depends heavily on the individual life situation.
Inform yourself in detail: Carefully compare the benefits and cost structures of both systems.
Consider the long term: Think about the premium development in old age.
Examine individual options: Explore supplementary insurance (GKV) or tariff change options (PKV).
Seek qualified advice: Due to the complexity, qualified advice is recommended.
Summary
The assumption that serious illnesses automatically lead to higher premiums must be differentiated.
In the PKV, individual premium increases or terminations due to illness are legally and contractually excluded. General adjustments apply to the entire collective.
In the GKV, an individual illness also does not lead to a direct premium increase. The community bears the costs.
Both systems have their own mechanisms for cost regulation. Understanding these differences is crucial for making an informed decision.