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Contribution Calculation for Pensioners in GKV and PKV: A Detailed Comparison

The transition into retirement brings a variety of changes, including how health insurance contributions are calculated. The decision for statutory health insurance (GKV) or private health insurance (PKV), often made years earlier, shows its financial consequences in old age based on fundamentally different models. This article illuminates the mechanisms of contribution calculation in both systems to enable a comprehensive understanding of the respective frameworks for pensioners.

1. Fundamentals of Health Insurance Systems

Statutory Health Insurance (GKV): GKV is based on the principle of solidarity. Contributions are based on income, and benefits are based on medical need. In the pay-as-you-go system, current income is used directly to finance current expenses. No individual reserves are built up for old age.
Private Health Insurance (PKV): PKV follows the principle of equivalence. Contributions are based on tariff, age of entry, and health status; benefits are individually agreed upon by contract. In the funded system, part of the contributions is saved as retirement reserves.

2. Contribution Calculation in GKV for Pensioners

For most pensioners, compulsory insurance under “Krankenversicherung der Rentner” (KVdR) applies.

Assessment Bases: Contributions are levied on statutory pensions, company pensions, and income from life insurance policies. For voluntarily insured pensioners, all income is considered (including rent, capital assets).
Contribution Rate: The rate consists of the general rate (currently 14.6%) and the fund-specific additional contribution (forecast 2025: 2.5%).
Subsidies: Pensioners receive a subsidy from the pension insurance (7.3% of the statutory pension).
Long-term Care Insurance (SPV): Contributions to long-term care insurance are also due on the pension.

3. Contribution Calculation in PKV for Pensioners

In PKV, contribution calculation in old age is decoupled from current income.

Contribution Basis: The contribution amount continues to be based on the originally chosen tariff.
Retirement Reserves: Reserves accumulated over decades are used to offset rising healthcare costs.
Contribution Alleviation Factors in Old Age:
- Abolition of the Statutory Surcharge: The 10% surcharge paid until the age of 60 is abolished.
- Abolition of Daily Sickness Allowance: The contribution for this service, no longer needed, is dropped.
- Contribution Alleviation Tariffs: Additional provision can specifically reduce contributions in old age.
- Tariff Change: The statutory right (§ 204 VVG) to change tariffs within the insurance remains in place.
Contribution Adjustments: Despite stabilization, adjustments may be necessary in the event of high cost increases.
Social Security: For emergencies, there is the basic tariff, whose contribution is limited to the GKV maximum contribution.

4. Comparison of System Dynamics

Challenge for GKV: In the pay-as-you-go system, a shrinking number of contributors financing a growing number of pensioners can lead to an increase in contribution rates.
Challenge for PKV: In the funded system, stability depends on the development of healthcare costs and capital market returns.

Statistics on historical contribution developments should be viewed with caution, as they often only compare percentage increases and do not reflect the absolute contribution amount.

5. Decision Factors for Health Insurance in Old Age

GKV Advantages: Contributions are adjusted to the level of retirement income. In the case of a low pension, this leads to a correspondingly low contribution.
PKV Advantages: Contributions are decoupled from income in old age. Those with high income benefit from this. The scope of services is contractually guaranteed.

A return from PKV to GKV is generally not possible for pensioners. The decision is therefore usually final.

Summary

In GKV, contributions are linked to the amount of retirement income. The system reacts directly to demographic and economic developments.
In PKV, contributions are based on a lifelong contract and pre-calculation with retirement reserves. They are independent of income in old age.

The choice of the appropriate system depends on individual life and financial planning, risk tolerance, and personal preferences regarding the relationship between contribution and benefit.

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