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PKV Tariff Change and Tariff Optimization: How to Adjust Your Tariff
Ensuring affordable healthcare is a central concern for many people. In the face of rising healthcare costs, both the statutory health insurance (GKV) and private health insurance (PKV) face challenges in premium design.
Especially for those insured in the PKV, the question arises as to how they can manage their premiums in the long term. Changing tariffs within one's own insurance is a legally anchored instrument for tariff optimization. This article highlights the fundamental differences between the financing systems, explains the importance of old-age provisions, and shows what options insured individuals in the PKV have to manage their premiums.
Basics: Two Paths to Healthcare Financing
Statutory Health Insurance (GKV): The GKV is based on the pay-as-you-go system and the principle of solidarity. Current revenues finance current expenses. No individual provisions are made for old age. Contributions are income-dependent up to the contribution assessment ceiling (BBG).
Private Health Insurance (PKV): The PKV operates on the principle of funded insurance and the equivalence principle. Insured individuals use their contributions to prepare for their own age-related healthcare costs. A key element is the formation of old-age provisions. Premiums are based on the chosen tariff, entry age, and health status.
The Role of Old-Age Provisions: A Retirement Fund for Health
Old-age provisions are savings components within the PKV premium, built up from the start. Their goal is to stabilize premiums in old age and avoid premium increases solely due to aging. A portion of the monthly premium is used to build up these provisions over the years.
At the end of 2023, the PKV industry managed old-age provisions totaling 328 billion euros for its approximately 8.7 million fully insured members. This funded coverage makes it possible to guarantee contractually agreed benefits for life, whereas the scope of GKV benefits is legally defined and can be adjusted through reforms.
Premium Development: GKV and PKV in Comparison
Premium development in both systems shows different patterns.
In the GKV, the maximum premium regularly increases with the adjustment of the contribution assessment ceiling. For 2025, the monthly maximum GKV premium (including nursing care insurance) will be approx. 1,184 € for those with children and approx. 1,218 € for those without children.
Statistical comparisons by industry associations show that the percentage increase in premium income per capita in the GKV has been slightly higher than that of premium income in the PKV in recent decades. However, such averages do not reflect the individual situation and are therefore only of limited significance.
Premium Adjustments in PKV: Necessity and Transparency
Despite old-age provisions, premium adjustments are also necessary in the PKV. These are not arbitrary but are strictly regulated by law. Reasons include:
Rising healthcare costs due to medical progress.
Changes in the life expectancy of the insured.
The interest rate environment in the capital market, which influences the returns on provisions.
The decision on adjustments requires the approval of an independent trustee.
Tariff Optimization in PKV: Actively Managing Premiums
The PKV offers its policyholders various mechanisms to influence premium development.
The main instruments are:
Statutory Surcharge: A 10% premium portion paid between the ages of 21 and 60 is additionally allocated to retirement savings. This surcharge ceases at age 60, leading to automatic relief.
Premium Reduction Tariffs: Policyholders can voluntarily save additionally to specifically and guaranteed reduce their premiums in old age.
Discontinuation of Daily Sickness Allowance Insurance: Upon retirement, the premium for daily sickness allowance insurance generally ceases.
Tariff Change Right (§ 204 VVG): PKV policyholders have a legally guaranteed right to switch to other tariffs within their insurance company and take their old-age provisions with them. This allows them to adapt their insurance coverage to changing needs, for example, by choosing a tariff with a higher deductible to reduce the monthly premium.
Basic Tariff: As a social safety net, the basic tariff offers GKV-like benefits. The premium is capped at the GKV maximum premium and can be reduced if help is needed.
Switching back to the GKV is only possible under certain conditions and usually leads to the loss of accumulated old-age provisions.
What to Consider During Tariff Changes and Optimization
A strategic tariff change can be an effective way to optimize your premium burden.
Analyze Individual Needs: Carefully check which medical services are important to you and which deductibles fit your financial situation.
Utilize Legal Rights: Exercise your legal right to change tariffs to reduce your premium without losing valuable old-age provisions.
Consider Loss of Old-Age Provisions When Returning to GKV: Carefully weigh the aspect of capital loss if you consider returning to the GKV.
Seek Qualified Advice: Given the complexity, qualified and neutral advice is recommended to identify the most suitable options.
Conclusion: Actively Shaping Health Care Provision
Old-age provisions are a structural feature of the PKV, aiming to stabilize premiums in old age. They fundamentally distinguish the PKV from the GKV's pay-as-you-go system. Although the PKV is also subject to premium adjustments, mechanisms such as the legally enshrined tariff change offer policyholders effective tools for premium optimization. These options allow for actively shaping one's health care provision and adapting it to changing life circumstances.