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.
Switching to Private Health Insurance (PKV): Important Aspects and Potential Pitfalls
Switching to Private Health Insurance (PKV) is a long-term financial decision. Mistakes in the selection process can lead to coverage gaps or suboptimal premium structuring. While the PKV offers individually definable benefits and contractual guarantees, its premiums, unlike those in statutory health insurance (GKV), are not dependent on income but primarily on age at entry and health status at the start of the contract.
Due to the long-term commitment, precise planning and knowledge of relevant factors are crucial. This article highlights important aspects of switching to the PKV and how they can influence costs. First, the basics of premium calculation will be explained, followed by an analysis of five key points, and finally, a checklist for the switch will be provided.
1. Basics of PKV Premium Calculation
The cost structure in the PKV differs fundamentally from that of Statutory Health Insurance (GKV).
GKV – Income and Distribution: In the GKV, contributions are income-dependent up to the contribution assessment ceiling (BBG). Financing is based on the distribution principle, with no individual age reserves being formed.
PKV – Risk and Age: In the PKV, premiums are based on the selected tariff, the age at entry, and health status. The PKV operates on the funded system principle. This means that the premium includes the formation of age reserves to compensate for the rising healthcare costs in old age. Getting older alone does not lead to a premium adjustment.
2. Analysis: Five Key Aspects and Their Consequences
Certain factors in the switching process have significant financial implications.
Aspect 1: The Timing of the Switch
The premium in the PKV is significantly dependent on the age at entry.
Consequence: Since the premium is calculated over the entire insurance period in the funded system, a later entry means less time for building up age reserves. The insured person must save higher reserves in a shorter period, resulting in a higher initial premium.
Aspect 2: The Health Check
Health status is a central calculation factor. The health check is mandatory.
Consequence and Risk: Incomplete or false information can lead to the contract being challenged and loss of insurance coverage. If pre-existing conditions are disclosed, the insurer may agree on a risk surcharge. Although the surcharge increases the premium, it secures full coverage for the condition in question.
Aspect 3: Family Planning
The PKV is based on the equivalence principle, meaning each family member pays their own premium.
Consequence: Unlike the contribution-free family insurance of the GKV, premiums for children and non-earning partners accumulate in the PKV. In so-called mixed marriages (one parent in PKV, the other in GKV), under certain income constellations, children may also have to be insured on a contribution-paying basis.
Aspect 4: Tariff Selection
Choosing an unsuitable tariff can lead to unwanted costs.
Tariffs that are too low: Inexpensive tariffs may have coverage gaps (e.g., for dental prosthetics), which can lead to high out-of-pocket expenses in the event of a claim.
Tariffs that are too high: Those who opt for benefits they do not need pay unnecessarily high premiums. To specifically reduce premiums in old age, premium reduction tariffs (BEK) can also be taken out.
Aspect 5: Financial Framework (Taxes and Subsidies)
Failure to utilize financial advantages increases the monthly net burden.
Cost optimization: Premiums for basic coverage are tax-deductible (approx. 80-95% of the total premium, depending on the tariff). Additionally, the employer contributes a subsidy towards the premiums, reducing the actual burden for the employee.
3. Recommendations for Action for Cost-Conscious Switching
A strategic approach can help optimize insurance coverage.
Checklist for Switching:
Check prerequisites: For employees, switching is only possible if their regular annual income exceeds the annual income threshold (JAEG). The JAEG for 2025 is 73,800 Euros annually (6,150 Euros monthly) and is expected to be reassessed in Autumn 2025 for 2026.
Secure health status (Option Tariffs): Those who can or wish to switch to the PKV later can