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The Changing Costs of Private Health Insurance with Age: An Overview
Choosing health insurance is a significant financial decision. A key aspect of this is the long-term development of premiums, especially in Private Health Insurance (PKV). The concern about high premiums in old age is widespread. This article examines the mechanisms of premium calculation in the PKV across different life stages, compares it with Statutory Health Insurance (GKV), and shows which factors influence costs.
1. Basics of Premium Calculation and System Differences
In the GKV, premiums are income-dependent up to the contribution assessment ceiling (BBG). The system operates on a pay-as-you-go basis, where current income covers current expenses. No individual age reserves are accumulated.
In the PKV, premiums are primarily dependent on the chosen tariff, entry age, and health status. In a funded system, a portion of the premium is saved as age reserves to finance age-related increases in healthcare costs.
For 2025, the annual income threshold (JAEG), above which employees can switch to the PKV, is €73,800. The maximum GKV contribution (including long-term care insurance) for childless individuals is approximately €1,218 per month.
2. Premium Development in the PKV in Old Age
A common concern regarding the PKV is premium development in old age. The system includes several mechanisms designed to stabilize premiums. Premium adjustments are legally regulated and not arbitrary. The calculation includes components from the outset to dampen premiums in old age:
Age Reserves: A significant portion of the premium is saved from the beginning to compensate for future cost increases (end of 2023: approx. €328 billion industry-wide).
Abolition of Statutory Surcharge: A 10% premium surcharge is waived upon reaching the age of 60.
Abolition of Daily Sickness Benefit Insurance: Upon retirement, the premium for daily sickness benefit insurance is typically waived.
Pensioner's Subsidy: Pensioners insured in the PKV also receive a subsidy from the statutory pension insurance.
Premium Relief Tariffs: Insured individuals can make additional provisions to specifically reduce their premiums in old age.
3. Premium Trajectories and Entry Age
The entry age is a crucial factor for the premium amount in the PKV. An earlier entry means a longer saving period for age reserves, which generally has a positive impact on long-term premium stability. A later entry leads to higher initial premiums, as the same reserves must be accumulated in a shorter time.
4. Comparison of Premium Development GKV vs. PKV
In the GKV, the burden is directly linked to income development and the annual adjustment of the BBG.
In the PKV, adjustments depend on the general cost development in healthcare and returns on the capital market.
Statistics from industry associations show that the percentage increase in contribution income per capita in the GKV has been slightly higher than that of premium income in the PKV over the past decades. However, such averages do not reflect the individual situation and are of limited significance.
5. Tax Deductibility and Family Aspects
Taxes: Contributions for basic health and long-term care insurance are equally tax-deductible for both GKV and PKV insured individuals. Premiums for comfort services in the PKV (e.g., single room) are generally not deductible.
Family: The GKV offers the advantage of contribution-free family insurance. In the PKV, each family member requires their own premium. However, there are heavily subsidized tariffs for children, and employers provide a subsidy for their employees' children's premiums.
6. Flexibility and System Commitment
Benefits: In the PKV, benefits are contractually guaranteed. In the GKV, the scope of benefits is legally defined and can be adjusted through political reforms.
Tariff Change: PKV insured individuals have a legal right (Sec. 204 VVG) to switch to other tariffs within their company. Age reserves are retained in this process.
System Change: A return from the PKV to the GKV is only possible under certain conditions and generally only up to the age of 55.
Conclusion and Outlook
The decision between GKV and PKV should be based on a long-term perspective. Premiums in the PKV are calculated to be stabilized in old age through age reserves. Nevertheless, like GKV premiums, they are not static.
While the GKV offers an income-oriented premium burden and family insurance, the PKV allows for customizable and contractually guaranteed benefits. Long-term affordability in the GKV depends on societal development, and in the PKV, on individual savings and the development of healthcare costs. Careful planning and independent advice are therefore essential.