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.
As I get older, my contributions to the Private Health Insurance also increase.
A differentiated perspective
This article discusses the development of health insurance contributions in old age. It objectively compares statutory health insurance (GKV) and private health insurance (PKV) to analyze the concern about unaffordable contributions in retirement. To this end, the factors influencing costs in both systems are examined, and recommendations for long-term provision are given at the end.
Basics: An Overview of the GKV and PKV Systems
The German healthcare system is based on two pillars: statutory health insurance (GKV) and private health insurance (PKV). Both meet the requirements of compulsory insurance but differ fundamentally.
Statutory Health Insurance (GKV)
GKV is based on the solidarity principle. Contributions are based on income, while benefits are provided according to need. A key feature is the pay-as-you-go system: current income directly finances the healthcare costs of the elderly and sick. Retirement reserves are not formed. The scope of benefits is legally defined in SGB V as "adequate, appropriate, and economical care."
Private Health Insurance (PKV)
PKV follows the equivalence principle. Contributions are based on individual risk and the chosen scope of benefits (tariff, age at entry, health status). A significant difference is the formation of old-age reserves, which are already included in the contribution to cushion costs in old age. Benefits are contractually guaranteed and cannot be reduced by the insurer. Financing is provided without tax subsidies.
In-depth: Contribution Development in Detail – Facts and Mechanisms
GKV Contribution Development
Income Dependency: Contributions are based on income up to the contribution assessment ceiling (BBG). With every salary increase or increase in the BBG, the contribution automatically rises. In 2025, the maximum GKV contribution will be €1,174.18 per month (incl. long-term care insurance, with children).
Demographic Change: The pay-as-you-go system is influenced by the ratio of contributors to beneficiaries.
Cost Development: Contributions have risen in the long term due to medical progress and general cost increases.
Contributions in Old Age: For pensioners, the contribution is also based on income (statutory pension, company pensions, etc.).
PKV Contribution Development
Legal Regulation: Contribution adjustments are made for an entire tariff group when general factors such as treatment costs or life expectancy change.
No Individual Increase: Individual age or new illnesses after the contract has started do not lead to an unscheduled adjustment or termination.
Old-Age Reserves: Part of the contribution is used from the beginning to finance age-related increases in healthcare costs and stabilize contributions in old age.
Mechanisms for Contribution Design and Relief in Comparison
In Private Health Insurance (PKV)
Statutory Surcharge (GZ): A 10% surcharge (from age 21 to 60) is used to cushion contribution increases from age 65 onwards. The surcharge is waived upon reaching the age of 60.
Abolition of Daily Sickness Allowance (KT): Upon retirement, this portion of the contribution ceases.
Contribution Relief Tariffs (BEK): Optional tariffs to additionally save for a guaranteed contribution reduction in old age.
Right to Change Tariffs (§ 204 VVG): Insured persons can switch to other tariffs, with old-age reserves being fully credited.
Basic Tariff: A tariff with benefits comparable to GKV, whose contribution does not exceed the maximum GKV contribution and can be reduced in cases of need.
In Statutory Health Insurance (GKV)
Contribution-Free Family Insurance (§ 10 SGB V): Spouses and children can be insured free of charge under certain conditions.
Income-Dependent Contribution Adjustment: If income decreases (e.g., in retirement), the contribution automatically decreases.
Contribution Payment for Wage Replacement Benefits: Contributions are paid by the providing agency, e.g., when receiving unemployment benefit I.
Subsidy for Pensioners: Compulsorily insured pensioners receive a subsidy from the pension insurance towards their health insurance contribution.
Hardship Regulations: Regulations for reducing the contribution assessment basis in cases of low income.
Differences in Benefits in the Context of Costs
GKV: The scope of benefits is based on the economy principle (§ 12 SGB V). Co-payments and fixed amounts are regulated by law.
PKV: The scope of benefits is based on the individually chosen tariff and is contractually guaranteed. Instead of co-payments, an annual deductible is often common.
Recommendations for Action: How to Shape Your Health Insurance in Old Age
Analyze Your Situation: Consider your career, family planning, and expected income.
Understand the System Differences: Familiarize yourself with pay-as-you-go and funded systems.
Consider the Benefits: Clarify which scope of benefits meets your needs – the legally uniform scope of GKV or the individually selectable scope of PKV.
Use Advisory Services: Qualified advice is essential to find tailor-made solutions.
Inform Yourself About PKV Relief Options: Know and use options such as contribution relief tariffs and the right to change tariffs.
Check Tax Deductibility: Contributions to health insurance and relief tariffs are tax-deductible.
Summary
The development of contributions in old age in PKV and GKV is managed through different approaches.
PKV uses a funded system with old-age reserves and contractual options for provision.
GKV is based on a pay-as-you-go system, where development depends on wage and cost developments as well as demographic factors, and the contribution is linked to income.
A well-informed decision requires understanding the principles and an individual assessment of personal circumstances to ensure appropriate healthcare provision in the long term.