The decision to take out private health insurance should be carefully considered. Contributions to private health insurance can increase significantly as you get older and it is often no longer possible to switch back to statutory health insurance.
Private health insurance is particularly worthwhile for civil servants or people who expect a high income in old age. And unlike those with statutory health insurance, those with private insurance can insure exactly the services that are important to them. This enables individual health care that is tailored precisely to your personal needs and living circumstances.
Private health insurance is a form of health insurance coverage in which insured persons insure their health services from private providers.
Self-employed people, civil servants and employees whose income is above the annual salary limit can take out private insurance.
Advantages include single rooms, senior physician treatment and faster access to special treatments.
Higher contributions in old age and dependency on health status are possible disadvantages.
The contribution depends on the entry age, the state of health and the tariff selected.
Private health insurance (PKV) is a form of health insurance that exists in Germany alongside statutory health insurance (GKV). It enables those insured to individually design their health care and choose additional services that are not included in the GKV. This flexibility makes them particularly attractive to people who want more comprehensive medical care.
Private health insurance is not available to everyone. In order to join the PKV, you must be uninsured. This does not mean that you do not need health insurance or that you do not have health insurance at all. Freedom from insurance simply means that you are exempt from compulsory insurance in statutory health insurance. The following professional groups can choose between statutory and private health insurance:
Switching to private health insurance is particularly worthwhile for people who want to benefit from the wider range of services than in statutory health insurance. However, it should be borne in mind that contributions to private health insurance increase with age and the pension must be sufficient for this. In addition, switching back to statutory health insurance can be difficult depending on your age, employment and previous illnesses. Nevertheless, there are some aspects that speak in favor of private care.
According to the Association of Private Health Insurance, the average cost of private health insurance (PKV) is 529 euros per month, but can vary greatly depending on individual factors such as age and state of health and continues to increase with increasing age. A switch back to the statutory health insurance is possible under certain, often restrictive conditions, for example if the self-employed take up paid employment or employees reduce their salary below the annual salary limit. The decision in favor of private health insurance should therefore be carefully considered and include the certainty that it is the right choice.
PKV is particularly attractive for healthy people, as the contributions are often even lower than in GKV if the risk is low. In addition to the costs, the quality of the services must also be taken into account. Cheap tariffs can lead to high additional costs in the event of illness, as important services may be missing and adjusting the insurance is not easy, but requires a new health check, which can have a negative impact, especially if you have pre-existing illnesses. For people with pre-existing conditions, accessing private health insurance can be difficult and expensive. Private providers have the right to reject applications or exclude certain services. In the GKV, however, previous illnesses are not taken into account and there are no applications rejected.
A major disadvantage of PKV is that it does not represent a solidarity system like GKV. While the contributions in the GKV are income-dependent, in the PKV they are based on age and health status. Although premiums may initially be affordable for young and healthy people, they increase over time. An analysis by the Scientific Institute of PKV (WIP) shows that contributions have increased by an average of 3.2 percent per year over the last 10 years (2014 to 2024). This results in a total increase of almost 38 percent during this period. For example, anyone who paid 500 euros a month in 2014 would already have to pay around 690 euros a month in 2024. Despite these increases, not every increase is permitted and special guides explain how you can take action against impermissible contribution increases.
In private health insurance, retirement provisions are created to cushion the costs in old age, since visits to the doctor are more likely to occur as you get older. However, these provisions do not cover the rising treatment costs due to medical advances and inflation, so contributions can continue to rise even in the retirement phase. In order to avoid financial bottlenecks in old age, it is advisable to make financial provisions for health costs in old age at an early stage. Otherwise there is a risk that the contributions will lead to excessive demands, especially if the pension is low or unemployment occurs. In addition, it is hardly possible to return to statutory health insurance after the age of 55.
In addition, life events such as the divorce of a civil servant spouse can also increase contributions. With the divorce, the state aid granted to civil servant families no longer applies, which makes it necessary to re-register with a more expensive private health insurance plan.
Those with private insurance often have to pay medical bills themselves first and are later reimbursed by their health insurance company, which can take up to a month. For inpatient hospital stays, billing is carried out via a chip card, as with statutory health insurance, with the exception of treatment by a senior physician, which is billed directly.
When it comes to billing, there are often discrepancies between the insured and their health insurance companies. Sometimes doctors bill for treatments that are not covered by insurance, so that the insured are stuck with the costs. Before undergoing expensive medical treatment, it is advisable to check the contract documents and clarify with the treating doctor which services will be covered.
In private health insurance, certain services are indispensable regardless of individual needs. It is advisable to insure at least the standard benefits of statutory health insurance. Particular attention should be paid to:
These services form the basis for comprehensive protection in private health insurance and should be taken into account when choosing the right tariff.
When choosing the PKV tariff that is right for you, the insurance broker will show you various options that should meet your requirements in terms of benefits and contributions. It is important that you compare the services offered with those in your previous service overview to see which tariffs best suit your needs. Private health insurance rates vary widely and it can be difficult or expensive to find the perfect plan to cover all your needs. Therefore, it is important to prioritize and decide which services you absolutely need and which you can compromise on.
Also pay particular attention to unclear wording in the contract terms. Promises that are only made with reservations cannot be kept later. Your insurance broker should explain to you exactly what each clause means and what it means if certain insurance features are missing.
It’s also important to look at the insurer itself, including its customer service and how it handles health issues. Although less stringent health checks may make it easier for people with pre-existing conditions to be admitted, this can lead to higher premiums in the long term. If you have health problems, anonymous advance risk inquiries are important. These make it possible to check which insurance company would take you on and under what conditions without disclosing your personal data. This prevents a rejection from affecting your chances with other insurers. This careful review and advice will allow you to choose a tariff that represents a good compromise between cost and performance and meets your individual needs.
There is no free family insurance in private health insurance. This means that partners and children have to be insured individually, which can lead to higher costs, especially for single earners, even if the tariffs for children are usually cheaper than for adults. In the GKV, however, children and life partners can also be insured free of charge through the family insurance.
Private health insurance offers significant advantages, especially for civil servants and higher earners, as it enables tailored health services and preferential medical treatment. The decisive factor when choosing private health insurance is your individual needs and living circumstances, which determine the type and extent of the desired insurance coverage.
It should be taken into account that private health insurance contributions can increase as you get older and it may not be possible to return to statutory health insurance (GKV). This makes long-term planning and consideration essential before making the switch.
One of the main advantages of private health insurance is the possibility of insuring specific health services that go beyond the standard of the GKV, such as: B. Single rooms, senior physician treatment and faster access to special therapies. On the other hand, there are challenges such as higher premium costs in old age and the dependency of the premiums on the state of health and age at the time the contract is concluded.
In summary, private health insurance enables comprehensive and individual medical care, but requires careful consideration of the long-term financial and health situation. People considering purchasing private insurance should carefully consider all aspects, from the benefits to the possible risks, in order to make an informed decision.