Private health insurance plan analysis: choosing the right plan and insurer

Our assessment of insurers is based on the Morgen & Morgen rating for health insurers, which evaluates the insurers as a whole over a period of five years. It rests on three central partial ratings:

• Success: earning power and efficiency, measured among other things by net interest yield, cost ratios and underwriting result.
• Portfolio: development and growth of the portfolio, especially in comprehensive and supplementary insurance.
• Security: financial stability, for example equity ratio, provisions, valuation reserves and solvency ratios.

The rating makes one thing clear. The choice of the right insurer should not rest on single figures or snapshots, but on a long-term view of stability, profitability and portfolio quality.

A low entry price is one of the most common selection criteria in private health insurance. For a lasting decision, the premium development in the past says much more. Important questions are:

• How often were the premiums adjusted over the last 10 to 20 years?
• Were there stable phases or regular premium jumps?
• How strong were the adjustments in comparison with the market average?
• On which principles are the entry premiums of new plans calculated?

Many private plans differ less in their benefits than in their calculation philosophy. This only shows over the years, not in a comparison calculator.

Figures from the association of private health insurers on the price development of medical services show how strong the cost pressure in healthcare is:

• Costs of one day of care in hospital: +37.5%
• Costs of removing the tonsils: +16% (with 120% more cases)
• Costs of a cardiac catheter examination: +29% (with 120% more cases)
• Costs of medical aids, for example wheelchairs, prostheses and care beds, in 2024 alone: +10.4%
• Hospital treatments in 2024 alone: +8.7% more cases

New private plans do not automatically start cheaper than existing plans. What matters is how the insurer calculates the entry premium and how it compares with the previous plans.

The following examples from our analysis practice show how new plans are calculated compared with existing plans and how the premiums develop. In each case, an older plan (blue) is compared with a new plan (red) at a similar level of benefits.

The older Universa plan was adjusted moderately over many years. The average premium increase was about 2.36% per year, below the market average of 3.4% (association of private health insurers, 2006 to 2026). The curve of the new plan makes clear that, in our view, Universa offers the plan uni-Top/Privat 300 too cheaply. We therefore expect a higher adjustment in this new plan on January 1, 2027.

The new plan Exklusiv SI from Signal Iduna deliberately does not start cheap. In our view, it takes the current cost developments in healthcare into account realistically. We therefore consider the premium calculation of Signal Iduna sensible.

The charts show very clearly that new plans often do not start cheaper, but frequently already at the premium level that older plans only reached after many years of adjustments. The reason is simple. Insurers calculate new plans more cautiously and take known cost developments into account from the start. Older plans often start cheaper, but have to be adjusted more strongly over the years.

The comparison makes clear why the starting premium alone is not a reliable decision criterion. What matters is how a plan was calculated and how the premiums develop in the long term, regardless of whether it is an older or a new plan. Comparison portals usually do not take exactly these differences into account. We analyze real premium histories from practice, not just theoretical model calculations.

Costs in healthcare will keep rising in the future too, through new treatment methods, price increases and higher staff costs. This will continue to shape the premium development of private health insurance and the contributions of statutory health insurance.

The term plan hygiene describes how a private plan is maintained over the years. It is a central factor for premium stability and is hardly taken into account in online comparisons. It covers, among other things:

• whether the plan is open to new customers
• composition and ageing of the group of insured people
• regular benefit updates instead of one-off corrections
• a clean separation between old and new plan generations

Tariffs with poor plan hygiene often develop above-average premium increases, an unfavorable risk pool and limited switching options within the company. Our assessment is based on market observation and experience with existing customers, not on advertising claims of the insurers.

When choosing the right plan, the price for children is often underestimated. Yet private health insurers sometimes differ considerably here. Points to consider are the amount of the premium for children, how premiums for children develop over time and the rules for adding newborns to the policy.

A plan that is cheap for adults can quickly become a permanent extra burden with several children. We therefore take current and future family situations into account, not only today's status.

What happens when your circumstances change? No private plan is ideal for every phase of life. This makes exit options and flexible ways to adjust within private health insurance all the more important. Decisive points are:

• internal plan changes under § 204 VVG
• ways to reduce the premium in old age
• adjustment when you change job or your income changes
• sensible alternative plans with the same insurer

Many plans are attractive at entry, but later turn out to be a strategic dead end. We think the choice of plan through strategically, including possible switching options, before they become necessary.

With us, a plan analysis goes far beyond the monthly premium. We compare private plans in a structured way by deductible, benefits, plan hygiene, premium development, premiums for children, exit options and special features, to show transparently which plan really fits in the long term.

The following example shows an anonymized analysis from our advice. In the table, we write out the terms in full: deductible, no-claims refund, premium adjustment and employer.