Private health insurance in old age for employees: premiums, subsidies and safety mechanisms

Rising health insurance contributions are not only an issue of private health insurance. Between 2006 and 2026, premium income per insured person in private health insurance rose by an average of 3.4 percent per year. In statutory health insurance it was 3.9 percent per year (association of private health insurers and its research institute, 2026).

This statistic does not predict how a single private plan will develop. It does show that both systems have seen clear cost increases over a long period. We describe separately how you can judge the premium stability of a single plan.

In statutory health insurance, the burden rises through the contribution rate, the Zusatzbeitrag (i)ZusatzbeitragThe additional contribution each statutory health insurance fund charges on top of the general rate. Its level differs from fund to fund.More about Zusatzbeitrag → and the contribution ceiling. In 2026 the Beitragsbemessungsgrenze (i)BBG · BeitragsbemessungsgrenzeThe contribution ceiling of statutory health and long-term care insurance. Income above this amount is not used to calculate contributions.More about BBG → is €5,812.50 per month or €69,750 per year, the general contribution rate is 14.6 percent and the average additional contribution is 2.9 percent.

With the average Zusatzbeitrag, the maximum health insurance contribution in 2026 is therefore €1,017.19 per month. For a parent, long-term care insurance at 3.6 percent adds at most €209.25, so the total is €1,226.44 before the employer's share.

The long-term development is a comparison of systems, not a forecast. For a specific employee, entry age, plan, level of benefits, pension level and own provision remain decisive.

When the contract is signed, private health insurance already takes into account that health costs typically rise with age. Part of the premium therefore goes into ageing reserves, which help to finance later age-related extra costs.

Premium adjustments can still become necessary if actual costs develop differently from the calculation over a longer period. Insurers may not set their premiums freely.

Under § 155 (3) VAG, the insurer must compare the required benefits with the calculated benefits at least once a year. If the difference is more than 10 percent, the calculation must be reviewed, unless the insurance conditions set a lower threshold rate. For the calculated mortality rates, the statutory threshold rate is more than 5 percent, § 155 (4) VAG.

These threshold rates are called triggering factors. A plan can therefore stay fairly stable for several years and then take a larger premium step when the threshold rate is reached and the calculation has to be adjusted.

The new calculation takes further calculation bases into account, including insurance benefits, the actuarial interest rate, mortality and the safety loading, § 2 KVAV.

The start of your pension does not mean that the whole private premium of today simply continues unchanged. What matters is which components the contract consists of.

We calculate elsewhere what the employer contribution amounts to during employment. The risk surcharge, by contrast, remains part of the premium in retirement.

In substitutive medical expenses insurance, privately insured people pay a statutory surcharge of 10 percent. Under § 149 VAG, this surcharge is charged up to and including the calendar year in which the insured person turns 60.

The funds built up stay with the contract. Under § 150 (3) VAG, they are used from age 65 to finance later premium increases in full or in part. Amounts not used up are applied to lower the premium from age 80 at the latest.

Privately insured pensioners who receive a statutory pension can apply for a subsidy towards private health insurance. For 2026 it is 8.75 percent of the statutory gross pension, but at most half of the actual expenses for private health insurance.

With a statutory gross pension of €3,500, the subsidy in 2026 is €306.25 per month. The Deutsche Rentenversicherung pays no subsidy towards the private Pflegepflichtversicherung (i).

A company pension does not raise this subsidy. Only the statutory pension counts. How the subsidy works in general is explained in our article on private health insurance in old age.

For a fair comparison, we look at the same income situation. In 2026 our model person receives a statutory pension of €3,500 and a company pension of €750 per month. For long-term care insurance, the contribution rate for parents of 3.6 percent applies (PKV-Welt model calculation 2026).

Statutory health insurance as a compulsorily insured pensioner. With compulsory membership in the Krankenversicherung der Rentner (i)KVdR · Krankenversicherung der RentnerStatutory health insurance for pensioners. Whether you qualify depends on how long you were in statutory insurance during your working life., the pension insurance pays half of the health insurance contribution on the statutory pension. In 2026, health insurance applies an allowance of €197.75 per month to company pensions. This allowance does not apply to long-term care insurance. If the pension payment exceeds the relevant minimum income limit, the company pension is subject to long-term care contributions.

The actual statutory contribution can differ because each fund sets its own additional contribution.

Private health insurance with the same statutory pension. The calculation shows how the premium components change. It is not a forecast of the later premium of an employee who is young today.

Under these assumptions, the calculated own cost in 2026 is €555.89 in statutory health insurance and €443.12 in private health insurance. This is not a general cost advantage of private health insurance. It is a model calculation for exactly this pension and plan situation.

In retirement, statutory health insurance cannot be shown with a single flat figure. What matters is whether you have compulsory insurance in the KVdR (i) or a voluntary membership.

The KVdR (i) follows the so-called 9/10 rule under § 5 (1) no. 11 SGB V. In the second half of your working life, at least nine tenths of the time must be covered by statutory health insurance. Each child counts as a flat three years.

For pensioners with voluntary statutory insurance, other income such as capital gains and income from renting and leasing can be taken into account up to the contribution ceiling.

A premium relief plan first increases your private premium during your working life. In return, the health insurance premium is reduced from an agreed age by an amount fixed in the contract.

For employees, this structure has an extra advantage. The employer can contribute to the premium of the premium relief plan within the statutory limit of the employer contribution. The part of the premium that goes towards the later relief of basic cover can also be taken into account for tax under § 10 (1) no. 3 EStG.

For employees who want to stay with their chosen insurer in the long term, we consider a premium relief plan a strong component. Free retirement savings remain more flexible alongside it, because the capital is not tied to the health insurance (PKV-Welt advice assessment 2026).

A higher private premium does not automatically mean that the insured person has to change company. Under § 204 (1) VVG, an insured person can switch to other plans with the same insurer that offer similar cover. Acquired rights and ageing reserves are credited.

If the benefits of the target plan are higher or wider, the insurer may require extra conditions for the additional benefits. When you switch to a cheaper plan with fewer benefits, however, § 204 VVG can be an important lever to reduce the premium.

For our advice, this means the following. Before a change of company, we first check the internal plan options under § 204 VVG for people in old age who have been privately insured for many years (PKV-Welt advice practice 2026).

The Standardtarif (i)StandardtarifA statutory social plan for people who have been privately insured for many years. Its benefits are close to statutory health insurance, and its premium is capped. is not open to every privately insured person. One requirement is that you already had full health insurance with your current insurer before January 1, 2009, and that you have been privately insured for at least ten years. Depending on age, further requirements apply.

In 2026 the maximum premium of the Standardtarif (i) is €848.62 per month plus private long-term care insurance. Existing ageing reserves can reduce the actual premium.

The Basistarif is a social plan of private health insurance regulated by law. Its maximum health insurance premium in 2026 is €1,017.18 per month plus Pflegepflichtversicherung (i). In case of need under social law, the premium is halved if the statutory requirements are met.

The order of the safety mechanisms is therefore clear. Regular plan and own provision come first. Then the internal plan change under § 204 VVG. The Standardtarif (i), if accessible, and the Basistarif (i)BasistarifA statutory social plan that every private insurer must offer. Its benefits are comparable to statutory health insurance, and its premium is capped at the statutory maximum contribution.More about Basistarif → remain fallback solutions.

The age limit of 55 is especially relevant. Under § 6 (3a) SGB V, a new compulsory insurance can be excluded after your 55th birthday under certain conditions.

A decision for private health insurance should therefore not rely on being able to simply switch back to statutory health insurance shortly before retirement.

For an employee, retirement planning has several levels. Ageing reserves and the statutory surcharge are already part of the private system. The subsidy from the pension insurance can later replace part of the employer contribution that ends.

In addition, premium relief plans can make the later premium more predictable. If the burden rises more than expected, § 204 VVG offers an internal plan change, and the Standardtarif (i) and Basistarif (i) provide further fallback options.

Today's gross premium is therefore not your later own contribution in retirement. If you want to judge private health insurance for employees, look at the whole path into retirement. We describe the starting point in the costs for employees and in the private health insurance comparison for employees.

• Association of private health insurers and its research institute, premium development 2006 to 2026.
• Association of private health insurers, premium calculation, premium relief plans and Standardtarif (i) and Basistarif (i) 2026.
• Federal Ministry of Health, calculation values and contributions 2026.
• National Association of Statutory Health Insurance Funds, contributions on pension payments 2026.
• Deutsche Rentenversicherung, subsidy towards health insurance 2026 and KVdR (i).
• § 155 VAG, premium adjustment and triggering factors.
• § 149 and § 150 VAG, statutory surcharge and use of the funds.
• § 2 KVAV, calculation bases.
• § 204 VVG, plan change.
• § 5 (1) no. 11 SGB V, Krankenversicherung der Rentner (i).
• § 6 (3a) SGB V, exemption from compulsory insurance from age 55.
• § 10 EStG, provision expenses.
• PKV-Welt model calculation 2026, statutory gross pension of €3,500, company pension of €750, long-term care contribution rate for parents.
• PKV-Welt advice practice and advice assessment 2026.