Private health insurance in old age for the self-employed: plan your premium early

An employee receives an employer contribution during working life. A self-employed person pays health insurance and Pflegepflichtversicherung (i) from their own income.

The premium in retirement is therefore already part of your retirement provision when you choose your plan today. If you only compare the current private premium with today's statutory contribution, you see only part of the cost decision.

Rising premiums 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, according to calculations by the research institute of the private health insurers. In statutory health insurance it rose by 3.9 percent per year.

These figures say nothing about the future development of a single plan. They do show that contributions in both systems have risen over the long term, and that on average private health insurance did not rise more than statutory health insurance in the period under review. We describe separately what makes up the premium stability of a single plan.

Under § 146 VAG, private comprehensive health insurance is calculated in the same way as life insurance. Part of the premium goes into ageing reserves, so that the higher health costs expected in old age are partly financed during the insured period.

The ageing reserve does not prevent premium adjustments caused by higher treatment costs or medical progress. It does ensure that the premium does not rise year after year simply because the insured person gets older.

Private comprehensive health insurance charges a statutory surcharge of 10 percent. Under § 149 VAG, this surcharge ends in the calendar year in which the insured person turns 60.

The funds built up from it are used from age 65 to finance later premium increases in full or in part. Amounts not used up must be applied to lower the premium from age 80, § 150 (3) VAG.

In 2026 our sample client pays €43.08 per month for a Krankentagegeld of €120 from day 43 (PKV-Welt sample calculation 2026). During self-employment, this component covers lost income in case of a longer inability to work.

If the self-employed work ends for good, this need for cover no longer exists in its previous form. Whether and when the Krankentagegeld (i) ends depends on the insurance conditions.

Simply extending today's total premium of €482.08 to retirement age would therefore be wrong. Krankentagegeld (i), the statutory surcharge, ageing reserves and possible subsidies change the later burden.

In 2026, privately insured pensioners who receive a statutory pension can get a subsidy from the Deutsche Rentenversicherung on application. In 2026 the subsidy is 8.75 percent of the statutory gross pension and is limited to half of the actual expenses for private health insurance.

The Deutsche Rentenversicherung pays no subsidy towards the private Pflegepflichtversicherung (i). The pensioner pays this premium alone.

For the self-employed, this sets a clear limit. Without a statutory pension, there is no subsidy from the Deutsche Rentenversicherung towards private health insurance. If you only build up small entitlements, you should expect only a small subsidy. How the subsidy works in general is explained in our article on private health insurance in old age.

A professional Versorgungswerk pays no automatic subsidy under the rules of the Deutsche Rentenversicherung. Whether your own Versorgungswerk (i)VersorgungswerkThe professional pension scheme of the chambers, for example for doctors, lawyers and tax advisors. Members pay into it instead of the statutory pension insurance.More about Versorgungswerk → provides for a subsidy must be checked in its statutes.

The Versorgungswerk (i) of lawyers in Baden-Württemberg, for example, states explicitly that it pays no subsidy towards the health insurance premium. Self-employed doctors, lawyers, tax advisors and other freelancers with a Versorgungswerk should therefore check this point before planning their retirement.

With a premium relief plan, the insured person pays an extra premium during working life. In return, the private premium is reduced by a fixed amount from the agreed age. The association of private health insurers describes this relief as a later premium reduction guaranteed by contract.

For the self-employed, this component is especially interesting if you plan to stay with your chosen insurer in the long term. The part of the premium that goes towards the later relief of basic cover can be taken into account for tax under § 10 (1) no. 3 EStG.

The planned relief, however, is tied to the contract with the insurer. If you later change company, the agreed relief is not available at the new insurer like freely available savings. The specific consequences depend on the plan conditions (PKV-Welt advice assessment 2026).

Free private provision remains available independently of the health insurer. It can therefore make sense if you want to keep a later change of insurer or other uses of the capital open.

For the self-employed, we therefore often see a combination as sensible. A predictable relief component for part of the later premium, plus freely available savings for flexibility (PKV-Welt advice assessment 2026).

If your private premium during self-employment is clearly below the comparable statutory contribution, do not treat the whole difference as extra available income. Part of it can be set aside specifically for the health insurance premium in retirement.

This turns today's premium difference into a component of your retirement provision. Whether you use a premium relief plan, free private provision or a combination depends on how much flexibility you want.

Under § 204 (1) VVG, privately insured people can switch to other plans with similar cover within their insurer. Acquired rights and ageing reserves are credited, and for additional benefits the insurer may require extra health conditions.

For a self-employed person who has been insured for many years, an internal plan change can therefore be an important lever if the premium later rises more than planned. The range of plans at the chosen insurer can become relevant decades after the contract was signed.

If the regular private premium in old age is no longer affordable despite internal switching options and your own provision, there are fallback plans regulated by law. In our view, 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. and the Basistarif should still not be the goal of normal retirement planning.

In 2026 the Standardtarif (i) is only open to insured people who already had full cover with their current insurer before January 1, 2009, have been privately insured for at least ten years and meet further statutory requirements.

The maximum premium of the Basistarif (i) in 2026 is €1,017.18 per month. In case of need under social law, this premium is limited to half in 2026, and a social welfare agency can provide additional support.

Insured people cannot switch to the Notlagentarif voluntarily. It applies when there are considerable premium arrears and is only intended as temporary protection with very limited benefits.

Our self-employed client, born in 1992, pays a total of €482.08 per month in 2026. Of this, €439 goes to health insurance including private Pflegepflichtversicherung (i) and €43.08 to Krankentagegeld (i) (PKV-Welt sample calculation 2026).

Until retirement, the premium, medical costs, the legal framework and personal income can change. A specific premium at age 67 would therefore be false precision today.

What can be planned today are the relevant components. Ageing reserves, the end of the statutory surcharge, the end of Krankentagegeld (i), a possible pension subsidy, premium relief, free provision and the right to a plan change.

For the self-employed, we do not only check whether today's premium is affordable. Our advice also covers which income will finance the health insurance later, and which part of the provision is built up inside or outside private health insurance.

A self-employed person with a statutory pension has different conditions from someone with a Versorgungswerk (i) or with purely private retirement provision. Retirement planning must therefore fit the actual pension history.

For our sample client, the right task in 2026 is therefore not to invent a premium for the year he retires. He should decide today which relief mechanisms he uses and which extra reserve he builds up for health insurance in retirement.

• § 146 VAG, calculation in the same way as life insurance.
• § 149 VAG, statutory surcharge in private comprehensive health insurance.
• § 150 VAG, use of the funds from the statutory surcharge.
• § 204 VVG, plan change.
• § 10 EStG, provision expenses.
• Association of private health insurers and its research institute, premium development 2006 to 2026.
• Association of private health insurers, premium relief plans.
• Association of private health insurers, Standardtarif (i) 2026 and Basistarif (i), Standardtarif and Notlagentarif (i)NotlagentarifAn emergency plan for privately insured people who fall behind on their premiums. It covers only acute illness and pain, as well as pregnancy and childbirth, until the arrears are paid.More about Notlagentarif → 2026.
• Deutsche Rentenversicherung, subsidy towards health insurance 2026, press release of March 23, 2026.
• Versorgungswerk (i) of lawyers in Baden-Württemberg, pension information.
• Federal Ministry of Finance, income tax guidance notes 2025, margin number 113.
• PKV-Welt sample calculation 2026, self-employed, born in 1992, €439 including private Pflegepflichtversicherung (i) with a deductible of €600, plus €43.08 for a Krankentagegeld (i) of €120 from day 43.
• PKV-Welt advice assessment 2026 on combining a premium relief plan and free provision.