The benefit expenditure of private health insurers rose by 44 percent from 2018 to 2025. This comes from an analysis by the Cologne rating agency Assekurata, reported by the trade magazine Cash. on September 23, 2026. In 2024 alone, expenditure grew by around 10 percent, and in 2025 by around 7 percent again.
If you receive a letter about a premium adjustment this fall, these figures show the cause. They also explain why the insurers are currently rebuilding their own business model.
The figures at a glance
| Period | Development of benefit expenditure | Source |
|---|---|---|
| 2018 to 2025 | plus 44 percent | Assekurata |
| 2024 | plus around 10 percent | Assekurata |
| 2025 | plus around 7 percent | Assekurata |
| 2025, private health insurance overall | €42.1 billion, plus 7.1 percent | Association of Private Health Insurers |
| 2025, health insurance only | €39.0 billion, plus 6.9 percent | Association of Private Health Insurers |
The figures from Assekurata and the Association of Private Health Insurers fit together. For 2025, both arrive at an increase of around 7 percent. At around 10 percent, 2024 was clearly above average. Such jumps reach the premium with a delay, because the insurer only detects the difference afterwards and then recalculates.
What drives the costs
There is no single reason. Several developments in the health system are moving in the same direction at the same time:
- rising costs in the health system as a whole
- more expensive medicines and new therapies
- higher hospital costs
- more services being used
- medical progress, which makes treatments possible that did not exist a few years ago
The last point belongs to an honest assessment. Part of the cost increase is the price for the fact that illnesses can be treated today where medicine used to reach its limits. How large individual bills can become is shown by the analysis of the most expensive treatment cases of a large insurer.
From cost reimburser to health partner
For a long time, the role of a private health insurer was simple: a bill arrives, the bill is checked, the money is reimbursed. Assekurata describes how the industry is moving away from this. The insurers start at two points.
| Approach | What it includes |
|---|---|
| Health management | Prevention programs, disease management for chronic illnesses, case management for serious cases, second opinion procedures, medicines management, services such as arranging appointments or supplying medical aids |
| Benefit management | Checking bills, checking medical necessity, increasingly supported by digital tools and AI |
For insured people, this has two sides. Good case management can really ease the burden after a serious diagnosis, because someone coordinates the treatment and shortens the way. Stricter checking of bills, on the other hand, you notice as more frequent queries or reduced reimbursements. In our advice practice, we see both. What counts is what the terms and conditions of your plan say, because every check has to be measured against them.
Why your premium does not simply rise with age
A common misconception is that private health insurance premiums rise because the insured person gets older. That is not correct. Getting older is included in the calculation from the start. Part of the premium goes into the ageing reserves, which are meant to absorb the higher need in old age.
The premium is adjusted when the actual benefit expenditure in a plan differs from the original calculation. Under § 155 VAG, the insurer must check this at least once a year. If the difference is more than 10 percent, the plan must be recalculated, unless the terms provide for a lower threshold. An independent trustee reviews the result. If the reasons given in the adjustment letter are insufficient, the increase can be formally invalid, as a recent ruling on a premium increase shows.
Two things follow from this that often surprise customers. Premiums rise in steps, because a plan can stay below the threshold for several years and then a large step comes. And two people of the same age can receive very different adjustments, because what matters is the plan pool, not the individual.
What you can do now
You cannot influence the cost development in the health system. You can, however, influence how well your own contract copes with it.
- Check your plan by its premium development over the past ten years, not by today’s monthly premium.
- In the event of an adjustment, look first at the plan change under § 204 VVG. Your ageing reserves are kept.
- Weigh a higher deductible against your actual use of services, not only against the premium saving.
- Do not switch insurers just because of a cheaper starting premium. The reserves you have built up are largely lost, and at most you can take the transfer value with you.
Our assessment
A rise of 44 percent in seven years is not a slip but a trend. It will shape the premium adjustments of the coming years at all insurers. Whether the health management programs will noticeably slow down the increase cannot be said reliably today. The figures over several years are still missing.
Something else is reliable: plans that were calculated carefully from the start cope better with rising costs than plans that won customers with a low starting price. If you have your contract reviewed before the next adjustment, you have more options than someone who only reacts after the letter.
Frequently asked questions
Does my premium rise because I get older?
No. Getting older is built into private health insurance from the start. Part of your premium goes into the ageing reserves, which are meant to absorb exactly this effect. Premium adjustments happen when the actual benefit expenditure in your plan differs from the original calculation and the legal threshold is exceeded.
Will premiums rise again in 2027?
For some plans, this is already certain. Several insurers have announced their adjustments as of January 1, 2027. You can find the figures per plan and entry age on our pages about the premium increase. How much your own contract is affected depends on the plan, not on the market average.
Can the insurers' health management lower my premium?
Not directly. Programs such as second opinions or case management are meant to avoid unnecessary costs across the whole plan pool and so slow down the increase. Whether this works will only show over several years in the premium development of a plan.
