How it works over 55

As you get older, private health insurance quickly becomes expensive. But if you then want to switch to the statutory system, it’s difficult. For whom exceptions apply.

When actor Heinz Hoenig needed expensive heart surgery in May of this year and was unable to provide proof of health insurance, the issue of private versus statutory health insurance (PKV versus GKV) became “prominent” again. Hoenig, now 72 years old, had long since left the PKV because he could apparently no longer pay the high premiums. However, he was now too old to switch to the GKV.

Basically, if you are 55 years or older, it is very difficult to switch from the private health insurance system (back) to the statutory health insurance system. We explain why this is the case and the few exceptions that exist in this guide.

The reason why it is difficult to switch from the statutory to the private system after a certain age is due to the financing systems behind them and the desire to prevent “abuse” of these systems.

• In the legal systemwhich is intended as a solidarity system, the contribution depends solely on the income of the insured person. Young people who earn a good salary but rarely have to go to the doctor pay a comparatively high amount. In return, as pensioners they benefit from a low contribution, even though they probably use more medical services.
• In the private systemwhich follows the principle of equivalence, everyone pays for the costs they incur: the premium depends on the services selected, the age at the time of signing the contract and any pre-existing medical conditions. The premium is therefore often low when you are young, but can rise significantly as you get older.

Especially in old age, there is an incentive for those with private health insurance to switch to the statutory system: depending on income, the premium could be significantly lower than in private health insurance. By setting an age limit of 55 for switching, the legislator prevents anyone from benefiting from both systems at the expense of the solidarity community.

Or to put it another way: Anyone who wants to switch to the statutory system will have to contribute money to the system for a few more years – in other words, contribute more (money) than they receive (benefits).

A change from private health insurance back to statutory health insurance for insured persons who are 55 years or older is only possible in exceptional cases – and often only if someone has already paid contributions into the statutory system. There are the following three options.

• In the five years prior to the intended change back to the statutory health insurance scheme, already legally insuredA number of conditions apply here, such as that you have not been self-employed for too long during the period or have not earned more than a certain amount of money. The exact requirements can be found in the Social Security Code. In simple terms, you would have to have been legally insured for at least two and a half years.
• You will be given a Severe disability of at least 50 percent You then have three months to apply to a statutory health insurance company for voluntary admission. However, the health insurance companies can refuse you or have the right to set a maximum age for voluntary admission, which is often under 55 years.
• Her Spouse or registered life partner is legally insured and your own income does not exceed 505 euros per month. If you are employed, you can earn up to 608 euros per month – 505 euros plus 102.50 euros for business expenses. A mini-job is also possible.

Of the three exceptions, the third option is probably the most viable for most people who switch. However, it assumes that you have almost no regular income, i.e. that you are not working full-time, nor receiving rental income, interest credits or private pensions. And it depends on your partner’s insurance.

• Tax declaration: Is private health insurance tax deductible?
• Advantages and disadvantages: Private health insurance or statutory health insurance – which is better?

Privately insured people who are older than 55 have fewer options to switch to statutory health insurance than those who are younger. In particular, the following options remain closed to older people:

• She reduce your income for one year below the so-called compulsory insurance limit – in 2024 this will be 69,300 euros gross income. This can be done, for example, by working part-time or on parental leave as an employee or by taking temporary leave. As a self-employed person, you can, for example, get a job.
• You quit or give up your business and register as unemployed for at least one month.
• She move to a European countrywhich has compulsory health insurance, and take out insurance there for at least twelve months. Often you also have to work there to do this. Possible options include the Netherlands or Sweden.

Even if most people over 55 are prevented from returning to the statutory health insurance system, this does not mean that there are no alternatives. Most older people who want to switch are probably interested in reducing their health insurance premiums. This also works if they change tariffs within the private health insurance system.

Depending on when someone joined the private health insurance scheme, either the standard tariff or the basic tariff may apply.

• The Standard tariff is open to private health insurance policyholders who concluded their contract before 2009 and remained in the gender-specific tariff (bisexual tariff). To switch to the standard tariff, they must have an income below the compulsory insurance limit (69,300 euros in 2024) or be over 65 years old.

  According to the PKV Association, insured persons in the basic tariff will pay an average of 400 euros per month in 2024, plus a deductible of up to 306 euros per year. Provisions that insured persons have saved over the years of contributions are already included. The list of benefits is generally smaller than that of statutory health insurance.

• The Basic tariff is intended for private health insurance policyholders who concluded their contract after 2009 or who switched to the so-called unisex tariff beforehand. There are no further requirements for the switch, for example in relation to income or age.

  The services in the basic tariff are comparable to those in the statutory health insurance. This is one of the reasons why the contribution is usually higher than in the standard tariff. The maximum amount is often due, which is based on that of the statutory health insurance: in 2024 this will be around 900 euros per month. If there is a need for assistance according to the Social Security Code, the private health insurance must reduce the contribution upon request.

Another tip: If you receive a statutory pension but have private health insurance, you can apply to the statutory pension insurance for a subsidy towards your health insurance contributions.