Statutory health insurance: well insured in old age

The statutory health insurance is a fixed part of the social system in Germany. It also reliably protects pensioners in old age, without making contributions unaffordable despite high health care costs. But what exactly is public health insurance and what are the options for being insured after retirement?? We show tips and background. We also provide you with a list of public health insurance and a comparison of the cheapest premiums.

Statutory health insurance: list of health insurance companies

Around 90 percent of the population in Germany is insured under the statutory health insurance scheme. If you are self-employed or your salary exceeds the annually adjusted income threshold, you have the option of either taking out private insurance or remaining in the GKV on a voluntary basis. However, he must choose one of the two options, because in Germany health insurance is compulsory by law. Without health insurance may be no resident of the Federal Republic, even if there are isolated citizens who still fall through this grid.

But which health insurances are legal? In Germany, there are the following different types of health insurance:

• General local health insurance funds (AOK)
• Substitute insurance companies (EK)
• Guild health insurance funds (IKK)
• Company health insurance funds (BKK)
• Agricultural health insurance (LKK)
• Knappschaft (KBS)

All health insurance companies that have these designations in the name are therefore statutory. The differences between them are on the one hand slightly in their contribution rate and their benefits, on the other hand in their carrier. Most of these funds are now open to all – the distinction is merely historical.

What does statutory health insurance mean?

The statutory health insurance (GKV) was introduced in 1883 by Chancellor Bismarck in Germany and was intended at that time to help ensure that especially the continued payment of wages in case of illness for a certain period was secured. Even then, the costs were divided between employers (one third) and employees (two thirds).

Today, both parties share the contributions equally – they make up about 15 percent of the gross salary, depending on the fund. Not only does it ensure a paycheck, but it also covers the high medical and hospital expenses.

Statutory health insurance is thus an integral part of the German social security system, along with statutory pension insurance, unemployment insurance, statutory accident insurance and long-term care insurance.

Can I leave the statutory health insurance?

Anyone who is self-employed or who exceeds the so-called contribution assessment ceiling (in 2021: 58.050 per year) with his earnings can leave the statutory health insurance in favor of private health insurance (PKV). This decision should be well considered, because a return to the GKV is then only possible if the insured person returns to an employment relationship, in which he earns below the contribution assessment ceiling.

Private and statutory health insurance differ fundamentally in their structure – especially with regard to the calculation of premiums and benefits. While the contributions in the GKV depend exclusively on the earnings, the costs for a PKV orient themselves after the secured achievements and the height of the annual deductible.

The maximum contribution to be paid for statutory health insurance is also determined by the income threshold. This means that income above this is no longer included in the calculation of the contribution rate.

Statutory health insurance: compulsory or voluntary?

But when is one compulsorily insured by law? In principle, every employee is first of all insured in the statutory health insurance scheme. As mentioned, he can take out private health insurance if his income exceeds the income threshold. Or he remains voluntarily in the public health insurance system.

This does have its advantages, as public health insurance provides free coverage for immediate family members (spouse, children) who do not have their own income. Another advantage is the billing method: So the doctors and hospitals settle directly with the statutory health insurance. Those with private insurance, on the other hand, receive a bill for which they have to pay in advance and which is then reimbursed by the insurer.

However, especially for young people, private health insurers offer better benefits at lower premiums. This is attractive for many people. The fact that they can no longer return to the statutory health insurance in old age and then often can not pay the contributions – think of the fewest.

Statutory health insurance: comparison

Every insured person is free to choose his health insurance fund. In the question of which is the right statutory health insurance in an individual case, the additional benefits also play a role in addition to the premiums. There are now quite a few sites on the Internet for an overview, which offer an insurance comparison and compare this in detail in a table.

Who wants to see which statutory health insurance is the best for him in comparison 2021, for example, can compare benefits and contributions on these two pages:

Statutory health insurance: costs and contributions

What is decisive for many when making their choice: How much does the statutory health insurance cost?? Contributions vary between 15 and 17 percent of income. Whereas the contribution rates can change annually among the individual insurers.

The cheapest health insurance plans in 2021 are:

• HKK – 14.99 percent
• BKK Firmus – 15.44 percent
• Debeka BKK – 15.5 percent
• BKK 24 – 15,6 percent

Statutory health insurance: These are the benefits

Statutory health insurance is largely bound to the provisions of the Fifth Social Code (SGB V) – only the offer of some additional services (for example, the reimbursement of alternative therapies such as acupuncture, homeopathy or chiropractic) distinguish the individual insurance companies from each other.

The compulsory services consist of payments of:

• Precautionary, early detection and prevention
• Medical treatment and psychotherapy
• Dental treatment and dental subsidies
• Subsidies for prescribed medicines, remedies and aids
• Hospitalization
• Rehabilitation
• Sickness benefit
• Health insurance
• Home care and home help
• Delivery

Statutory health insurance in old age

If you were insured in a private health insurance before retirement, this will remain the case in retirement as well. To ensure that premiums can continue to be financed, so-called premium reserves for old age were retained during the years of employment and are now being offset. Although this reduces costs considerably, private health insurance is still difficult for many retirees to afford, which is why many regret not being allowed to switch to statutory health insurance.

Who was member in its last occupation years (90 per cent of the second half of the working life) on the other hand in the GKV or as independent ones a requirement on a legal pension has, is insured with the retirement in the health insurance of the pensioners (KVdR) and is exempted with many incomes from the contributions. The KVdR is not a separate insurance but only a variant of the GKV. The carriers are still the corresponding health insurance companies.

Anyone who does not meet these requirements must take out voluntary health insurance coverage. At first glance, this sounds absurd, as there is a compulsion to take out "voluntary" insurance, but this is due to the compulsory health insurance that exists in Germany.

Contributions to retiree health insurance

For those insured on a voluntary basis, this means that you will remain in your respective health insurance fund, just as you would if you were insured under the KVdR. Both groups must pay there on a contribution of 7.3 percent on their statutory pension. This applies not only to the old-age pension, but also to other state pension payments, such as the widow's pension.

In addition, both voluntarily insured persons and members of the health insurance of pensioners have to pay 14.6 percent of a possible gross income from a professional activity as usual, half of which is paid by the employer, as mentioned above. Those who continue to work at retirement age also continue to pay their contributions, as long as their earnings are above the mini-job limit.

This also applies to pension payments such as company pensions from an allowance of currently 164.50 euros per month (as of 2021). What distinguishes the KVdR from the voluntary statutory health insurance in old age is the fact that all other income is not counted in the KVdR, but in the voluntary GKV already. This concerns in particular:

• Rental income
• Interest and dividends
• Private pensions

Voluntary members of the public health insurance system must pay a flat rate of 14 percent on this income. Therefore, in this point the possibility to be in KVdR is quite attractive.

Change to compulsory health insurance

For many, it can therefore be quite attractive in retirement age to be insured in the health insurance of pensioners. However, it is almost impossible, especially for privately insured persons, to simply cancel their insurance and switch back. At the age of 55 at the latest, the door is usually closed for a return, unless the persons concerned fall below the compulsory insurance limit as an employee, which happens in the rarest cases.

Therefore, everyone who has the possibility to remain voluntarily in the statutory health insurance should decide early on how they want to be insured in old age. It is recommended to make this long term decision even before the 40. to meet the age of 10, if possible, because otherwise it will be difficult to get into the KVdR later on.

However, anyone who decides to take out private health insurance should not be blinded by attractive premiums at a young age, but should also have the expected payments at retirement age calculated and then decide to what extent these correspond to the possibilities of one's own retirement provision. So later nasty surprises can be avoided. Those who are close to retirement usually no longer have a choice about how they will be covered in the event of sickness.