Health insurance for pensioners (KVdR): myth and reality

Why the self-employed are often barred the way to low-cost health insurance in old age


Self-employed people are lured away from statutory health insurance at a young age with reference to the lower contributions of private health insurance (PKV). Only with a lot of luck they do not find out only in old age that the costs of their PKV will rise drastically in old age. With annual premium increases around 7% for older people you are often right, if you are lucky it will only be around 4%. But 4% are already 5 times after 40 years, 7% even 15 times. – Freelancers and tradesmen then realise that the premiums could at some point in old age be higher than their own pension provision – but a switch back to statutory health insurance (GKV) is then often no longer possible. However, possible returnees are also treated worse there due to their previous PKV membership.


Myth: Mostly no compulsory insurance in the KVdR for self-employed persons

The KVdR is a compulsory insurance in the GKV for social pensioners. Only social pensioners are compulsorily insured in the health insurance scheme for pensioners (KVdR) from the start of their pension if they were voluntarily or compulsorily insured in the GKV for 90% of the time in the second half of their working life. In the case of survivors, the pre-insurance period may be satisfied by the deceased relative or the survivor’s own insurance periods. Social pensioners who do not fulfil this pre-insurance period cannot take out voluntary insurance in the KVdR, but they can remain voluntarily insured in the GKV if they were also insured in the GKV immediately before – but this can be considerably more expensive than compulsory insurance.


Myth: Lower assessment basis for compulsory GKV insurance in KVdR

Social pensioners have to pay about half of the contributions to the statutory health insurance and the full contributions to the long-term care insurance on their GRV pension. Anyone who receives company pensions or other benefits in addition to the social pension or is self-employed must also pay the full contribution rate on this income up to the maximum limit and, in the case of dependent employment, the employee contributions to health and long-term care insurance are due.
On the other hand, all other types of income, such as rent and capital income, are also fully liable for contributions in the case of voluntarily insured persons. In principle, contributions must be paid for every source of income – however, in the case of payments above the income threshold, a refund can later be applied for from the GKV.


Myth: Contribution subsidy from the pension insurance only on application

Only upon application can those insured under private health insurance and those voluntarily insured under statutory health insurance receive a contribution subsidy. This amounts to 7.3% of the domestic pension – but to a maximum of half of the KV contribution for those insured under private health insurance up to the maximum contribution of the GKV.


Myth: Without social pension no affordable health insurance for pensioners

Some self-employed people have never paid into the social pension funds or had their contributions refunded, e.g. when transferring to a pension scheme. However, if they later draw a pension of some kind, they have no possibility of being insured under the KVdR because they are not entitled to a social pension. The KVdR is a pure event for social pensioners – who does not know this, was possibly wrongly advised – with luck he can then make the adviser liable for the damage.


Myth: PKV is not interested in whether the pension is sufficient for the payment of contributions

About a possible liability of the insurance intermediary can also think about who his complete pension is hardly enough to pay contributions to the insurer. Here the PKV mediator comes into consideration, who did not inform properly about the premium development in the age. Some PKV-insured have not even experienced before that the PKV contributions are calculated actuarially according to the necessary medical costs in the tariff without any consideration of the available pension, and also increase even more in old age. However, a change of tariff with full actuarial crediting of the ageing provision in a cheaper tariff of the same insurer can result in savings of up to more than 50 %, especially for long-standing older insureds with high ageing provisions which also have a premium-reducing effect when changing tariff.


by Dr. Johannes Fiala and Dipl.-Math. Peter A. Schramm


by courtesy of

and (May 2013 issue under the headline: Health insurance for pensioners (KVdR): Myth and realities)

and (under the heading: Health insurance of pensioners only myth)

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Dr. Johannes Fiala Dr. Johannes Fiala

Dr. Johannes Fiala has been working for more than 25 years as a lawyer and attorney with his own law firm in Munich. He is intensively involved in real estate, financial law, tax and insurance law. The numerous stages of his professional career enable him to provide his clients with comprehensive advice and to act as a lawyer in the event of disputes.
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