Statutory or private health insurance: There are advantages on both sides

Created: 01/04/2023, 16:00

By: Laura Knops

It is not possible to say in general terms whether private or statutory health insurance is better.

Both systems have their advantages and disadvantages.

Munich – Legal or Private?

Choosing health insurance is a life decision for many people.

Because once you leave the statutory cash register, it is difficult to get back in.

Both statutory and private health insurance offer some advantages.

While privately insured patients usually get an appointment with a specialist more quickly and in some cases receive special treatment services, statutory insurance seems to offer financial advantages in particular.

However, there is no general answer as to which of the two health insurance companies is better.

Statutory or private health insurance: There are advantages on both sides

In Germany, every citizen is obliged to take out health insurance.

Some patients are spoiled for choice: because there are two systems in this country - statutory health insurance (GKV) and private health insurance (PKV) - with different contributions and benefits.

Many employees have to take out statutory insurance, but private health insurance makes more sense for other professional groups.

While the statutory health insurance (SHI) is generally accessible to everyone - with a few exceptions - inclusion in the private health insurance is only possible under certain conditions.

Not every employee can take out private health insurance.

Because with private health insurance, the so-called annual income limit (JAEG) applies, which is currently 64,350 euros.

The self-employed and those entitled to benefits can switch to a private provider regardless of their income level.

One of the biggest differences is how the contributions are calculated:

• Statutory health insurance (GKV): The contributions are calculated based on income.

  So if you earn more money, you also have to pay more – up to the contribution assessment limit, which this year is 58,050 euros.

  The contribution rate is currently 14.6 percent of gross income.

  There are also various additional contributions.

• Private health insurance (PKV): With a private policy, the contributions depend on the age and state of health of the insured person.

Statutory or private health insurance: these are the advantages of statutory health insurance

In addition to the contributions to be paid, statutory and private health insurance also differ in terms of benefits.

Since the statutory fund is a solidarity system, every insured person receives the same protection regardless of the contributions made.

There are only a few differences between the health insurance companies, because most medical services are stipulated by law.

Individual additional services are, however, possible.

A major advantage of statutory health insurance, especially for families, is that insured persons can also insure their spouses and children up to the age of 25, who earn little or no money, free of charge.

The statutory health insurance companies also accept anyone who is subject to statutory insurance, regardless of age, previous illnesses and current state of health.

Another important point is that members do not have to pay in advance and that bills are processed via the statutory health insurance.

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Statutory or private health insurance: These are the advantages of private health insurance

Those with private health insurance can actually count on some advantages when it comes to health care.

In some cases, private patients receive better medical services, can get an appointment with a specialist more quickly and can get by with more privacy in the hospital.

In addition, they do not have to make co-payments for medicines prescribed in the hospital.

When it comes to benefits, private health insurance is clearly ahead.

Since the contribution can be selected individually, people with private health insurance can choose from a wide range of services and thus adapt their health insurance to their needs.

Both higher and lower benefits are possible than with statutory insurance.

These contractually agreed benefits are also guaranteed until the end of life.

They cannot therefore be reduced by law, as is the case with statutory insurance.

Statutory or private health insurance: These are the disadvantages

However, if you are thinking about switching to private health insurance, you should think twice about it.

Private insurance does not make sense for everyone.

For example, while private health insurance may seem cheaper at first, this can change quickly as you get older.

Because a certain age, but also previous illnesses can lead to higher contributions in private insurance.

Leaving statutory health insurance at an advanced age can be associated with a certain risk.

Because after the age of 55, a return is only possible in a few exceptional cases.

Children and life partners without income are also not automatically insured in private insurance.