Private health insurers are raising prices significantly

The private health insurers (PKV) will increase the premiums for their 8.7 million fully insured customers by an average of 4.1 percent at the beginning of next year. The PKV-Verband has calculated that. Some insured persons will not be affected at all, but for others the adjustments will be much more severe.

The rise in premiums has flattened out: a year ago it was 8.1 percent. The 4.1 percent are still significantly higher than the long-term average, which is 2.6 percent. The corona pandemic does not play a role in this: it tended to relieve private health insurance because fewer treatments were required. On the other hand, the companies made special payments to doctors and clinics.

In November and December of each year there are repeated debates about the increases in private health insurance. Because in these weeks the company will inform its customers what contribution they will have to pay in the coming year. There are also tariffs in which the insured are confronted with sharp increases, double-digit adjustments are not uncommon. This triggers reactions from customers, consumer advocates and politicians.

Insurance for civil servants, the self-employed and employees with higher incomes

The private health insurance is controversial: only civil servants, self-employed and employees with higher incomes are allowed to take out insurance. 73.4 million inhabitants are therefore members of a statutory health insurance fund (GKV). Private patients usually find it easier to get appointments with specialists. Many have insured treatment by the chief physician and single rooms in the hospital. On the other hand, older people insured with private health insurance keep complaining that the premiums are too high.

The alleged privileging of those insured with private health insurance has long since become a political issue. Like the Left, the SPD and the Greens are actually in favor of citizens’ insurance, which would largely abolish the differences between GKV and PKV. But the three parties that are currently negotiating the Ampel-Coalition have already put the issue aside: PKV and GKV will be retained. The FDP has made sure of that.

The “Hamburg Model”

However, under the new government, the federal government could make it easier for its civil servants to stay in a statutory health insurance fund: Then it would have to pay the civil servants in the GKV a subsidy, as it does with the allowance for those with private health insurance. So far, only Hamburg and individual other federal states have paid a subsidy for new civil servants in the GKV, the federal government has not. There is little acceptance of the “Hamburg model” in the federal states.

In order to take the wind out of the sails of the PKV critics with the price increases, the association’s own Scientific Institute of PKV (WIP) has again published a comparison of the contribution development in GKV and PKV. After that, the private sector is currently better off in a long-term comparison.

Age and individual risk instead of salary

In the current short analysis, the WIP authors Lewe Bahnsen and Frank Wild refer to the different mechanisms of contribution determination in GKV and PKV. While in the GKV the contribution depends on the salary of the insured person, in the PKV the age and the individual risk are decisive.

In the GKV, the contributions increase when the income is higher, at least up to the so-called contribution assessment ceiling of currently 58 050 euros per year. It will remain unchanged in 2022. As a rule, the contribution does not change beyond this limit, unless the general contribution rate or the additional contribution of the respective health insurance company is changed.

In the private health insurance, on the other hand, there are fixed mechanisms for premium adjustments. They are only possible if the so-called triggering factors take effect. It denotes changes in mortality or – much more crucially – in insurers’ benefit expenditures. Only when they go up by five or ten percent, depending on the contract, can and must the insurers adjust the premiums. In that case, however, they also have to take into account all the other factors that have an influence on the premium amount. At the moment this is mainly the low interest rates. Everything together can cause violent rashes.

The private health insurance industry has long advocated other rules that would allow more regular but more moderate adjustments. So far, however, she has fallen on deaf ears in politics, especially the SPD. That is unlikely to change in the coming legislative period. The PKV pays for the success that the traffic light coalition does not want to shake the system with by not receiving any political support when it needs it.

The core of the WIP analysis is the comparison of the premium development in the GKV and the PKV in the period 2012 to 2022. In the ten-year comparison, according to the calculations of the institute, the premium income per fully insured person in the PKV increased by 29.7 percent, in the GKV by 37 , 8 percent. “This increased the burden on those insured with private health insurance in the period under review to a lesser extent than in the GKV”, write Bahnsen and Wild. They put the average annual increase at 2.6 percent in private health insurance and 3.3 percent in statutory health insurance.

However, the analysis also shows that the long-term comparison could shift in favor of statutory health insurance in the coming years. Because in the years 2021 and 2022, the per capita increase in premium income in the statutory health insurance is three percent and two percent. This contrasts with the 8.1 percent and 4.1 percent in private health insurance.

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