Statutory or private health insurance?



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Stiftung Warentest: stay in the statutory health insurance or switch to private health insurance?

Switching between private and statutory health insurance has been made significantly easier since the beginning of the year. In its current issue, the magazine “Finanztest” took a closer look at the advantages of statutory and private health insurance.

Financial test compares private and statutory health insurance In its March edition, "Financial test" compares the benefits of statutory and private health insurance and clarifies who might benefit from a change and what to look out for. Since January 2011, a change in the direction of private health insurance (PKV) has been possible with a one-time annual gross income over 49,500 euros. Previously, insured persons had to earn more than 49,950 euros for at least three years to be able to switch to private health insurance. But the change of insurance is not worthwhile for everyone who meets the criteria, warns the Stiftung Warentest in the current issue of its magazine "Finanztest".

As part of the health care reform, the black and yellow federal government decided last year to significantly simplify the switch between statutory and private health insurance in the future. The Stiftung Warentest has now examined in detail the advantages of such a change for the insured and has published its results in the current issue of the magazine “Finanztest”. The testers made it clear in advance that a change of insurance should be well considered in any case, that it is usually a decision for life. Anyone who leaves the statutory health insurance system has little chance of being reinstated. A return is only possible if the persons concerned are employed as employees with their income below the compulsory insurance limit. For people over the age of 55, it is generally almost impossible to return to the statutory insurance system, reports “Finanztest”. Therefore, policyholders should not be blinded by possible short-term benefits, but always keep an eye on the long-term prospects of the respective insurance system, according to the testers.

Advantages of private health insurance According to the "Finanztest", most tariffs of private health insurance offer significant advantages such as higher doctor's fees (correspondingly shorter waiting times at the doctor), treatments by alternative practitioners and the assumption of the costs for over-the-counter medicines and for the treatment by the chief doctor compared to the statutory health insurance. The contractually guaranteed benefits are also guaranteed permanently, according to the statement in the current edition of “Finanztest”. However, the advantages also have a price: The contributions of the private health insurance are regularly adjusted and can increase significantly. While young, healthy, well-earning insured persons in the private health insurance only pay relatively low premiums despite the additional benefits, the premiums usually increase significantly in old age and can become an almost unaffordable burden for the insured upon retirement. The system-critical family doctor and SPD city councilor from Ingolstadt, Anton Böhm, had recently stated regarding the costs of the private health insurance that he "knows enough cases that the pension will be enough for the insurance at some point." , the contributions are to be paid regardless of the insured person's income, so that the contributions cannot be reduced even if income is reduced. “Finanztest” therefore recommends that the insured person put money aside on a monthly basis in order to be able to pay the contributions even after retirement. In order not to be forced to change tariffs (including loss of benefits), the insured, who are not civil servants and do not receive any allowance, should save about 150 to 250 euros per month in addition to the contribution, "Finanztest" advises.

Benefits for civil servants with subsidies According to the results of “Finanztest”, private health insurance offers the most significant advantages for civil servants, since here the employer pays subsidies instead of the employer subsidy. For example, officials only have to cover the remaining part of the cost of private insurance, which is cheaper for them than if they were voluntarily insured under the law, "Finanztest" explained. Because in statutory health insurance, the civil servants would have to pay the full contribution, which would be calculated based on their income and, for many civil servants, would correspond to the maximum rate of the SHI of around EUR 575. However, private health insurance poses a significant financial risk to employees and the self-employed who normally do not receive any allowance and whose income is not permanently secured, so that statutory insurance is usually the better choice for them, reports “Finanztest”.

Health benefits are guaranteed at the PKV. While private health insurance provides a guarantee for health benefits when a contract is concluded, such a guarantee cannot be requested from the statutory health insurance. In the past, services were repeatedly restricted or new fees charged. An example is the introduction of the practice fee of 10 euros, which is charged by the patients every quarter when they visit a doctor. In addition, numerous reimbursable drugs were discontinued at the turn of 2011.

GKV calculates contribution rate based on income. However, the contributions are always calculated depending on income. In addition, the contribution is funded by employers and employees in almost equal proportions (equal principle). The employer's share is currently 7.3 and the share for employees is 8.2 percent. As part of the reforms at the turn of the year, however, the employer's share was frozen. This means that in the event of future increases in health insurance contributions, only the insured themselves will be affected. On the part of the social associations and unions, this is called the gradual dissolution of equal funding for health insurance. In addition, the additional contributions from health insurance patients must be borne alone. In the near future, numerous health economists expect the nationwide introduction of additional contributions. This year, the health insurance companies with an additional contribution are still in the minority (13 out of 160). It is hardly possible to calculate the costs here. If the benefits from the health fund are no longer sufficient, the health insurers either have to increase the contributions in principle or demand higher additional contributions.

Family insurance Advantage of statutory health insurance Family insurance is a decisive advantage of statutory health insurance. Children and partners without their own income can automatically be insured without the premiums increasing. The PKV, on the other hand, does not have such co-insurance. Here children and partners have to be specially insured with an independent tariff. The statutory mother-child cures or loss of earnings in the case of a long-term illness (after six weeks) also pay.

So it depends very much on your own family situation and the respective income. Anyone who changes should also be aware that a return to the legal framework remains almost closed. PKV tariffs should not only be selected according to the contributions, but also according to the service catalog. The consumer advice centers also offer independent advice. (fp, sb)

Read about health insurance:
Switching to private health insurance is often not advisable
As of 2016351a2cc0b08c03Health costs
The health care reform comes into force
Private health insurance: that is changing

Image: Gerd Altmann / Gerold Meiners / pixelio.de

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