Legal or private health insurance?

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

02.03.2011

Since the beginning of the year, the switch between private and statutory health insurance has been significantly simplified. The advantages of statutory and private health insurance have the magazine „Finanztest“ more closely examined in their current issue.

Financial test compares private and statutory health insurance
In his March issue compares „Finanztest“ the benefits of legal and private health insurance and clarifies for whom a change could be worthwhile and what to look for. Since January 2011, a change in the direction of private health insurance (PKV) is already possible from a single annual gross income over 49,500 euros. Until now, insured persons had to earn more than 49. 950 euros for at least three years in order to be able to switch to private health insurance. But not for anyone who meets the criteria worth the change of insurance, warns the Stiftung Warentest in the current issue of their magazine „Finanztest“.

As part of 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 benefit of such a change for the insured, the Stiftung Warentest has now examined more closely and their results in the current issue of the magazine „Finanztest“ released. The testers made it clear in advance that a change of insurance should always be considered carefully, which is usually a decision for life. Who leaves the statutory health insurance system, has hardly a possibility to be resumed. A return is only possible if those affected in an employee relationship as an employee with their income below the mandatory insurance limit. For people over the age of 55 years, the return to the statutory insurance system is generally virtually impossible, reports „Finanztest“. Therefore, policyholders should not be blinded by potential short-term benefits, but always keep track of the long-term prospects of each insurance system, the testers said.

Advantages of a private health insurance
Loud „Finanztest“ Most rates offered by private health insurances offer clear advantages, such as higher doctor fees (correspondingly shorter waiting times for the doctor), treatments by non-medical practitioners and the assumption of the costs for over-the-counter medicines as well as treatment by the head physician in relation to the GKV. Also, the contractually guaranteed benefits are permanently guaranteed, so the statement in the current issue of „Finanztest“. However, the advantages also have a price: The contributions of private health insurance companies are regularly adjusted and can rise significantly. While young, healthy, well-paid insured people in private health insurance pay relatively low contributions despite the additional benefits, the contributions in old age generally increase significantly and can become a barely affordable burden for the insured when they enter retirement age. Also the system-critical family doctor and SPD city councilor from Ingolstadt, Anton Boehm, had recently explained in terms of the cost of PKV, he „know enough cases, since at some point the pension just for the insurance.“ Because as well „Finanztest“ Now, it has to be considered, the contributions are to be paid regardless of the income of the insured, so that even with loss of income no reduction of contributions is possible. Therefore recommends „Finanztest“ To provide the insured person with monthly money to be able to pay contributions even at retirement age. In order not to be forced to change tariffs (including loss of benefits), insured persons who are not civil servants and do not receive any allowances should save about 150 to 250 euros a month in addition to the contribution „Finanztest“.

Benefits for civil servants with subsidies
The most significant benefits offered by Private Health Insurance are the results of „Finanztest“ According to officials, here the employer pays aid instead of the employer's allowance. For example, civil servants only have to cover the remainder of the cost of private insurance, which is cheaper for them than if they were voluntarily insured by law „Finanztest“. For in the statutory health insurance, the civil servants would have to pay the full contribution, which would be calculated on the basis of their income and for many officials would correspond to the maximum statutory health insurance of around 575 euros. For employees and the self-employed, who normally do not receive any allowance and whose income is not permanently secured, a private health insurance company presents a significant financial risk, so that for them usually the legal insurance is the better choice „Finanztest“.

Health benefits are guaranteed by private health insurance
While the private health insurance provides a guarantee for health services at the conclusion of a contract, such a guarantee of the statutory health insurance can not be demanded. In the past, benefits were repeatedly restricted or new fees charged. As an example, the introduction of the practice fee of 10 euros is mentioned here, which is collected every quarter by the patients at each visit to the doctor. In addition, at the turn of 2011, numerous reimbursable medicines were canceled.

GKV calculates contribution rate income-dependent
However, the contributions are always calculated based on income. In addition, the contribution to almost equal proportions (equality principle) is financed by employer and employee. The employer's share currently stands at 7.3 and the share for employees at 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 future increases in cash contributions alone the insured themselves are affected. On the part of the social federations and trade unions this is called the gradual dissolution of the equality financing of the health insurance. In addition, the additional contributions from health insurance patients alone must be borne. Already in the near future, many health economists expect the nationwide introduction of additional contributions. This year, the health insurance funds are still in the minority with an additional contribution (13 out of 160). A calculation of the costs is hardly possible here. If the funds from the health fund are no longer sufficient, the funds must either increase their contributions in principle or demand higher additional contributions.

Family insurance advantage of the legal
A decisive advantage of the statutory health insurance is the family insurance. Children and partners without their own income can be co-insured automatically, without increasing their contributions. On the other hand, private health insurance does not know such co-insurance. Here children and partners have to be specially insured with an independent tariff. Also pay the statutory mother-child cures or loss of earnings in a long-lasting illness (after six weeks).

It depends so much on your own family situation and on the income. Anyone who changes, should also be aware that a return to the legal remains almost closed. PKV tariffs should also not only be selected according to the contributions, but also according to the service catalog. Independent advice is also offered by consumer advice centers. (fp, sb)

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Picture: Gerd Altmann / Gerold Meiners