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Health insurance for self-employed and founders: PKV vs GKV

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When establishing a company, all necessary registration forms are complemented by registration with the health insurance company. When starting your first self-employment, you can choose whether you want statutory or private insurance (you cannot do this as an employee). You should make your choice carefully, because you can't undo it later. Important in this decision are the following factors, which we will show you in detail in this article:

  • range of services
  • costs/contributions
  • situation in old age
  • lost profit
  • family insurance

Of course, health insurance is not enough: which ones Insurance companies as founders you should consider, we have summarized you in a separate article.

Comparison point 1: Basic insurance logic of public and private health insurance

When deciding between the two insurance alternatives, it is often helpful to understand how both types of insurance work. This is fundamentally different for public health insurance (GKV) and private health insurance (PKV).

This is how compulsory health insurance works

Statutory health insurance takes a certain percentage of the income from all of its policyholders and pools this income into a large pot. At the same time, every insured person is entitled to the payment of medical treatment costs – up to a certain limit – from this overall fund. Compulsory health insurance therefore works in solidarity. Everyone pays for everyone else.

This is how private health insurance works

The individual cost risk of the insured person is relevant for private health insurance in order to determine the contribution. Depending on age, gender and health status, insured persons can have very different statistical cost risks: with a fit and healthy 20-year-old parent, there is only a very small risk that companies health insurance will have to bear costs. For someone in their 50s with some pre-existing medical conditions, things are very different. The health insurance premiums of the individual insurers also vary accordingly.

Conclusion for the self-employed and founders

Solidarity is good: from a social point of view there is probably no doubt which principle of health insurance is better because it is more equitable. When viewed individually, however, it must be admitted that young founders and the self-employed in particular can define their services more precisely with the corresponding costs in a private health insurance company and are therefore more targeted.

On purpose: You can find one in this article Comparison of private health insurance for founders.

Comparison point 2: Costs for private and public health insurance

Health insurance costs are a challenge for every self-employed person: these costs are incurred even at the beginning of the foundation, when there is little or no money available.

Legal expenses of health insurance

Self-employed pay the full rate (between 14.95% and 17.1% of income depending on health fund/state), plus compulsory long-term care insurance at 3.05% or the 3.4% if you don't have children.

But there is a so-called contribution assessment limit (2022: 4,837.50 EUR per month), which means that you only pay the health insurance contribution for the first EUR 4,837.50 you earn. If you earn more, you no longer pay higher contributions. If you calculate with a contribution rate of 16.1%, the maximum health insurance contribution payable is EUR 778.84 per month.

At the same time, there is also a minimum contribution that you have to pay in any case, even if you earn little or nothing. There's one for that Minimum tax base (2022: 1,096.67 EUR). With an assumed contribution rate of 16.1%, you pay at least EUR 156.67 with the GKV. Even if you gain nothing or make a loss.

costs of private health insurance

With private insurers, the premium is set individually depending on the insured person – this can vary around 180 euros for healthy young adults without particular risks (smoking, obesity, extreme sports) and beyond well over 1,000 euros per month for elderly, previously ill policyholders move. Age is the first decisive point here: even healthy older people pay significantly more than young people. In second place, of course, are previous illnesses and existing medical diagnoses. Anyone who has already had two heart attacks and a stroke can usually only get very expensive insurance from private insurers.

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To mitigate this a bit, there are three things with private health insurances: on the one hand, so-called old-age pensions, on the other hand (with many insurers) so-called premium refunds and a deductible which can usually be chosen .

age disposition

In the case of retirement provision, a part of the premiums is set aside by the insurance company at an early age in order to amortize the higher contributions that are forced to occur at an older age. Anyone who becomes privately insured very early can “save” very large amounts, which will often benefit later in life.

deductible

With a deductible you cover yourself lower treatment costs and drug costs of up to a few thousand euros a year – this relieves the insurance companies of numerous small amounts, in exchange for which a lower monthly premium is offered.

Refunds

If you do not have to go to the doctor for an entire calendar year and do not incur any costs for the insurance company, a small part of the premiums paid (usually 1 – 3 months) is reimbursed by many insurers at the end of the year. In fact, for many younger, healthier people, this is very often the case: Doctor visits usually only get more frequent as you get older. Furthermore, as a privately insured person, you can always decide to pay lower costs yourself in order to qualify for premium reimbursement.

Conclusion for the self-employed and founders

The fundamental difference between the two health insurances is particularly evident in the cost structure: in the private one, the decisive factor is how old you are as an insured person. The older, the more expensive. As a young (and healthy) founder, it can therefore clearly be worthwhile to take out private health insurance. Especially since the scope of services can differ significantly…

Comparison point 3: Scope of private and public health insurance services

It's not just a cliché… in the German healthcare system, the privately insured has clear advantages.

Compulsory health insurance benefits

Legal health insurance companies have a fixed catalog of benefits, which is usually not very extensive. Since the contribution rates (statutory rate and additional contribution depending on the health insurance company) cannot be increased so easily in Germany, this service catalog is rather limited and becomes smaller and smaller as costs rise in the field of medicine. This means in a nutshell: The Kasse only pays for a minimum of services, those who need more services must pay or take out additional private insurance (monthly additional costs). To get money from the insurer for unusual services, you usually have to make a lot of effort and thus fail in most cases, even if the treatment makes medical sense.

A list of all GKV services can be found at Federal Ministry of Health.

Private health insurance benefits

With private insurance, on the other hand, a very extensive range of services is usually offered, which you can also determine yourself. You get what you pay for. Many of the services that a statutory fund would not cover can easily be included with private insurers. So if you need effective insurance that actually covers all the necessary costs, you will more or less inevitably end up with private health insurance.

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In addition, as a private patient you are in many cases seen much more by doctors, have a significantly shorter waiting time when it comes to appointments and usually receive more attention from the doctor. This should not be the case, but unfortunately it is a harsh reality in Germany, which you can feel very clearly as a private patient. As soon as you mention that you have private insurance, the tone at the reception or on the phone usually changes abruptly.

Conclusion for the self-employed and founders

If you need fast appointment times, quality and special health services, then private health insurance is at an advantage. However, founders should always ask themselves which of these services they actually need and whether they want to pay extra for them.

Comparison point 4: Private and public old-age health insurance

Thinking ahead is essential when choosing a health insurance company. Because the advantages and disadvantages of GKV and private health insurance change significantly with age. Not to enter the Old age poverty among the self-employed you should carefully consider your choice.

Retirement costs with private health insurance

If you look at the costs in both places, it quickly becomes clear: Private health insurance carries a high cost risk Everyone inevitably ages, and health insurance costs automatically go up, even if you earn less. With some civilization-typical diseases in our luggage and a constantly increasing age, the costs continue to rise – and even the average age provisions can no longer really compensate for this. You often need additional reserves in order to afford your health insurance.

Furthermore, there is a legal requirement that every private insurer must offer a so-called basic rate, which is based on the services of the GKV and can only cost a little – whether and when it is possible to switch to the basic rate varies greatly from insurer to insurer .

Retirement costs with public health insurance

Compulsory health insurance, on the other hand, is based on current income: those who earn little pay less and those who get older therefore do not pay more. This is a nice reinsurance for economically lean times, which, however, are paid for with a radically reduced scope of services and some disadvantages in medical care.

It should also be considered that statutory health insurance funds are not doing well economically – stagnant wages and periods of low economic activity with high unemployment can quickly affect health insurance funds – with the result that the health insurance contribution rate will not is increased or the state measures in, but that in As a result, the scope of services is once again reduced.

No one can see the future along these lines, but in many countries, state-payer systems are already struggling to maintain reasonably reasonable medical care. In principle, this is no different in this country.

Conclusion for the self-employed and founders

Since you can't just switch back and forth between the two systems, you shouldn't make the decision as a founder on short notice. He also thinks about the long term.

Comparing point 5: Loss of earnings in private and public health insurance ing

A very important point for any self-employed person is, of course, that you cannot work if you are sick, so you earn nothing. This loss of income must be compensated for in some way so that you can still cover your fixed expenses and finance your life when you are unable to work due to illness.

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Legal insurance companies provide a (limited) opportunity for this, you can be really good at designing things pay for sickness and his daily hospital allowance but only with private insurers. If you're willing to pay a little more each month, you can also protect yourself with high replacement costs if you get sick.

Comparison point 5: Family insurance with private and public health insurance

In the statutory health insurance, children and spouses or life partners with an income of less than EUR 470 and even grandchildren can be insured free of charge.

This possibility is excluded with private insurance companies. Each family member (including children) must complete their own contract, including a health check. Depending on the extent of the services, the costs for younger children can range from EUR 200 to EUR 400 per child in a comparison of the world of private health insurance. For the non-working partner, the insurance therefore costs a contribution based on his individual risk of medical expenses, as for every adult in private health insurance – in older years it can even be 700-900 EUR or more.

Conclusion for the self-employed and founders

If you plan to start a family later, you should probably opt for statutory health insurance, because there are many other advantages here.

Overview of the advantages and disadvantages of private and statutory health insurance and conclusion

The decision for one of the two forms of insurance is therefore complex and depends heavily on your life situation as well as your age and state of health.

Young people pay in PKV extension often significantly lower contributions, even if they earn a lot. Conversely, older people often pay very high contributions to private health insurance, even if they earn next to nothing.

In the GKV, contributions are income-related – there is only limited protection, even in the event of loss of earnings.

Comprehensive insurance for a family with a non-working partner and several children can cause enormously high costs in private health insurance – in statutory insurance it is usually much cheaper.

In addition to these basic facts, which you should think about, you should always consider the desired scope of coverage and make sure you make several insurance comparisons with private health insurance. There are also small differences in the scope of services and the contribution rate between the individual health insurance companies – here, too, a comparison is worthwhile, and you should also take a look at the additional services offered and the possibility of private additional insurance .

VK private statutory KV
Services wide range of services limited services
costs/contributions cheaper as a young founder based on income and equal for all
in old age it gets more expensive with age and disease regardless of age and disease
in case of loss of profit Sickness benefit is not included but many guarantees can be booked Sick pay, hardly any other protection
family insurance each insured person pays possible for partners, children and grandchildren
supplier change Private health insurers can refuse, with a change there is always a loss of part of the retirement reserve edit always possible to another GKV
in litigation No right of objection regulated by law, i.e. costs depend on the value of the dispute, higher risk of legal costs, if the case is lost you also pay the opponent's costs Free objection, social law case with lower risk of legal costs, because the costs are not limited by the disputed amount but by law, in the event of an unsuccessful case, only your own costs, not those of GKV

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