Your PKV Premium Just Went Up: What You Can Actually Do

Why your premium went up

A PKV premium adjustment (Beitragsanpassung, BAP) is a recalculation an insurer may run when the actual cost of claims across a tariff drifts more than 10 % from plan, or mortality more than 5 %.[1] The law allows that recalculation,[2] but does not leave it to the insurer alone: an independent actuarial trustee, the Treuhänder, has to approve the figures before anything takes effect.[3] Your individual claims are not part of the calculation.

Every PKV tariff is priced on assumptions about how often the cohort sees doctors, how much each treatment costs, and how long people live. When real experience drifts too far from those assumptions, the insurer is allowed to recalculate.[2]

The thresholds are set by law.[1] Actual claim costs across the cohort have to diverge from plan by more than 10 %, or mortality by more than 5 %, before anything happens. Two details are worth having straight. The divergence counts in either direction, so the same mechanism can require a reduction. And once the threshold is crossed and the divergence is not merely temporary, the insurer does not simply get permission to adjust, it is required to review the tariff and adjust it,[1] with an independent trustee signing off. Some insurers set a tighter threshold in their own terms.

Even when a threshold is crossed, the recalculation is not unilateral. An independent Treuhänder (an external actuarial trustee, similar in role to an auditor) reviews the maths and has to approve it before any adjustment takes effect.[3] The Treuhänder checks the numbers, not the wider question of whether the increase feels fair.

The result is a single percentage applied to every contract in the affected tariff cohort. Your individual claim history is not part of the calculation. Filing a claim does not raise your own premium; the trigger is collective, never personal.

Several drivers have stacked up in recent years:

• Treatment costs have grown faster than originally assumed. This is the biggest single factor.
• People are living longer, so the payout periods PKV is funding extend.
• Interest rates dropped in the years after 2010, which means insurers' reserves earn less, and the part of every premium that flows into those reserves has to grow.
• Older tariff cohorts have built up substantial Altersrückstellungen, which get revisited as the cohort ages.

What are your two options after a PKV premium increase?

A premium-adjustment letter opens two regulated options. A Tarifwechsel moves you into another tariff with the same insurer, with no new health check for equivalent or lesser benefits and your Altersrückstellungen preserved in full.[4]

An Anbieterwechsel moves you to a different insurer. There you are underwritten afresh, and only the Basistarif-equivalent share of your reserves travels with you.[5] Neither route is a default best answer. The deciding factor is your insurer's long-term record on premium stability against what fresh underwriting elsewhere would deliver.

Two further routes exist, and they matter in narrower situations. A return to the public system is open to some people, most often through salaried work below the income threshold, and effectively closed from 55 for anyone with a long private history. And the statutory Basistarif caps the premium at the public maximum, though only for a group the law defines, essentially people already privately insured or free to leave the public system.[6] For contracts taken out before 2009 the older Standardtarif serves the same purpose. Both are floors for hard cases rather than everyday options.

Most insureds end up with one of these two routes. A small set of cases sits at break-even where either works; in that situation the call usually goes to whichever delivers the simpler long-term contract.

Can you switch tariffs within the same insurer?

Yes. Every PKV-insured has a statutory right to switch tariffs within the same insurer at any point in the contract's life.[4] For equivalent or lesser benefits no new health check is required, and accumulated Altersrückstellungen carry over in full. The detailed mechanics:

Equivalent or lesser benefits: no new health check. If the new tariff has the same or fewer benefits than your current one, the insurer cannot require fresh underwriting. Existing risk surcharges (Risikozuschläge) from the original health check carry forward proportionally to whatever scope they were originally placed on.

Better benefits → health check only on the additional scope. If the new tariff includes benefits your current one does not (a richer dental tier, for example, or higher reimbursement on alternative medicine), the insurer can underwrite the difference. They cannot re-underwrite what you already had.

Altersrückstellungen carry over in full. Your accumulated ageing reserves stay attached to the contract. This is the structural advantage of an in-house Tarifwechsel that the external route cannot match.

Insurers must provide an overview of available alternative tariffs on request. In practice, the in-house options the insurer surfaces in the letter are not always the strongest in the catalogue. A structured Tarifoptimierungs-Beratung (Tarifwechsel review) compares the full available tariff set and identifies the ones that genuinely improve the price-benefit ratio for your specific entry age and health profile, including older tariffs that the insurer is not pushing but is required to make available.

Beyond the tariff itself, two structural levers can make a measurable difference without a switch. An adjusted Selbstbeteiligung (deductible) lowers the monthly premium directly and works for clients with stable claims experience. A Beitragsentlastungstarif (premium-relief rider) builds in a fixed-euro reduction for retirement and is independent of tariff choice. Restructuring optional riders (for example, switching a separate Krankentagegeld from a high-benefit/low-waiting-period setup to one matched to your actual income-protection need) can free up real money without changing the core cover.

This route fits when the current insurer has a solid long-term track record on premium stability, the existing tariff line has internal alternatives worth moving to, and the value of preserved Altersrückstellungen plus the fixed entry-age pricing outweighs what a fresh underwriting elsewhere would deliver.

Option 2: Anbieterwechsel (changing PKV insurer)

The second route is moving to a different PKV insurer entirely. The cancellation runs through the Sonderkündigungsrecht, the two-month right of cancellation that the premium notice itself opens.[7] The Übertragungswert carries the Basistarif-equivalent portion of your accumulated reserves across to the new insurer.[5]

How the reserve transfer works. The Übertragungswert is calculated by the outgoing insurer and confirmed in writing.[8] It corresponds to the share of your Altersrückstellungen that the Basistarif scope of cover would have funded. Anything you have built up beyond that scope stays with the old insurer.

This is a normal feature of how inter-insurer mobility is handled in the PKV system, not a penalty. The trade-off is direct: you give up a portion of accumulated reserves for the prospect of long-term premium stability at a different insurer. When the current insurer's record on premium discipline has been weak across multiple adjustment cycles, that trade-off can be substantially in your favour over a 20- or 30-year horizon.

The new insurer will underwrite you fresh. This is the gating factor on whether the route is open to you at all. A profile that was unproblematic at age 30 may now face surcharges or exclusions at 50, depending on what has happened to your medical history in between. An anonymous Risikovoranfrage (a market-wide risk pre-check) is the standard way to clarify what acceptance, surcharge, and exclusion responses you would actually receive without putting your name on file at any insurer.

This route fits when the current insurer's premium adjustments have been frequent or sharp across multiple years and the comparison with more disciplined insurers shows a meaningfully better long-term trajectory, your health profile still permits clean acceptance at a different insurer (or acceptance with manageable surcharges), and the long-term math favours stability over preserved reserves on a multi-decade horizon.

How long do you have to decide once the notice arrives?

The premium notice opens a two-month window in which you can cancel the contract, even when an ordinary contract term would otherwise apply.[9] This is the timing constraint for the Anbieterwechsel route. Two technical points matter.

The window starts on the date you receive the premium adjustment notice, not on the effective date of the increase. Mark the date the letter arrives; the deadline is calculated from there.

The cancellation only takes effect with proof of a seamless follow-on contract in place. Every German resident has to hold continuous health insurance cover,[10] and the cancellation rules enforce that from the other side.[7]

Two points on timing that the letters rarely spell out. The cancellation takes effect on the date the increase would have taken effect,[9] not at some later notice date. And the proof of new cover does not have to be in hand on the day you cancel: the law gives you two months from the cancellation itself to show that the person is insured elsewhere without a gap.[11] In practice it is still safer to have the new contract confirmed early. Without that proof the cancellation is ineffective, and your existing contract and premium obligation continue. The system protects itself against accidental gaps in cover.

One technicality often missed. A Krankentagegeld-only premium increase does not trigger Sonderkündigung of the Vollversicherung. They sit in separate AVB (insurance terms). A Zahnzusatz (supplementary dental) increase usually does not either, for the same reason: supplementary dental cover is normally its own contract with its own terms, and the right of cancellation follows the contract whose premium went up.[9] Only where the dental cover is a module inside the comprehensive contract does an increase reach the whole of it. Read the letter for which contract the adjustment refers to before assuming the right of cancellation applies.

If the chosen route is Tarifwechsel within the same insurer, no Sonderkündigung is needed and the deadline does not constrain you.

Which actions should you avoid?

Do not cancel without a follow-on contract in hand. A cancellation without proof of seamless cover is simply ineffective for the Vollversicherung. You stay in your existing contract, and if you stop paying, you trigger the Mahnkaskade, the statutory dunning cascade: written reminders, a one-month deadline, and ultimately demotion to the Notlagentarif.[12] That emergency-only tariff[13] covers acute care, pain treatment, pregnancy and child preventive care, and nothing beyond that. It is the worst possible outcome of any reaction to a premium increase.

Do not take comparison-portal "switch saves €200 a month" claims at face value. Online aggregators routinely benchmark headline premiums without surfacing what is actually being compared: the long-term premium-stability track record of the new insurer, the transferred reserves, the underwriting result you would actually receive, and benefit differences that look small in a feature list but matter in real medical situations. A genuine comparison runs the math at that level of detail, with the new insurer's adjustment history specifically in view.

Do not leave the letter unread. If the contract is left to drift, the next adjustment cycle compounds on top of the current one, and both routes are designed to be used. That is not the same as saying you must move. Checking the options and deciding to stay in the tariff you have is a legitimate outcome, and sometimes the right one: a switch can cost you rights attached to an older contract, and a move to better benefits can bring fresh underwriting with it. What is not defensible is not looking.

What an independent broker actually does in this conversation

A Versicherungsmakler owes you advice, and that duty does not end once a contract is placed.[14] It runs for as long as the mandate does, because the courts treat a broker as the client's Sachwalter rather than as a seller.[15] When a client brings a premium adjustment notice in for review, the structured workflow:

1. Verify the legal basis of the adjustment. Was the auslösender Faktor, the triggering threshold, actually met?[1] Was the Treuhänder approval documented? An adjustment is not contestable on the basis that it is high; it is contestable when the procedural requirements were not met.
2. Run a premium-stability analysis on the current insurer. How frequent and how large have the adjustments been across the relevant tariff lines over the past 10 to 20 years? How does that compare with the more disciplined insurers in the market for a profile like yours? This is the comparison that decides which of the two routes fits.
3. Run a Tarifwechsel review against the insurer's full catalogue, not just the in-house options the letter surfaces. Identify the tariffs that match or improve current scope at lower cost, plus structural levers (Selbstbeteiligung, Beitragsentlastungstarif, optional riders).
4. If Anbieterwechsel is the answer, run a Risikovoranfrage before any application. The anonymous market check returns acceptance, surcharge, and exclusion responses without putting your name on file. This avoids a permanent Ablehnung-Vermerk if the new market does not take you cleanly.
5. Time the Sonderkündigungs-window if Anbieterwechsel is the call. The 2-month deadline is non-negotiable; the new contract has to be signed and confirmed before the cancellation date.

For TheGoodBroker clients, this is the work: take a premium adjustment notice, run the full premium-stability analysis plus a Tarifwechsel review, lay both routes out with the underlying numbers transparent, and act on whichever one improves your math. Book a consultation for a structured review of your specific letter.

What to do when the letter arrives

The day a premium adjustment notice lands, work through this five-step sequence: confirm the two-month deadline starts on the notification date, request your insurer's available in-house tariff alternatives, request a Risikovoranfrage for fresh-underwriting acceptance at alternative insurers, weigh the in-house Tarifwechsel against an Anbieterwechsel based on your insurer's BAP track record, and decide before the deadline. Each step is broken out below.

1. Read the letter carefully. Note the new gross monthly premium, the effective date, and the Sonderkündigungsrecht deadline (typically 2 months from receipt). Mark the deadline in your calendar with a one-week buffer for paperwork.
2. Request the insurer's Tarifwechsel options. Insurers must provide a list of available alternative tariffs and the relevant comparisons on request. This is the document that tells you what is even available before deciding anything.
3. Get an independent premium-stability analysis. A Versicherungsmakler compares the current insurer's premium-discipline track record against the rest of the market for your profile, and compares the in-house Tarifwechsel options against what would actually fit you across both routes.
4. Decide on a route, jointly. If Tarifwechsel within the insurer wins on the numbers, no Sonderkündigung is needed. If Anbieterwechsel wins, the new contract has to be in place before the cancellation date.
5. Document the Übertragungswert (in case of Anbieterwechsel). The transfer value is calculated by the outgoing insurer and confirmed in writing. Keep that document; it is the formal record of what reserves have transferred and what stayed with the old insurer.

The single biggest mistake on a premium increase is treating the letter as a verdict on PKV. It is not. It is the standard mechanic of a regulated long-term contract, and you have two regulated levers to respond with. Pulling the right one depends on a comparison that the insurer is not required to run for you.

If you would like the worked numbers for your specific situation, book a consultation; we will run the premium-stability analysis, the Tarifwechsel review, and a Risikovoranfrage if Anbieterwechsel is on the table, then make sure the timing works on whichever route you choose.