Altersrückstellung

What is the Altersrückstellung?

Every month a portion of your PKV premium is saved, not spent. The insurer holds that portion, invests it, and uses the return later to soften the effect of rising healthcare costs as you age. That stored-and-invested capital is the Altersrückstellung, the ageing provision.

It is the single mechanism that separates the PKV from the GKV. The PKV runs on a funded model (Kapitaldeckungsverfahren) where each generation pre-funds its own future care. The GKV runs on pay-as-you-go (Umlageverfahren) where current workers pay for current retirees. Both systems are valid. They handle demographic change differently.

Think of the Altersrückstellung as a savings account inside your premium. You do not see it on your payslip, and you cannot withdraw from it directly. It works only by reducing future contributions.

The 10 % legal surcharge (§ 149 VAG)

From your 21st birthday until the end of your 60th year, German law (§ 149 VAG) requires a 10 % surcharge on top of your PKV premium. Every cent of that surcharge flows into your ageing provision. The aim is simple: accelerate reserve accumulation during the years when you are earning well and using healthcare little.

The cut-off is calendar-year-based, not birthday-based. Someone who turns 60 in March pays the surcharge until 31 December of that year; it ends automatically on 1 January of the following year, regardless of retirement status. For a €550 monthly premium that is a €55 reduction visible on the first invoice of the new year.

What happens to my premium at retirement?

Several effects stack at the retirement transition, and they are often lumped together under "Altersrückstellung" even though they are separate mechanisms:

1. The 10 % surcharge is already gone. It ended at 60, not at retirement.

2. Krankentagegeld can be cancelled. The daily sickness allowance is income replacement, so once you are not earning, it is no longer needed.

3. From age 65, § 12a VAG kicks in. Insurers are required to deploy part of the reserve (the "Beitragsteil zur Limitierung") to stabilise the premium against future increases. It dampens adjustments that would otherwise raise the premium for older cohorts, rather than actively cutting the monthly figure. Active reduction from surplus reserves only sets in at much higher ages, typically the early 80s.

4. The DRV subsidy. The German pension insurance (Deutsche Rentenversicherung) adds 8.75 % in 2026 of your state pension toward your PKV-Krankenversicherung premium (KV share only; the Pflege share is not subsidised). Capped at half your actual KV premium.

The two predictable reductions are the § 149 surcharge ending (exact −10 % off the pre-60 premium) and Krankentagegeld cancellation (variable, depending on the prior daily benefit). § 12a VAG and the DRV subsidy are separate effects, working as a stabiliser and as a subsidy respectively, not as further reduction mechanics. Measurable, but not dramatic.

Why it does not make PKV "cheap" in old age

This is the most common expat misunderstanding. The Altersrückstellung is a dampener, not a windfall. Healthcare costs genuinely rise with age. The reserve reduces the slope, it does not flatten it.

Over a two-decade window (2005-2025), average annual premium growth was roughly:

• PKV: +3.1 % per year

• GKV (at the contribution ceiling): +3.8 % per year

(Source: WIP-Analyse 2005-2025, Wissenschaftliches Institut der PKV.)

The PKV has been the slightly slower mover. But neither system is immune to cost growth, and any article claiming "PKV is stable, GKV is the problem", or the reverse, is cherry-picking.

What happens if I switch PKV insurers?

Since 2009, German law guarantees a transfer value (Übertragungswert) when you move from one PKV company to another (§ 12 Abs. 1 Nr. 5 VAG, § 146 VAG, § 204 VVG). The catch: only the portion of your reserve that corresponds to the Basistarif level of coverage transfers with you. Anything your reserve holds above that level stays with the old insurer and is pooled back into the tariff's collective capital.

There is no universal figure for the transfer value. It is calculated by the insurer on request under § 146 VAG and depends on your entry age, current age, tariff, premium level, and years insured. Ask for an Übertragungswertbescheinigung, your current insurer is required to provide one.

The structural reality is the same regardless of the specific number: the transferable portion is the share that would have funded Basistarif-level coverage. Everything you built up beyond that level stays behind, and that share is typically the larger one, with the gap widening substantially with age.

Practical consequence: before age 50, the transfer value is usually still enough to make a switch viable. From about 50 onwards, the non-transferable portion is typically large enough that switching to a new insurer rarely pays off, a tariff change inside your current insurer (§ 204 VVG) preserves the full reserve and is often the better move.

What the Altersrückstellung cannot do

• It cannot be inherited. If the policyholder dies, the reserve stays inside the tariff's collective pool. Heirs receive nothing. A separate life insurance policy is the instrument for survivor benefits.

• It cannot be withdrawn or paid out. It is not a personal account you can access. It only works by reducing future premiums.

• It does not follow you into the GKV. If you return to the public system, the reserve stays in the PKV collective, from your personal perspective, it is lost.

• It does not protect against all premium adjustments. Insurers can and do increase premiums under § 203 VVG i.V.m. § 155 VAG when underlying cost assumptions are exceeded, the reserve reduces the increase's size, but does not prevent it.