Steuerliche Absetzbarkeit

How PKV premiums are deducted

PKV premiums in Germany are deductible as Sonderausgaben, special expenses, under § 10 EStG. The deduction has two parts, handled differently by the tax system:

1. Basisabsicherung: unlimited

Under § 10 Abs. 1 Nr. 3 EStG, the portion of your premium that covers basic medical care at the level of statutory insurance is deductible without any cap. This is the big one. For most PKV members, the Basisabsicherung portion is 80-90 % of the total premium, the insurer allocates it explicitly in the annual Jahresbescheinigung and, from 2026, reports it electronically via ELStAM.

The legal history: a 2008 Constitutional Court decision (BVerfG, 2 BvL 1/06) found that basic healthcare provision must be fully deductible. The Bürgerentlastungsgesetz implemented it on 1 January 2010.

2. Komfortanteil: capped

The portion of your premium that covers above-basic benefits (chief physician access, single-room cover, premium dental, private psychotherapy beyond GKV scope) falls under the general cap for "other insurance provisions" in § 10 Abs. 4 EStG:

• €2,800 per year, for self-payers (self-employed, freelancers, retirees without KV subsidy)

• €1,900 per year, for employees with an Arbeitgeberzuschuss, civil servants with Beihilfe, pensioners with a statutory KV subsidy

The same cap pool also covers BU insurance, household liability, car liability, term life, anything under Nr. 3a EStG.

A worked example

A self-employed PKV member with a €7,500 annual premium and a Basisabsicherung share of 85 %:

• Basisabsicherung: €6,375, deductible in full under Nr. 3

• Komfortanteil: €1,125: goes into the €2,800 cap pool with any BU/liability policies

At a 42 % marginal tax rate, the Basisabsicherung deduction alone saves roughly €2,678 in tax, close to the value of one and a half monthly premiums, returned as tax relief.

The Topf-Problem

For most PKV members, the €2,800/€1,900 cap is already completely exhausted by the Basisabsicherung portion alone, 85 % of a typical premium far exceeds these caps. The tax office's automatic Günstigerprüfung then chooses the "Basis-only" variant (unlimited Basis deduction), which does not include BU, liability, or term life.

The consequence: for most PKV members, buying additional Vorsorge insurance, BU, household liability, car liability, term life, produces no additional tax deduction. You still need those products for the protection they provide, but the expected tax benefit is zero in the PKV case.

This is the quiet cost of the deduction advantage: you win on health insurance tax relief, and you partially lose on tax relief for other insurances.

Günstigerprüfung: no action required

The tax office automatically runs a Günstigerprüfung comparing two variants of your deduction and selects the better one:

• Variant A: Total sum of all insurance premiums capped at €2,800 / €1,900

• Variant B: Basisabsicherung portion only, unlimited (no BU/liability/etc.)

You do not choose. The tax software runs the comparison; the better of the two is applied to your return. For most PKV members, variant B wins.

(Historical note: the "große Günstigerprüfung" that used to compare against pre-2010 tax law expired in 2019. It no longer applies.)

BRE offset

The Beitragsrückerstattung reduces the deduction in the year it is paid out (§ 10 Abs. 4b EStG):

• You paid €5,000 in premiums

• You received €500 BRE

• Your deduction for the year is €4,500

The effect: a gross BRE of €500 at a 42 % marginal tax rate has a net value of about €290. The BRE is still economically positive, but the net is meaningfully smaller than the headline.

See the Beitragsrückerstattung entry for the full mechanics.

Vorauszahlung: prepay up to 3× the annual premium

A specific design tool worth knowing about: under § 10 Abs. 1 Nr. 3 Satz 5 EStG, you can prepay up to three times your annual PKV premium in advance and deduct the full amount in the year of payment. This concentrates the deduction in a high-income year, then leaves the following two years with no PKV deduction (because the premium is already paid). For high earners with variable income it is one of the most effective tax-design moves available. The earlier 2,5-fach cap was raised to 3-fach; check the current rules with your tax advisor before structuring.

The Arbeitgeberzuschuss side

The Arbeitgeberzuschuss (§ 3 Nr. 62 EStG) is tax-free up to the legal maximum, the €613.22 (€584.15 in Sachsen)/month cap in 2026. It is not deducted from your taxable income because it was never taxed in the first place. Any excess the employer chooses to pay above that cap becomes ordinary taxable salary.

Why it matters for the GKV-vs-PKV decision

In most expat PKV comparisons, headline premiums are quoted gross. That misses the deductibility. The real comparison should use:

• GKV: premium after employer share, then compare net monthly cost

• PKV: premium after employer share, then apply the Basisabsicherung deduction × your marginal tax rate

For a self-employed member at 42 % marginal rate, the tax-adjusted net PKV cost can be 15-25 % lower than the headline premium, a material difference that a headline-only comparison completely hides.