Your private health insurance premium is going up: what you can do

A private health insurer can raise your premium only when the costs it calculated with have moved for good: when claims in your tariff differ by more than 10 % from what it planned (or a lower figure its terms set), or life expectancy by more than 5 %, and an independent trustee has approved the new premium. The rise takes effect at the start of the second month after the letter reaches you, so a letter in November usually means a new premium from 1 January. Within two months of receiving it you can cancel that policy, as long as new cover follows without a gap, and at any time you can move to another tariff with the same insurer and keep the savings you've built up for old age.

1. Why premiums go up

A private health insurer can't cancel your full health cover, so the law lets it adjust the premium instead, but only on a set trigger (§ 203(2) VVG). Every year it compares, tariff by tariff, two things it calculated with against what actually happened (§ 155 VAG):

• Claims (Versicherungsleistungen). If what the tariff pays out differs by more than 10 % from what was planned, the insurer has to review the premiums. Your policy terms may set a lower trigger, such as 5 %.
• Life expectancy (Sterbewahrscheinlichkeit). A difference of more than 5 % triggers a review too.

If the change isn't only temporary, the insurer recalculates the premium, and an independent trustee (Treuhänder) has to check the calculation and approve it first. A deductible or an agreed surcharge can be adjusted with it, where the contract provides for that.

Your age isn't the reason. Part of every premium goes into an ageing reserve (Alterungsrückstellung) so that getting older doesn't raise it by itself. Rises come when medical costs or life expectancy move, and because the trigger has to be crossed, they tend to come in steps: some years nothing, then a larger jump. Rising interest rates can't trigger a rise on their own, though once a trigger is crossed the insurer recalculates on all its current assumptions.

So plan on premiums following medical costs into retirement, when an employee's employer share stops and the pension insurance pays a smaller subsidy on the state pension instead (§ 106 SGB VI). The pension gap calculator shows what your income in retirement has to cover.

2. The letter, and when the new premium applies

The new premium applies from the start of the second month after the insurer tells you the new amount and the reasons for it (§ 203(5) VVG). A letter that reaches you in November takes effect on 1 January, which is why most of these letters arrive in November and December.

The letter, often called a Beitragsanpassung, has to include:

• The new premium for each person and tariff it affects.
• The reasons. Which of the two calculation bases (claims, life expectancy, or both) crossed its trigger in your tariff. The insurer doesn't have to say by how much (BGH, IV ZR 294/19, 16 December 2020).
• Your right to switch tariffs, with the text of § 204 VVG (§ 6(2) VVG-InfoV).
• From 60, cheaper tariffs by name. If you are 60 or older, the insurer has to name up to ten tariffs with comparable cover that would cost you less, with the premium you'd pay in each, and explain how to move to the standard or basic tariff and what that would cost.

Keep the letter and its attachments. They are what you need to weigh the options below, and what anyone checking the rise will ask for.

3. When a rise isn't valid

You don't have to agree to a rise: if the conditions are met, it applies. There is no objection (Widerspruch) that stops it. What you can do is check whether the conditions were met, and the courts have set out what that means.

• Reasons that don't say enough. A letter that only repeats the legal conditions, without saying which calculation basis changed in your tariff, doesn't start the clock. If the insurer gives proper reasons later, the rise applies from the second month after that letter, not back to the original date (BGH, IV ZR 294/19 and IV ZR 314/19).
• A calculation that doesn't hold. The trigger may not have been crossed, or the trustee may not have approved it properly. Checking this means the insurer's actuarial documents, usually in a court case.
• Getting money back has a time limit. Premiums paid on a rise that never took effect can be claimed back, but each payment's claim lapses after the regular three years, counted from the end of the year it was paid in, once you had the letter (§§ 195, 199 BGB; BGH, IV ZR 113/20, 17 November 2021). A later rise in the same tariff that is valid sets the premium afresh from its own date.

Whether a particular letter holds up is a legal question about that letter. A lawyer for insurance law (Fachanwalt für Versicherungsrecht) or a consumer advice centre (Verbraucherzentrale) can look at it. Keep paying the new premium while it's being checked: arrears in health insurance have consequences of their own.

4. Switching tariffs with the same insurer

This is usually the strongest option, and it's a right: your insurer has to accept a move to any of its tariffs with comparable cover, and your ageing reserve and the rights you've built up count in full in the new tariff (§ 204(1) VVG). You can't waive this right, and you can use it at any time, not only after a rise.

• The same or less cover. No new health questions, no new waiting periods. Many insurers have newer or older tariffs with similar cover at a different price, because each tariff's premium follows its own group of customers.
• More cover. For the part that goes beyond your current tariff, the insurer may ask health questions and add a surcharge, a waiting period or an exclusion. You can avoid the surcharge and the wait by agreeing that the extra cover doesn't apply to that condition.
• What changes. Benefits differ in the detail: hospital rooms, dental work, glasses, the deductible, how much of the fee scale is paid. Compare them line by line before you move: getting a benefit back later counts as more cover.

Ask your insurer in writing which tariffs you could move to and what each would cost. From 60 the letter has to name them; before 60 you can still ask.

5. Other ways to lower the premium

• A higher deductible (Selbstbehalt). A lower premium, more paid yourself in a year with treatment. Weigh the saving over a year against the extra you'd pay in a bad one.
• Dropping optional cover. A private hospital room or chief-physician treatment, a daily hospital allowance, or a higher sick pay than your income now needs. Less cover can be taken off without a health check; adding it back later can mean new health questions.
• The standard tariff (Standardtarif), for contracts from before 2009: cover close to public insurance, for those who meet its conditions. From 60 the letter has to say what it would cost you.
• The basic tariff (Basistarif). Every private insurer offers it, with benefits much like public insurance and a premium no higher than the highest public contribution; if paying it would leave you in need of state support, it's halved (§ 152(3)–(4) VAG). It suits a tight budget more than it suits saving.
• Another insurer. A new insurer prices you at today's age and health, and for contracts since 2009 only the part of your reserve matching the basic tariff moves with you. The rest can stay with your old insurer in a supplementary tariff if you ask for one (§ 204(1) VVG). It's most often worth looking at early in a contract, and in good health.
• Back to public insurance. Possible in narrow cases, such as a job below the income threshold before 55. The rules are in what private health insurance costs over a lifetime.

6. The special right to cancel

A rise gives you a special right to cancel (Sonderkündigungsrecht): within two months of receiving the letter, you can cancel the insurance for the person whose premium rises, with effect from the day the rise would apply (§ 205(4) VVG). You don't have to wait for the end of the insurance year or give the usual three months' notice.

For full health cover, which everyone living in Germany must have (§ 193(3) VVG), a cancellation only takes effect once you show the old insurer that you're insured with a new one without a break, within two months of cancelling (§ 205(6) VVG). So the new cover comes first: have its acceptance before you rely on the cancellation.

Use this right with care. A new insurer prices you at today's age and health, and most of the ageing reserve stays behind. For many people a tariff switch with the same insurer lowers the premium without those costs; for some, a new insurer is worth it.

7. A worked example

Round numbers, to show how the pieces fit; treat this only as the method. An employee earning above the contribution ceiling pays €700 a month for private health cover, without care insurance. The letter raises it by 8 % to €756 from 1 January.

• The employer's share. The employer pays half, up to a cap of €508.59 a month in 2026 (§ 257(2) SGB V). Half of €756 is €378, under the cap, so the employer pays €378 and the employee's own share rises by €28 a month, not €56.
• A tariff switch. Suppose the insurer offers a tariff with comparable cover for €680. The employee's own share falls to €340, below what it was before the rise, with no health questions.
• A higher deductible. Suppose a €1,200-a-year deductible lowers the premium by €100 a month. Together the employer and the employee save €1,200 a year; in a year with treatment the employee pays up to €1,200 more. With the employer paying half, the employee keeps only half of the saving, so the trade works out differently for them than for someone who pays the whole premium.

8. When an insurance expert can help

An insurance expert can go through your insurer's tariffs with you, compare what each covers line by line, and show what moving would cost and save, with the same insurer or another. The choice is yours; they earn a commission when you take out a new policy through them. Have the rise letter with its attachments, your current policy schedule (Versicherungsschein) and tariff terms, your age and any health conditions that matter, and what you'd like to keep in your cover. You can ask for an insurance expert who works in English. Whether a particular rise was valid is a question for a lawyer, not for an insurance expert.

Primary sources checked on 1 November 2026: the statutes and the court decisions linked above.