Those who receive a statutory pension are generally insured in a separate health insurance scheme for pensioners (KVdR). This is operated by the normal statutory health insurance funds such as AOK, BKK or Ersatzkassen. Not every pensioner automatically becomes a compulsory member. For some, only voluntary membership is an option; others would like to remain privately insured. We answer some frequently asked questions:
Who becomes a compulsory member of the health insurance for pensioners?
Certain requirements must be met for compulsory membership in the statutory health insurance for pensioners (KVdR): If you were employed, you must have been in the 2. Have been insured at least 90 percent of the time during which they were gainfully employed – whether as a compulsory or voluntary member. Periods of family insurance are also eligible. Periods of remaining in a compulsory health insurance abroad are creditable for the countries of the European Economic Area and for countries with which a corresponding social security agreement exists.
In addition, a period of 3 years is credited as a pre-insurance period for each child of the pensioner. Foster children also count in full. In the case of adopted children and stepchildren, the legislator links consideration to special conditions. Pensioners with private health insurance can also take advantage of the crediting option for children. Whether this opens up a change to the statutory health insurance for her depends, however, if necessary on the number of years she has been insured. depends on further circumstances.
Special regulations apply to some groups of persons, such as artists or orphan pensioners. If you do not meet the requirements for KVdR, you may be able to take out voluntary health insurance or private health insurance.
Mrs. Schmitz was born in 1956. In July 1971, at the age of 15, she began an apprenticeship as a saleswoman. She worked in her profession until the birth of her daughter in 1986. While raising her children, she did not work and was privately insured through her civil servant husband. Only 15 years after the birth of the child Mrs. Schmitz worked since 2001 again insurable up to the pension. In July 2021 she applies for a pension at the age of 65.
Her working life extends from 1971 to 2021. For the health insurance only the 2 counts. Half, i.e. from 1996 to 2021. That is 25 years. 5 years of which she was still privately insured. For the health insurance she would have to have been 22.5 years legally insured (9/10 of 25 years). Accordingly, she does not fulfill the pre-insurance periods.
However, Mrs. Schmitz can have 3 years credited for her daughter and thus comes into the health insurance of pensioners.
Who can be exempted from the health insurance obligation?
Anyone who would actually have to be insured in the retirees’ health insurance because of receiving a statutory pension may be exempted from this obligation under certain conditions. This applies, for example, to those with private health insurance who are eligible for benefits. They can continue their private health insurance while receiving a pension. However, they must apply for exemption to a health insurance fund within a period of 3 months.
Which pensioners can take out voluntary insurance with a fund??
Who is legally insured, but does not meet the minimum insurance period for KVdR, can in principle insure as a voluntary member. In the past, certain pre-insurance periods were required for this purpose. A 2013 law is interpreted to mean that for people whose compulsory insurance (or family insurance) ends, there is normally no longer a need for a pre-insurance period for voluntary continued insurance.
For pensioners who do not qualify for KVdR and have only a low income, if necessary. a family insurance could be considered.
What changes for self-employed persons?
Anyone who works full-time as a self-employed person and applies for a statutory pension does not automatically become subject to health insurance as a result. The previous insurance remains in place, it has priority in this case. This does not apply to pensioners who only work part-time as self-employed persons.
How high are the health insurance contributions?
In principle, contributions are payable on statutory pensions (under certain conditions also on pensions from abroad), pensions and on earned income (profit from self-employment). The general contribution rate normally applies. Income is taken into account up to a limit of 4.837,50 Euro per month. The pension insurance institutions pay half of the health insurance contribution from the statutory pension. It is withheld directly from the pension and paid to the insurance funds. Pensioners with pensions or earned income have to pay the contributions on their own.
For voluntarily insured persons, interest, rent and other income subject to contributions are also taken into account. Under certain conditions, the income of the privately insured spouse can also influence the contributions of the voluntarily insured person. More detailed information can be found in the contribution procedure principles of the GKV-Spitzenverband (German Statutory Health Insurance Association).
Voluntary members pay the full contributions and, upon application, receive a health insurance subsidy from the pension insurance provider, which is calculated as a percentage of the statutory pension.
The insurance companies have the option of levying additional contributions based on individual incomes. Affected members have a special right of termination if health insurance funds raise or increase additional contributions. The additional contribution is paid in equal parts by the pension insurance provider and the pensioner.
If the pension insurance institution or the paying agency deducts the contributions to the health insurance fund, the increase in the additional contribution only takes effect with a 2-month delay.
Background: A transitional period was granted to the pension insurance institutions and the paying agencies of pension payments for the system changeover.
What is the situation for privately insured persons?
Similar to voluntarily insured persons, the pension insurance institution pays privately insured persons with entitlement to a statutory pension a contribution subsidy.
In the event of increased cost pressure, pensioners can consider cutting back on individual benefits with their insurer, increasing their deductible or, if available, choosing an equivalent tariff with lower premiums. In certain cases, however, the right to change to the so-called standard tariff may be lost if the insurance coverage is changed.
Although this has a very limited scope of benefits, its often low contribution can alleviate the financial situation to a certain extent in the absence of sensible alternative rates.
Persons whose entitlement to benefits changes due to retirement can adjust their private insurance tariff within 6 months without a new health examination.
If contributions are rightly levied on direct insurance?
Lump-sum benefits and settlements that serve to provide for old age and surviving dependents are subject to contributions under the statutory health and long-term care insurance system. However, these must have a connection to working life. Example: Private life and pension insurances are not affected in the case of pensioners subject to health insurance. The capital paid out is distributed arithmetically over ten years and the monthly contribution is then determined. An allowance applies to income from company pension plans: only the amount exceeding a monthly limit of 164.50 euros is taken into account for calculating contributions. According to the current legal situation, this regulation only applies to members of the insurance fund who are subject to compulsory insurance, i.e. not to voluntarily insured persons. The tax-free allowance also applies only to health insurance, not to long-term care insurance (where the current tax-free allowance remains in effect).
The Federal Constitutional Court (Az.1 BvR 1660/08) ruled in favor of (KVdR) pensioners who had continued to invest private contributions in an initially company pension plan after leaving their employment: At least the privately financed portion of the payment from a direct insurance must not be subject to health and long-term care insurance contributions in old age. However, company pensioners must be covered for the benefit to be classified as "private" Be registered as a policyholder in the insurance policy during the payment period after leaving the company. Decisions on the health insurance contributions of pensioners subject to compulsory insurance who continued to pay into pension fund contracts after the end of the company phase are comparable (Az.: 1 BvR 100/15 and 1 BvR 249/15). However, the situation is different for voluntarily insured pensioners: Since they generally have to pay contributions even on income of a private nature, they hardly benefit from the decisions mentioned above.