Health insurance for pensioners: Your guide to optimal coverage and contributions
28 Mar 2025
5
Minutes
Katrin Straub
CEO at nextsure
The transition to retirement raises many questions about health insurance. Protect yourself and understand your options for a worry-free future. This guide explains health insurance for retirees.
The topic in brief and concise terms
The health insurance for pensioners (KVdR) is usually the most affordable option, but it requires meeting the 9/10 rule of the pre-insurance period.
In the case of voluntary statutory insurance, almost all income is used to calculate contributions, unlike in the KVdR.
The German Pension Insurance contributes to the health insurance premiums on statutory pensions, both for KVdR members and for those who are voluntarily and privately insured.
Understanding the Basics of Retiree Health Insurance
Entering retirement marks the beginning of a new phase in life, which also requires adjustments in health insurance. Most retirees in Germany are mandatorily insured through the Health Insurance for Pensioners (KVdR). This is not an independent health insurance fund, but rather an insurance status with your current statutory health insurance provider. The KVdR often offers more favourable contribution conditions, as not all types of income are used for contribution calculation. Alternatively, there are options for voluntary statutory health insurance or private health insurance (PKV) for retirees. The right choice depends on your individual employment history and financial circumstances, with healthcare in old age playing a central role. The decision for a particular form of health insurance for retirees has far-reaching financial implications.
Mastering the requirements for mandatory health insurance (KVdR)
To be admitted to the coveted Pensioners' Health Insurance Fund (KVdR), two main criteria must be met. Firstly, you must be entitled to a pension from the statutory pension insurance and have applied for it. Secondly, fulfilling the so-called pre-insurance period, known as the 9/10 regulation, is mandatory. This rule states that in the second half of your working life, you must have been insured with a statutory health insurance for at least nine-tenths of the time. Compulsory, voluntary, and family insurance periods are counted. Three years for each child are credited towards this pre-insurance period, which can facilitate access to the KVdR. Your health insurance provider will check these requirements as soon as you submit your pension application. Early clarification of your insurance options is advisable.
Correctly calculate and optimize contributions to the KVdR
For pensioners obligatorily insured in KVdR, the contribution consists of the general contribution rate (currently fourteen point six percent) and the individual additional contribution from the health insurance fund. The German Pension Insurance covers half of these contributions for the statutory pension. Contributions are also payable on pension entitlements (e.g., company pensions) and earned income from self-employment. With company pensions, there is a tax-free amount (e.g., 187.25 Euros in 2025), only amounts above this are fully subject to contributions. Income from rental, leasing, or capital gains usually remains contribution-free in the KVdR. The exact contribution amount depends on your health insurance fund and your income. A thorough check can save actual money here.
The following incomes are typically subject to contributions in the KVdR:
Statutory pension (old age pension, incapacity pension, survivor's pension)
Pension entitlements (e.g., company pensions, pensions) above the tax-free amount
Earned income from part-time self-employment
Foreign statutory pensions
Renters usually bear the contributions to long-term care insurance alone, with the rate depending on the number of children. This highlights the importance of forward planning for pensioners' health insurance.
Utilise voluntary statutory health insurance as an alternative
If you do not meet the requirements for the KVdR, for instance, due to too short a previous insurance period, voluntary statutory health insurance is often an alternative. In this case, your entire financial capability is used to calculate the contributions. This means that, in addition to the statutory pension, income from capital assets, rental and leasing, as well as private pensions, are subject to contributions. A minimum assessment basis applies (e.g. 1,248.33 euros in 2025) and the general contribution assessment limit (e.g. 5,512.50 euros monthly in 2025). The German pension insurance also pays a subsidy to voluntarily insured individuals for contributions to the statutory pension upon application. This subsidy corresponds to the share they also cover for compulsorily insured pensioners. The contribution limits must be observed in this case. However, you bear the contributions for other income alone.
Review private health insurance (PKV) in retirement age
If you were privately insured before retirement, you will generally remain so as a pensioner. Switching back to statutory health insurance after the age of 55 is only possible under very strict conditions. [3,] The German Pension Insurance also grants a subsidy for health insurance contributions to privately insured pensioners upon request. The amount of this subsidy is based on the amount that would apply to a pensioner with statutory insurance, that is, half of the general contribution rate plus half of the average additional contribution rate on the statutory pension. Contributions to private health insurance are not determined by income, but by the chosen tariff and entry age. [] It is advisable to check the terms of your private health insurance at an early stage for the retirement phase. Also consider whether an additional health insurance might be beneficial.
Expert knowledge: Harness special cases and optimisation potentials
The topic of health insurance for pensioners is complex and shaped by individual factors. An important aspect is the correct crediting of child-rearing periods for the 9/10 rule of the KVdR; here, three years per child can be claimed (§ 5 Abs. 2 SGB V). When receiving foreign pensions, double taxation agreements and social security agreements must be examined, as these can affect the obligation to contribute. Pensioners who work alongside their pension must keep an eye on the additional income limits and their effects on the contribution amount. Our expert tip: Have your insurance status and sources of income checked in good time before retirement begins to choose the most advantageous and suitable form of health insurance for pensioners. For example, the obligation to contribute to private pensions may vary depending on the insurance status. A careful examination of § 201 SGB V regarding reporting obligations is also advisable.
Important paragraphs and regulations include:
§ 5 SGB V (Compulsory insurance, incl. 9/10 rule for KVdR)
§ 226 SGB V (Income subject to contributions for compulsorily insured pensioners)
§ 240 SGB V (Income subject to contributions for voluntarily insured pensioners)
§ 106 SGB VI (Subsidy for pensioners' health insurance)
§ 201 SGB V (Reporting for pensioners' health insurance)
§ 247 SGB V (Contribution rate for pensioners)
§ 248 SGB V (Additional contribution)
Current judgments, such as those on the crediting of insurance periods abroad, can influence the legal situation and should be discussed with an expert if necessary. The question of what the health insurance provides remains central even in old age.
Foreign stays and health insurance: What retirees need to consider
If you are planning your retirement abroad, it is crucial to carefully manage your health insurance as a pensioner. Within the EU, EEA, and Switzerland, a German KVdR membership often remains intact if you receive only a German pension. [..] You will then receive medical services in your country of residence according to local terms, with costs settled between health insurers. If you reside outside these countries, usually a private international health insurance is required, as the German statutory insurance provides no or only very limited coverage there. Contributions to the German long-term care insurance generally continue to be payable abroad as long as there is a claim to benefits from the German long-term care insurance. Our expert tip: Be sure to clarify your insurance coverage with your health insurer and pension provider before moving permanently abroad. Also, check whether contributions are tax-deductible. The details can vary significantly depending on the destination country and agreements.
Your next step towards optimal security in retirement
More useful links
Bundesgesundheitsministerium provides information on contributions within the German healthcare system.
GKV-Spitzenverband explains the contribution assessment within the statutory health insurance system.
PKV-Verband offers comprehensive information on private health insurance for pensioners.
Deutsche Rentenversicherung explains the regulations regarding health and long-term care insurance for pensioners.
Statistisches Bundesamt (Destatis) contains current press releases and data on social security in Germany.
Verbraucherzentrale offers independent consumer advice on health insurance in retirement.
Gesetze im Internet provides the full text of Section 5 of the Social Code Book V (SGB V).
Bundesgesundheitsministerium provides detailed information on the financing of long-term care insurance.
PKV-Verband explains the contribution structure of private health insurance in old age.
FAQ
What is the health insurance for pensioners (KVdR)?
The KVdR is not a separate health insurance provider but a status for pensioners who are compulsorily insured in their previous statutory health insurance. It often offers lower contributions, as not all income is considered. One of the requirements is fulfilling the 9/10 rule.
How are the contributions to the KVdR calculated?
For the statutory pension, the general contribution rate plus the additional contribution is payable, with half being borne by the pensioner and half by the pension insurance. For pension benefits (above the allowance) and earned income, the pensioner usually pays the full contribution.
What happens if I do not meet the requirements for the KVdR?
Then, as a rule, you can voluntarily take out statutory health insurance. In this case, almost all your income is taken into account for the contribution calculation, up to the contribution assessment ceiling. Alternatively, there is private health insurance.
Does the pension insurance provide a subsidy for private health insurance?
Yes, privately insured pensioners can apply for a subsidy from the Deutsche Rentenversicherung. The amount is based on the contribution for those with statutory insurance.
Are child-rearing periods considered for the statutory health insurance for pensioners?
Yes, for fulfilling the minimum insurance period (9/10 rule), three years are credited for each child. This can facilitate access to KVdR.
Do I also have to pay nursing care insurance contributions as a retiree?
Yes, pensioners also pay contributions to the long-term care insurance. They usually bear these alone. The contribution rate depends on whether and how many children they have.
