Health insurance for pensioners: your guide to optimal cover and contributions
28.03.25
12
Minutes
Katrin Straub
Managing Director at nextsure
The transition into retirement raises many questions about health insurance. Make sure you’re covered and understand your options for a worry-free future. This guide explains health insurance for retirees.
The topic in brief and concise terms
Statutory health insurance for pensioners (KVdR) is usually the cheapest option, but it requires meeting the 9/10 rule for the previous insurance period.
Under voluntary statutory insurance, almost all income is taken into account for contribution calculations, unlike in the KVdR.
The German Pension Insurance pays a subsidy towards health insurance contributions on the statutory pension, both for KVdR members and for those insured voluntarily or privately.
Understanding the basics of pensioners' health insurance
When retirement begins, a new phase of life starts, which also requires adjustments to health insurance. Most pensioners in Germany are compulsorily insured through the health insurance scheme for pensioners (KVdR). This is not an independent health insurance provider, but an insurance status with your previous statutory health insurer. The KVdR often offers more favourable contribution conditions, as not all types of income are used to calculate contributions. Alternatively, statutory health insurance on a voluntary basis or private health insurance (PKV) are available as options for pensioners’ health insurance. The right choice depends on your individual employment history and financial circumstances, with preventive healthcare in later life playing a central role. Deciding on a particular form of pensioners’ health insurance has far-reaching financial implications.
Meeting the requirements for compulsory insurance (KVdR)
To be admitted to the coveted health insurance for pensioners (KVdR), two main criteria must be met. First, you must be entitled to a pension from the statutory pension insurance scheme and have applied for it. Second, fulfilment of the so-called previous insurance period, known as the 9/10 rule, is mandatory. This rule states that in the second half of your working life, you must have been insured with a statutory health insurer for at least nine tenths of the time. Mandatory, voluntary and family insurance periods are counted. A flat three years are credited for each child towards this previous insurance period, which can make access to KVdR easier. Your health insurer will check whether these requirements are met as soon as you submit your pension application. Early clarification of your insurance options is recommended.
Calculate and optimise KVdR contributions correctly
For retirees with compulsory insurance in the KVdR, the contribution is made up of the general contribution rate (currently fourteen point six per cent) and the individual additional contribution charged by the health insurance fund. The German Pension Insurance covers half of these contributions for the statutory pension. Contributions are also due on pension benefits (e.g. company pensions) and earned income from self-employed work. For company pensions there is an allowance (e.g. 187.25 euros in 2025); only amounts above this are fully subject to contributions. Income from letting and leasing, or from capital gains, is usually exempt from contributions in the KVdR. The exact contribution amount depends on your health insurance fund and your income. A careful review can save you real money here.
The following types of income are typically subject to contributions in the KVdR:
Statutory pension (old-age pension, reduced earning capacity pension, survivors' pension)
Pension benefits (e.g. company pensions, civil service pensions) above the allowance
Earned income from part-time self-employed activity
Foreign statutory pensions
Retirees usually pay long-term care insurance contributions themselves, with the rate depending on the number of children. This illustrates how important forward-looking planning for retiree health insurance is.
Use voluntary statutory health insurance as an alternative
If you do not meet the requirements for KVdR, for example because your prior insurance period is too short, voluntary statutory health insurance is often an alternative. In this case, your entire financial capacity is used to calculate your contributions. This means that, in addition to the state pension, income from capital assets, rental and leasing income, as well as private pensions, are also subject to contributions. A minimum assessment basis applies (e.g. EUR 1,248.33 in 2025 [:]) and the general contribution assessment ceiling (e.g. EUR 5,512.50 per month in 2025). The German Pension Insurance also pays voluntarily insured persons a subsidy towards the contributions on the state pension upon application. This subsidy corresponds to the proportion it also covers for pensioners with compulsory insurance. The contribution ceilings must also be observed in this context. However, you bear the contributions for other income on your own.
Review private health insurance (PKV) in retirement
If you were already privately insured for health before retirement, you will usually remain so as a pensioner. A switch back to statutory health insurance from the age of 55 is only possible under very strict conditions. [3,] The German statutory pension insurance also grants privately insured pensioners, on application, a contribution towards their health insurance premiums. The amount of this contribution is based on the amount that would apply to a pensioner insured under the statutory scheme, namely half of the general contribution rate plus half of the average additional contribution rate on the statutory pension. Premiums in private health insurance are not based on income, but on the chosen tariff and the age at entry. [] It is advisable to check the terms of your private health insurance well in advance for retirement. Also consider whether a supplementary health insurance policy could be worthwhile.
Expert knowledge: making the most of special cases and optimisation potential
The topic of health insurance for pensioners is complex and influenced 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 should be checked, as these can affect liability to pay contributions. Pensioners who work on the side must keep an eye on the earnings limits and their impact on the contribution amount. Our expert tip: Have your insurance status and sources of income checked in good time before retirement begins, in order to choose the most favourable and suitable form of pensioner health insurance for you. For example, the contribution liability of private pensions can vary depending on insurance status. A careful review of § 201 SGB V with regard to reporting obligations is also advisable.
Important paragraphs and regulations include:
§ 5 SGB V (insurance obligation, incl. 9/10 rule for KVdR)
§ 226 SGB V (contributory income of pensioners subject to compulsory insurance)
§ 240 SGB V (contributory income of voluntarily insured pensioners)
§ 106 SGB VI (subsidy towards health insurance for pensioners)
§ 201 SGB V (notification to health insurance for pensioners)
§ 247 SGB V (contribution rate for pensioners)
§ 248 SGB V (additional contribution)
Current court rulings, such as those concerning the crediting of insurance periods abroad, can influence the legal position and should be discussed with an expert if necessary. The question of what health insurance covers remains central in later life as well.
If you are planning your retirement abroad, you need to arrange your pensioner health insurance particularly carefully. Within the EU, the EEA and Switzerland, membership of the German health insurance scheme for pensioners often remains in place if only a German pension is received. [..] You will then receive medical treatment in your country of residence on the usual local terms, and the costs are settled between the health insurance providers. If you live outside these countries, private overseas health insurance is usually necessary, as German statutory insurance does not provide cover there, or only to a very limited extent. Contributions to German long-term care insurance generally also continue to be payable abroad, as long as you remain entitled to benefits from German long-term care insurance. Our expert tip: Be sure to clarify your insurance cover with your health insurer and pension provider before moving abroad permanently. Also find out whether contributions are tax-deductible. The details can vary considerably depending on the destination country and the agreement in place.
Your next step towards optimal retirement provision
Choosing the right health insurance in retirement is an important decision with financial implications. A careful review of your personal circumstances and all options is essential. Use the information provided here as the basis for your decision. We would be happy to assist you with a detailed analysis of your situation and tailored recommendations. We can help you find the right cover for your health insurance in retirement. Request your individual risk analysis now: Have your insurance situation reviewed free of charge and receive specific recommendations for improvement.
More useful links
Federal Ministry of Health provides information on contributions in the German healthcare system.
National Association of Statutory Health Insurance Funds explains how contributions are assessed in the statutory health insurance system.
Association of Private Health Insurance provides comprehensive information on private health insurance for retirees.
German Pension Insurance explains the regulations on health and long-term care insurance for retirees.
Federal Statistical Office (Destatis) contains current press releases and data on social insurance in Germany.
Consumer Advice Centre provides independent consumer advice on health insurance in retirement.
Laws on the Internet provides the full text of Section 5 of Book Five of the Social Code (SGB V).
Federal Ministry of Health provides detailed information on the financing of long-term care insurance.
Association of Private Health Insurance explains how private health insurance contributions are structured in later life.
FAQ
What is statutory health insurance for pensioners (KVdR)?
KVdR is not a separate health insurance fund, but a status for pensioners subject to compulsory insurance in their previous statutory health insurance fund. It often offers lower contributions, as not all income is taken into account. One requirement is, among other things, compliance with the 9/10 rule.
How are contributions to the KVdR calculated?
For the statutory pension, the standard contribution rate plus the additional contribution is payable, with each half borne by the pensioner and the pension insurance fund. For retirement 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 you can generally take out voluntary statutory health insurance. In this case, almost all of 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 towards private health insurance?
Yes, pensioners with private health insurance can apply to the German Pension Insurance for a subsidy. The amount is based on the contribution for those insured under the statutory scheme.
Are child-rearing periods taken into account for KVdR?
Yes, for the fulfilment of the prior insurance period (9/10 rule), a flat three years are credited for each child. This can make access to KVdR easier.
Do I also have to pay long-term care insurance contributions as a pensioner?
Yes, pensioners also pay contributions to long-term care insurance. As a rule, they pay these on their own. The contribution rate depends on whether and how many children they have.
