Private Health Insurance for Doctors: is Switching Worthwhile?

As a doctor, you’re facing the important decision of whether to stay in the statutory health insurance (GKV) or switch to private health insurance (PKV). This decision has far-reaching consequences for your financial security and the quality of your medical care. In this article, we’ll shed light on the advantages and disadvantages of both systems, particularly with regard to the special needs of doctors and the special doctor’s rates in PKV.

GKV vs. PKV: the Basics

The statutory health insurance (GKV) and private health insurance (PKV) differ fundamentally in their structure and the benefits offered.

Advantages of GKV

1. Solidarity principle: The GKV operates on the principle of solidarity, which means that contributions are income-based. Everyone pays according to their income, which is why GKV is often the cheaper option for low-income earners.
2. Family co-insurance: If you’re in the GKV, you can insure your family members without additional contributions.
3. Basic coverage: In the GKV, you receive basic coverage which is regulated in SGB 5 Paragraph 12, which states: The benefits must be sufficient, appropriate, and economical; they must not exceed the measure of necessity. Insured persons cannot claim benefits that are not necessary or uneconomical, service providers must not provide them, and health insurance funds must not approve them.

Disadvantages of GKV

4. Limited benefits: GKV patients often don’t have the freedom to choose their preferred doctor, and there are also waiting times for benefits to be approved.
5. Long waiting times: Compared to PKV, it can take longer to get appointments or certain treatments.
6. No comprehensive protection: Additional benefits often need to be supplemented privately, which can increase costs.

Advantages of PKV

7. Extensive benefits: In PKV, you usually have access to a more comprehensive range of services, faster treatment, and modern therapies.
8. Individual adjustment of rates: You can individually adjust your insurance coverage and specifically choose the benefits that are important to you.
9. Private hospitals: In cases covered by PKV, you often have access to better and more comfortable facilities.

Disadvantages of PKV

10. Higher contributions in old age: Contributions in PKV often increase with age, necessitating long-term financial planning. (Tip: precautions can be taken here)
11. No family insurance coverage: Each family member must be insured separately, which can increase costs.
12. Risk assessment: When entering PKV, health questions must be answered, which can lead to higher contributions or even rejection in case of pre-existing conditions.

Special Doctor’s Rates in PKV

For doctors, there are special rates in PKV that are adapted to professional requirements. These so-called doctor’s rates offer some advantages, but also have their own challenges.

Advantages of Doctor’s Rates

13. Extended benefits: Doctor’s rates sometimes offer special treatments and additional benefits not included in the regular PKV offer, such as the daily sickness benefit can be doubled when opening a practice and thus virtually create a non-cancellable practice failure insurance 😉
14. Exclusive rate: Doctors benefit from rates or contribution reductions specifically designed for the professional group.

Disadvantages of Doctor’s Rates

15. Higher contributions than normal rates: In some cases, the contributions for doctor’s rates are higher than for normal PKV rates.
16. Collective: With a tariff specifically for medical professionals, you are only pooled with other medical professionals with corresponding expenditure behavior – this can lead to higher premium adjustments than the market.

A Detailed Comparison of Private Health Insurance (PKV) and Public Health Insurance (GKV) for Doctors

1. Premium Amount

GKV:

• With a gross income of 7,000 euros, the GKV contribution (without changes to the contribution rates of the respective insurance providers) is about 14.6% plus an average additional contribution of about 1.1%.
• This means your monthly GKV contribution would be about 1,020 euros (7,000 euros x 15.7%).
• Since in Germany the employer bears half of the GKV contribution, your personal contribution would be about 510 euros.

PKV:

• In PKV, the premium depends on various factors, including age, health status, and chosen tariffs. Assuming you are 30 years old and healthy, your premium in an average tariff could be between 400 and 600 euros per month.
• For a tariff with more comprehensive benefits, the premium could be higher, possibly up to 800 euros or more, especially if you want specific services.

2. Scope of Benefits

GKV: GKV offers basic coverage according to SGB V. For common treatments such as physiotherapy or a doctor’s visit, you must adhere to the statutory provisions. Additional services such as alternative healing methods or special therapies are often not covered.

PKV: In PKV, you can expect a much more comprehensive range of benefits, e.g., access to better hospital rooms (single rooms) or special therapies not covered by GKV. Additional preventive examinations and alternative healing methods may be included in many tariffs.

3. Waiting Times and Appointment Availability

GKV: With GKV insurance status, you often have to wait several weeks for a specialist appointment, especially in high-demand specialties.

PKV: PKV insured individuals generally receive faster appointments. You can often see a specialist within a few days, and treatment times are usually shorter.

4. Family Insurance

GKV: In GKV, your dependents can be insured without additional costs as long as they have no income of their own or it is below a certain limit.

PKV: In PKV, each family member must be insured separately, which can dramatically increase monthly costs. For example, your wife or partner would need to take out their own contract.

5. Age Provisions

GKV: No age provisions are formed. Your contributions in GKV increase with income but are not specifically tied to aging.

PKV: In PKV, age provisions are formed to cushion premium increases in old age. This can lead to more stable premiums in old age, although they can still increase.

6. Health Check

GKV: In GKV, there is no health check or risk assessment that would affect your contributions, even if you have health problems.

PKV: With PKV, you must answer health questions, which can lead to a higher premium or possible rejection, especially if you have existing health problems.

Conclusion on PKV for Doctors

If your monthly gross income is 7,000 euros, GKV might initially seem cheaper in terms of premium amount (as an individual) and also offers the advantage of family insurance at no additional cost. PKV, on the other hand, could offer you advantages in care and range of benefits, but could be more expensive in the long run, especially if you have a family or want to use certain services.

The decision for one of the two options should be well-considered and take into account individual needs, life circumstances, and future developments. It can be helpful to consult an insurance broker to illuminate all aspects.

If you have any further questions about PKV for doctors or about PKV in general, please contact us.

We are very happy to assist you in choosing between GKV and PKV and also in selecting your private health insurance. To learn more about private health insurance, please visit our Blog.