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I'm considering switching to private health insurance (PKV) from the public one (GKV). The cost will be lower, and from what I understood I get better service like faster appointments. What are the downsides, why doesn't everyone do it?

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After actually switching to PKV, I've found some critical drawbacks:

  1. You can't switch back easily. In some cases, you can't switch back at all.
  2. If you are married, and your spouse doesn't work, they can't be insured for free like in GKV. Furthermore, their price in GKV will be higher than if they were alone - your income will be used to determine price for your spouse.
  3. Your children can't be in GKV, and private insurance for them will not be free.
  4. Your insurance price will grow as you age, putting you in hard situation if you don't save much for retirement.
  5. You have to send the invoices for each treatment, including simple visits to general practitioner, etc. - these things work automatically without your notice in GKV.

That being said, in my 30es I've actually saved some money and was able to switch back when a child was born. See my answer here for how that worked. I've also got a few appointments faster, but that was not worth the effort of switching back by far. I've had to research and manage the switch like a second job or something.

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The gesetzliche Krankenversicherung (GKV) is supposed to be sort-of-universal, and it acts very much as part of the welfare system. Insurance premiums are based on a percentage of the income, which is contrary to all actuary principles.

As to your question why people stay in, only people who earn more than a certain amount can switch out of this and take private Krankenversicherung (PKV). The limit is well above the average income.

The German health system has certain financial incentives for health care providers to treat as many PKV patients as possible, which makes it easier for them to get an appointment. But if the provider is paid more for a PKV patient than for a GKV patient, that money has to come from somewhere -- and somewhere are the PKV insurance premiums. This difference is obscured by the welfare aspects of the GKV, which also have to be funded.

Summary, if you earn well above the Jahresarbeitsentgeltgrenze, if you have no dependents, or if you expect to leave Germany soon, it might be clever to take PKV. Otherwise, GKV is the safe long-term bet. Your income obviously just went up beyond the limit. Good for you, but how much are you going to gamble that it stays that way?

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