Think of Altersrückstellungen as your PKV paying it forward. A portion of your monthly premium does not cover current medical costs. It goes into a reserve fund that your insurer invests and draws from later when your actual healthcare expenses exceed your premium.
Without these reserves, PKV premiums would need to increase dramatically every year as you age (because medical costs rise exponentially with age). With them, premium increases are smoothed. You overpay slightly when young so you underpay in old age.
How much accumulates
For a typical PKV contract starting at age 30:
- By age 40: ~€20,000-€30,000 in reserves
- By age 50: ~€50,000-€70,000
- By age 55: ~€70,000-€100,000
- By age 67: ~€80,000-€130,000
These reserves belong to the INSURER, not to you personally. If you switch PKV companies, you lose a significant portion (only the Basistarif-equivalent transfers since 2009). This creates a lock-in effect.
The portability problem
Since 2009, a portion of reserves (roughly equivalent to what the Basistarif would have built) is portable between PKV providers. But the additional reserves from your specific tariff stay behind. This means switching PKV providers after 20 years can mean starting premium calculation nearly from scratch: resulting in much higher premiums at the new insurer.
Why this matters for career planning
If you enter PKV at 32 and switch back to GKV at 45 (by reducing income), you lose all accumulated reserves. Those 13 years of overpayment are gone. This is why the GKV-to-PKV decision should be treated as permanent.
