KVdR: German public health insurance for pensioners

Retiring does not automatically keep your health insurance as it was. What matters is whether you qualify for the KVdR. If you do, you are compulsorily insured and pay contributions only on certain income. If you do not, you are a voluntary member or privately insured, which can cost considerably more. For people who spent part of their career abroad or in private insurance, this is one of the most important retirement questions in Germany. Status: October 2026.

The 9/10 rule

You enter the KVdR if you have applied for and qualify for a state pension and if, between starting your first job and the pension application, you were publicly insured for at least nine tenths of the second half of that period, as a member or as a family member (§ 5 (1) no. 11 SGB V).

Example: you started working at 20 and apply for your pension at 66. The period is 46 years, the second half 23 years. You need at least 20.7 years of public insurance within it.

Each child, stepchild or foster child counts as three years (§ 5 (2) SGB V). Time in private health insurance does not count as membership. If you were insured abroad, ask your health insurer early how those periods are treated; it checks the 9/10 rule when you apply.

What you pay

Income	Health insurance	Long-term care insurance
State pension	7.3 % + half your insurer’s additional rate; the pension insurance pays the other half (§ 249a SGB V)	3.6 %, 4.2 % without children, paid alone (§ 59 SGB XI)
Company pension	14.6 % + full additional rate, after a €197.75 monthly allowance (§ 226 (2), § 248 SGB V)	full rate, no allowance; free up to €197.75
Investment income, rent	none	none

In the KVdR only pensions, company pensions and similar benefits, and self-employment income are contributable (§ 237 SGB V). The €197.75 is one twentieth of the 2026 monthly reference value of €3,955.

Example for 2026

Gerd receives a €1,500 state pension and a €300 company pension. His insurer charges the average additional rate of 2.9 %, and he has children.

• State pension, health: €1,500 × 8.75 % = €131.25
• State pension, care: €1,500 × 3.6 % = €54.00
• Company pension, health: (€300 − €197.75) × 17.5 % = €17.89
• Company pension, care: €300 × 3.6 % = €10.80

In total €213.94 comes off, leaving €1,586.06 before tax.

If you do not qualify

You are then a voluntary member of public insurance. Contributions are based on your entire financial capacity (§ 240 SGB V), so investment and rental income count too. There is a minimum base of one ninetieth of the monthly reference value per day, €1,318.33 a month in 2026.

If you are privately insured, the pension insurance pays a subsidy: half of 14.6 % plus the average additional rate on the pension, capped at half your premium (§ 106 SGB VI).

What is known for 2027

Not much yet. The Federal Ministry of Health sets the average additional rate for 2027 by 1 November 2026; the official estimate group calculated 2.9 %. A government draft would raise the care surcharge for childless people from 0.6 to 0.9 percentage points from 2027. It has not been passed.

Common mistakes

• Measuring the whole career. Only the second half counts. Someone privately insured early and publicly insured later can still qualify; the reverse often fails.
• Forgetting contributions on company pensions. They pay the full rate, not half.
• Underestimating voluntary membership. If you retire early and live on investment income, you pay contributions on that income as a voluntary member.

In your plan

The German pension gap calculator deducts KVdR contributions from your pension. For the years between leaving work and the first pension payment, the retirement bridge calculator shows how far your money goes. The guide FIRE in Germany covers health insurance after an early exit.