German Private Health Insurance: The Biggest Losers in Full-Coverage Enrollment
If you're navigating the world of private health insurance, understanding market trends is key to making an informed choice. The German Private Health Insurance (PKV) sector has faced a persistent challenge: shrinking membership in its core full-coverage segment (Vollversicherung). Despite rising premium income, many insurers are continuously losing policyholders. This analysis identifies the companies that suffered the largest customer losses in recent years, examines the underlying causes, and draws insightful parallels to trends observable in the competitive US health insurance market.
The Dual Pressure on Full-Coverage PKV
The full-coverage PKV market operates under a double squeeze. On the cost side, expenses are driven up by new medical therapies, higher wages in the healthcare sector, and demographic aging. On the demand side, new business remains weak. In economically uncertain times, self-employed individuals and freelancers—a key PKV demographic—are increasingly switching back to the public statutory health insurance (GKV).
This pressure is evident in the membership numbers. Between 2018 and 2023, the number of full-coverage privately insured individuals shrank from 8.73 million to 8.71 million. A slight stabilization occurred in 2023 with a gain of 5,322 contracts, but given the minimal scale, the segment remains under significant structural pressure.
Contradictory Trends: Falling Membership, Rising Revenue
A paradoxical trend emerges when looking at finances. While membership declined, gross premium income in the full-coverage segment continued to rise, reaching approximately €30.9 billion in 2023—an 11% increase since 2019. This growth is not a sign of health but a necessary response to escalating claims costs. For the future, stabilizing the customer base is more critical than merely raising premiums.
The Rise of Supplemental Insurance as a Stabilizer
In stark contrast, supplemental health insurance (Zusatzversicherung) has become the PKV's growth engine. According to the PKV Association, the number of supplemental policies rose by 4.0% in 2024 to 31.02 million contracts. Nearly half the population now opts for private add-ons for dental care, hospital benefits, or alternative medicine.
This trend cannot rescue the full-coverage market, which faces additional headwinds. Since 2025, the income threshold for mandatory insurance has risen significantly to €73,800, making it harder for employees to switch to PKV and increasing the risk of some privately insured individuals falling back into the public system. Thus, supplemental insurance acts as a stabilizing anchor while full-coverage PKV remains under pressure.
The Biggest Losers: Companies with Major Customer Outflows
Data from the Branchenmonitor Krankenversicherung 2024 (Industry Monitor) by V.E.R.S. Leipzig GmbH tracks the 25 largest PKV companies over six years, revealing which insurers suffered the heaviest absolute losses in full-coverage customers.
1. DKV (Ergo Group) – The Largest Decline
The DKV experienced the strongest decline between 2018 and 2023, losing 75,217 full-coverage customers (from 757,692 to 682,475). Despite these losses, it still ranked third by membership size in 2023, generating about €3.2 billion in gross premiums from this segment—roughly 10% of the market's total full-coverage premium income.
2. Allianz Private Health Insurance – Significant Outflow
Allianz saw its full-coverage membership shrink by 42,790 policyholders (from 601,016 to 558,226) in the same period. It ranked fifth in the full-coverage market in 2023, with premium income of around €2.6 billion from this segment.
3. Continentale Health Insurance – Notable Losses
Continentale lost a total of 29,206 full-coverage insured persons between 2018 and 2023 (from 404,339 to 375,133). It ranked seventh in 2023, with full-coverage premiums of approximately €1.27 billion.
Other Notable Companies with Declining Membership
The trend affected a range of other insurers, including Axa, Debeka, and Signal Iduna, all of which reported measurable decreases in their full-coverage customer bases.
German PKV vs. US Private Health Insurance: A Comparative View
For American readers, this dynamic has echoes in the US private health insurance landscape. While the US doesn't have an identical dual system, the individual market (especially off the ACA Marketplaces) can experience volatility and consumer churn based on price and coverage. The German shift from core full-coverage to supplemental products mirrors a US trend where employers and individuals increasingly rely on high-deductible health plans (HDHPs) paired with supplemental products like Health Savings Accounts (HSAs) or specific gap policies. In both markets, insurers must adapt to a consumer base seeking more modular and often more affordable ways to manage healthcare costs.
Conclusion: What This Means for Policyholders
The continued decline in full-coverage PKV membership highlights a sector at a crossroads. For consumers, it underscores the importance of choosing an insurer with not only competitive benefits but also a stable and sustainable business model. The growth in supplemental insurance offers opportunities for tailored coverage but doesn't replace the need for a solid primary plan. Whether you're considering German PKV or evaluating US health insurance options, prioritizing insurers with strong financials and a clear strategy for navigating cost pressures is essential for long-term security.
Data Source: The figures are based on the Branchenmonitor Krankenversicherung 2024 by V.E.R.S. Leipzig GmbH, covering the 25 largest providers. The complete monitor is available for purchase on the experts' website.