Germany's 2026 health reform (GKV-BStabG): what the law changes

What does Germany's 2026 health reform change?

The reform makes public health insurance more expensive for high earners and harder to leave for employees. From 1 January 2027 it adds an extra €3,600 a year to both the income threshold for private cover and the income ceiling for contributions, raises co-payments by half and lowers the dental subsidy. From 2028 most non-earning spouses cost their earning partner an extra contribution.

Its full name is GKV-Beitragssatzstabilisierungsgesetz (often shortened to GKV-BStabG), the law to keep public health insurance contribution rates stable. It answers a growing funding gap. The average extra contribution (Zusatzbeitrag) that the health ministry sets each year rose from 2.5% in 2025 to 2.9% in 2026, and the rate the funds actually charged averaged 3.13% at the end of March 2026. The health ministry puts the savings in 2027 alone at almost €19 billion. The general rate of 14.6% stays unchanged.

Is the health reform already law?

Yes. The law was signed on 24 July 2026, published in the Federal Law Gazette on 29 July and has been in force since 30 July 2026. Most changes for insured people apply from 1 January 2027; the contribution for non-earning spouses, partial sick leave and the second-opinion procedure start on 1 January 2028.

The 2027 figures come from a separate annual regulation. The federal cabinet adopted it on 7 October 2026, based on wage growth of 4.38% in 2025; Bundesrat approval is still pending, but the figures follow a fixed formula and rarely change at this stage.[1] The health ministry set the average extra contribution for 2027 at 2.9% on 28 October 2026. We update this page once the Bundesrat has approved the thresholds.

Which figures change in 2027?

Three figures matter most for expats. The income threshold for private cover rises from €77,400 to €84,150 a year, and the income ceiling for contributions from €5,812.50 to €6,375 a month, which lifts the maximum public contribution. Employees who on 31 December 2026 are exempt because of their pay and fully privately insured keep a lower threshold of €80,550 in 2027. Our overview of what changes in German health insurance in 2027 has every figure for next year in one place.

The income threshold for private cover rises to €84,150

The JAEG (Jahresarbeitsentgeltgrenze, the income above which employees may choose private cover) normally moves each year in line with wages. For 2027 the law adds an extra €3,600 on top of that update, and the extra amount stays in the base for later years.[2] That takes the threshold from €77,400 to €84,150, a rise of 8.7% in one year, and the higher bar does not come back down.

The extra €3,600 does not apply to employees who on 31 December 2026 are exempt because their salary is above that day's threshold, and have full private health insurance. For them the 2027 threshold is €80,550, and from 2028 it moves with wages like the general one, so the difference of €3,600 stays.[3] Without this rule, privately insured employees earning between €80,550 and €84,150 would have had to return to public insurance.

For employees who want to switch, the way in depends on how they cross the threshold. A new job that pays more than the threshold lets you choose private cover from the first day. A pay rise only opens the switch from the following January, and only if the salary also clears the next year's threshold.[4] For a switch on 1 January 2027 that means more than €84,150.

Florian Reuther, director of the PKV-Verband, the association of private health insurers, called the planned rise "a direct attack on the freedom of choice of millions of workers" when the cabinet adopted the bill in April 2026.

High earners pay more for public cover

Public health insurance charges a percentage of income up to the BBG (Beitragsbemessungsgrenze, the income ceiling for contributions), which rises to €6,375 a month in 2027.[1] With the official average extra contribution of 2.9%, the maximum including long-term care rises by €118.69 a month with children, to €1,345.13, and by €122.07 without, to €1,383.38.

Employees pay half of the health and care contribution, so their own maximum rises by €59.34 a month with children and €62.72 without; self-employed members pay the full amount.

One figure is still open, and one depends on your Krankenkasse. Every 0.1 percentage point your Krankenkasse charges above the average of 2.9% adds €6.38 a month at the ceiling. The government also plans to raise the childless surcharge for long-term care from 0.6% to 0.9% in January 2027, which would take the childless maximum to €1,402.50. The cabinet approved that bill on 30 September 2026; parliament has not voted yet. Our guide on how public contributions are calculated shows each step.

The higher ceiling also raises the employer contribution to private cover. Employers pay half of the private premium, up to a maximum of €672.56 a month in 2027, up from €613.22 (€640.69 in Saxony).[5]

Non-earning spouses cost an extra contribution from 2028

From 1 January 2028 a member of public insurance pays an extra 2.5% of their income for a non-earning spouse or registered partner in Familienversicherung (free family cover).[6] The member pays it alone, without an employer share, on income up to the ceiling. At the 2027 ceiling of €6,375 a month that would be €159.38 a month.

There are several exceptions. No extra contribution is due if a child under 12 lives in the spouse's household, or a disabled child of any age; if the spouse cares at home for a relative with care grade 2 or higher; has reached state pension age; has care grade 3 or higher, a degree of disability of 60 or more, or a pension for full reduced earning capacity. Children stay covered free of charge. A matching surcharge of 0.52% in long-term care insurance is planned from 2028 in a separate bill. Our guide to health insurance for families covers households where one partner is public and the other private.

What else changes in public cover?

From 2027 the co-payment on a prescription is 10% of the price, at least €7.50 and at most €15, up from €5 and €10, and a hospital day costs €15 instead of €10.[7] The yearly limit on co-payments, 2% of income or 1% for the chronically ill, stays as it is.

The fixed subsidy for dentures falls from 60% to 50% of the standard treatment, or 60% and 65% with five and ten years of check-ups in your bonus booklet.[8] Homeopathic and anthroposophic medicines are no longer covered, and from 2027 individual public insurers may not offer them as an optional extra either.

Two changes follow in 2028. Employees can be signed off sick for part of their working time, at 25, 50 or 75%, and receive Krankengeld (public sick pay) for that part. And a second-opinion procedure applies to selected planned operations; the health ministry names hip replacements and spinal surgery first, while the final list is set by the joint committee of doctors and funds.

What does the reform mean for private health insurance?

The reform does not change private contracts. It narrows the way in for employees and makes public cover more expensive for high earners. From 2027 fewer employees qualify for private cover, those already privately insured keep a lower threshold for good, and the public maximum rises by around €120 a month at today's extra contribution, while private premiums are not linked to the income ceiling at all.

If you are already privately insured, the law does not reach into your contract. Your own premium depends on your tariff, and a Tarifwechsel within your insurer remains the most direct way to change it.[9]

Who is affected most?

Employees earning between €80,550 and €84,150

This is the group the extra increase hits hardest. Those who are exempt because of their pay and fully privately insured on 31 December 2026 stay private, in 2027 and after. Those still in public insurance need more than €84,150 from January, which their salary does not reach. If you are in this group and not yet privately insured, talk to us before the end of the year.

Single-earner couples on family cover

The contribution for non-earning spouses from 2028 changes the comparison for single-earner families. For an earning member at the 2027 ceiling it would add €159.38 a month to the public bill, paid without an employer share, unless an exception such as a child under 12 applies. In cases that were close before, the comparison now moves towards private cover; with private cover each family member has their own premium, so the comparison has to be run for the whole household.

Self-employed and freelancers

Self-employed people can choose between voluntary public insurance and private cover at any income, so the threshold does not affect them. Those insured voluntarily in public insurance at the ceiling pay the whole maximum themselves, from 2027 €1,345.13 a month with children. Our guide to public contributions for the self-employed explains how income is assessed.

What can you do before the end of 2026?

Five steps help before the 2027 rules apply: check whether you qualify, compare against the 2027 public maximum, run an anonymous risk check before you apply, review family cover before 2028 and, if you are already private, review your tariff. In detail:

1. Check whether you qualify. Employees need more than €84,150 from 2027; with a new job above the threshold you can choose from the first day. Self-employed people and freelancers can choose at any income.
2. Compare against the 2027 public maximum. Ask for the comparison at 2027 values, not today's, so you see what public cover will cost you from January.
3. Run an anonymous risk check first. Insurers ask about your health, and an application takes several weeks. An anonymous pre-check (Risikovoranfrage) shows which insurers would accept you and on what terms before you apply anywhere; our guide to the health questions in a private application explains how it works.
4. Review family cover before 2028. If your spouse is covered free of charge today and no exception applies, the 2028 contribution changes the family comparison.
5. Already private? Review your tariff. The reform does not touch your contract, but a regular tariff check keeps your own premium in view.

If you would like your own figures under 2026 and 2027 rules, book a consultation.

Sources

• Bundesministerium für Gesundheit (BMG), Bundestag beschließt GKV-Beitragssatzstabilisierungsgesetz, 10.07.2026.
• Deutscher Bundestag, Nach hitziger Debatte: Bundestag verabschiedet GKV-Finanzreform, Textarchiv 2026, KW 28.
• Bundesministerium für Gesundheit (BMG), GKV-Beitragssatzstabilisierungsgesetz.
• Bundesministerium für Arbeit und Soziales (BMAS), Referentenentwurf zur Sozialversicherungsrechengrößen-Verordnung 2027, 21.09.2026.
• Bundesministerium für Gesundheit (BMG), Kabinett beschließt Pflegeneuordnungsgesetz, 30.09.2026.
• PKV-Verband, Versicherungspflichtgrenze droht 2027 auf knapp 85.000 Euro zu steigen, 30.04.2026.