What Changes in German Health Insurance in 2027

What changes in German health insurance in 2027?

Three things change for most expats. Employees need more than €84,150 a year to choose private health insurance, up from €77,400. Public health insurance charges contributions on income up to €6,375 a month instead of €5,812.50, so high earners pay more. And childless members are set to pay a care surcharge of 0.9% instead of 0.6%. The thresholds follow the draft regulation published in September 2026.[1]

How much more do high earners pay in 2027?

At today's rates, about €120 a month more at the top. Public health insurance charges a percentage of income up to the BBG (Beitragsbemessungsgrenze, the income ceiling for contributions), and that ceiling rises by €562.50 to €6,375 a month.[1] The maximum including long-term care then rises from €1,226.44 to €1,345.13 a month with children, and from €1,261.31 to €1,383.38 without.

Employees pay half of the health and care contribution, so their own share rises by €59.34 a month with children and €62.72 without, between €712 and €753 a year. The self-employed pay the full amount, up to €1,465 more a year at today's rates. If the higher childless surcharge comes in, a childless self-employed member at the ceiling pays €141.19 a month more than in 2026, almost €1,700 a year.

Two things can still move these figures. The health ministry sets the average extra contribution (Zusatzbeitrag) for 2027 by 1 November, and each 0.1 percentage point above today's 2.9% adds €6.38 a month at the ceiling. The planned rise in the childless surcharge would add another €19.13 a month for childless members. Our guide on how public contributions are calculated shows each step.

How much do you need to earn to go private in 2027?

More than €84,150 a year, if you are employed. That is €6,750 more than in 2026, the biggest rise in at least 17 years, because the 2026 health reform adds an extra €3,600 on top of the usual yearly update in line with wages. The extra amount stays in the base for later years.[2] Without it, the JAEG (Jahresarbeitsentgeltgrenze, the income threshold for private cover) would have risen to €80,550.

What it means depends on where you stand. A new job above the threshold lets you choose private cover from the first day. A pay rise only counts from the following January, and only if your salary is also above the next year's threshold;[3] for 1 January 2027 that is more than €84,150. Employees who are already privately insured at the end of 2026 keep a lower threshold, €80,550 in 2027, and the gap of €3,600 stays in later years.[4]

Self-employed people, freelancers and civil servants are not affected: they can choose private cover at any income. Our guide to who can get private health insurance explains the rules in full.

What changes for people without children?

Childless members are set to pay more for long-term care. The government plans to raise the surcharge that childless members aged 23 and over pay on top of the regular care rate from 0.6% to 0.9% from January 2027. The cabinet approved the bill on 30 September 2026, and parliament still has to vote. At the income ceiling the surcharge would cost €57.38 a month instead of €38.25. Today employees pay this surcharge alone, without an employer share.

What changes for the self-employed?

Self-employed people and freelancers keep the free choice between public and private cover at any income. In public insurance the minimum income on which contributions are charged rises from €1,318.33 to €1,376.67 a month,[1] and at the top the full maximum applies: €1,345.13 a month with children at today's rates. The exact minimum contribution follows once the 2027 extra contribution is set. Our guide to public contributions for the self-employed explains how income is assessed.

What changes if you are privately insured?

The new law does not touch private contracts, and the employer contribution rises. Employers pay half of a private premium, up to a maximum of €672.56 a month in 2027 at today's rates, up from €613.22 (€640.69 in Saxony).[5] Employees who are privately insured at the end of 2026 also keep their lower threshold of €80,550.

Premium adjustments for 1 January are announced by letter. If one arrives, our guide explains what you can do after a premium increase.

What else changes in public health insurance?

From 2027 the co-payment on a prescription is at least €7.50 and at most €15, up from €5 and €10, and a hospital day costs €15 instead of €10.[6] The fixed subsidy for dentures falls to 50% of the standard treatment, from 60%,[7] and homeopathic medicine is no longer covered.

From 2028 most non-earning spouses in free family cover cost the earning member an extra 2.5% of income, without an employer share, unless an exception such as a child under 12 applies; children stay covered free of charge.[8] Our article on the 2026 health reform has the full list.

What is still open?

Three things. The health ministry sets the average extra contribution for 2027 by 1 November, which fixes the final maximum contributions. Cabinet and Bundesrat still have to approve the 2027 thresholds, which follow a fixed formula and rarely change at this stage. And parliament still has to pass the higher childless surcharge. We update this page as each one is decided.