Cabinet approves statutory health insurance reform: 7 changes affect you: You’ll Pay More, Get Less.
Germany’s Federal Cabinet has approved a draft reform package for statutory health insurance, aimed at preventing steep contribution increases. However, the proposal would still make coverage more expensive for many people through higher premiums, bigger co-payments, and reduced benefits.
The reform is being presented as a response to a widening funding gap in statutory health insurance, estimated at about €15 billion by 2027 and potentially rising to around €40 billion by 2030. Without changes, contributions could climb sharply—potentially reaching up to 19.3% of income.
A key feature of the plan is that the state would cut its annual subsidy to health insurance funds by €2 billion. While about €250 million per year in additional money is also planned for specific improvements, it would be ring-fenced and not available to close the overall deficit, leaving less flexible funding in the system.
One major impact would be higher premiums for insured people, driven by an increase in the contribution assessment ceiling (Beitragsbemessungsgrenze — contribution assessment ceiling). The draft estimates this change would shift around €1.2 billion more per year onto contributors, hitting higher earners most but potentially raising costs more broadly.
Family insurance (Familienversicherung — family insurance) would also be tightened. Spouses who were previously often insured free of charge would only remain non-contributory in limited situations such as childcare, caregiving responsibilities, or retirement age, while children would still be covered without contributions. In other cases, a surcharge of 2.5% of income would apply—about €75 a month on a €3,000 gross salary, around €100 at €4,000, and roughly €125 at €5,000.
Co-payments (Zuzahlungen — co-payments) would rise significantly for the first time in more than 20 years. Under the draft, insured people would pay at least €7.50 per service instead of €5, with a new upper limit of €15, increasing out-of-pocket costs for many routine treatments.
The reform would also reduce certain benefits directly. The draft states that fixed subsidies for dentures (Festzuschüsse für Zahnersatz — fixed subsidies for dentures) would be lowered back to the level that applied until 2020, which would likely push more of the bill onto patients.
To curb spending, treatments would face more controls, including mandatory second opinions (Zweitmeinung — second opinion) for certain planned procedures to reduce unnecessary operations. The package also introduces partial sick leave (Teilarbeitsunfähigkeit/Teilkrankschreibung — partial sick note), allowing long-term sick employees to return at 25%, 50%, or 75% workload if a doctor approves and the employer agrees, combining partial wages with partial sick pay.
Finally, the government plans a levy on sugar-sweetened beverages starting in 2028—a “sugar tax” (Zuckersteuer — sugar tax) expected to raise around €450 million a year. The proceeds would be earmarked for prevention rather than directly closing the insurance funding gap, but consumers could still see higher prices for soft drinks and energy drinks if manufacturers pass the cost on.