Germany Overhauls Statutory Health Insurance to Curb Rising Costs

Higher Out-of-Pocket Costs for Medications and Hospital Stays

Patients will face a significant increase in direct costs for medical services. According to SWR, statutory co-payments for prescription drugs, hospital stays, medical aids, and rehabilitation measures will rise by 50%. The minimum co-payment for medications increases from 5 euros to 7.50 euros, while the maximum cap rises from 10 euros to 15 euros.

The reform also targets dental care and pharmaceutical pricing. BR reports that fixed subsidies for dental prosthetics will drop from 60% to 50%, returning them to pre-2020 levels. To further reduce costs, the government is introducing a supplementary manufacturer discount, requiring drug makers to provide additional price reductions to health insurance funds.

Elimination of Homeopathy and Routine Screenings

The GKV will no longer reimburse several previously covered services. According to ZEIT and BR, coverage for homeopathic remedies and cannabis blossoms has ended because sufficient scientific evidence of their efficacy was not found. Additionally, routine skin cancer screenings for those over 35—previously available every two years—will no longer be paid for by insurance, except for high-risk patients.

The Ministry of Health is also introducing a second-opinion requirement for specific surgical procedures to avoid unnecessary interventions. BR reports this mandate applies to orthopedic surgeries on the hip, spine, and shoulders, as well as the removal of the gallbladder and uterus.

Changes to Family Insurance and Contribution Caps

The law modifies who can be insured for free and how much high-earners contribute. Starting in 2028, free family insurance for non-working spouses and partners will be restricted. According to SWR and BR, free coverage remains only for those caring for children under 12, individuals with a care level (Pflegegrad) of 3, 4, or 5, those receiving basic security, or those with full disability pensions. Other insured partners will face an additional contribution of 2.5% of the earner’s income.

For high-income earners, the contribution assessment ceiling (Beitragsbemessungsgrenze) will increase by 300 euros on January 1, 2027, in addition to the standard annual adjustment. This means a larger portion of a high salary will be subject to insurance contributions.

New Partial Sick Leave and Therapy Caps

A new “partial sick leave” (Teilkrankschreibung) system begins January 1, 2028. SWR reports that doctors can now certify a patient’s ability to work at levels of 25%, 50%, or 75%. This allows employees to return to work gradually while receiving a proportional mix of wages and sick pay, though employers maintain the right to reject partial sick leave, in which case standard payment rules apply.

Psychotherapeutic care is also being restructured. SWR notes that the reform introduces a cap on the volume of services health insurance funds will pay for. While current treatments will be fully funded until completion, new limits will prevent practices from billing unlimited sessions as demand increases.

Summary of Key Financial Changes

Service/Category	Previous Rule	New Rule (Post-Reform)
Medication Min. Co-payment	5.00 €	7.50 €
Medication Max. Co-payment	10.00 €	15.00 €
Dental Prosthetics Subsidy	60%	50%
Partner Insurance	Generally Free	2.5% surcharge (with exceptions)
Homeopathy/Skin Screening	Covered	Not Covered

Hardship regulations and exemptions for the chronically ill remain unchanged. According to SWR, the annual cost ceiling for those with chronic illnesses remains at 1% of gross household income, and 2% for all other insured persons.