Exemption from patient charges: how to use the burden limit of your statutory health insurance fund

Under the current law, people with statutory health insurance pay a charge of ten percent of the costs for many services, at least five euros and at most ten euros, but never more than the actual cost of the service. This applies, among other things, to medicines, medical aids and travel costs. For therapeutic remedies and home nursing care, there is also a charge per prescription. For inpatient hospital stays and many rehabilitation measures, the charge is currently ten euros per calendar day, in hospital limited to a maximum of 28 days per calendar year. Children and young people up to their 18th birthday are in principle exempt from patient charges. Travel costs are an important exception.

All statutory patient charges count toward the burden limit under § 62 SGB V. In principle, it is two percent of annual gross income for living expenses, and one percent for people who are seriously and chronically ill. For families, the patient charges of all family members with statutory health insurance are counted together.

Important with a view to the reform: under the GKV-Beitragssatzstabilisierungsgesetz, which the Bundestag passed on July 10, 2026, the charge amounts rise from 2027. The law sets €7.50 to €15 instead of the current five euros to ten euros. The daily charge for inpatient measures and the charge per prescription for therapeutic remedies and home nursing care also rise to €15. The caps of two and one percent remain.

The starting point is the annual gross income for living expenses of all family members living in the household, meaning salaries, pensions and rental income. The allowances are deducted from this. In 2026, they are €7,119 for the first family member living in the household, usually the spouse, and €9,756 per child. Two percent of the remaining amount forms the limit, or one percent with a recognized chronic illness.

A worked example for a family with two children and gross income of €75,000:

• gross income: €75,000
• minus €7,119 (spouse) and twice €9,756 (children)
• relevant amount: €48,369
• burden limit (two percent): €967.38 per year, half of that for a household with chronic illness

For people who receive citizen's income or social assistance, the standard rate is the basis of assessment. The limit is then only just over €135 per year.

If the collected patient charges exceed the limit, you submit an informal exemption application to the fund with proof of income and receipts. The fund refunds the amount above the limit and issues an exemption certificate for the rest of the calendar year. From then on, all further patient charges no longer apply. Many funds offer receipt booklets or digital receipt collections in their app for this.

The exemption always applies only to the current calendar year, and you must apply again every year. If you reach the limit regularly, for example because you need long-term care or take medication permanently, the advance payment option is the most relaxed way: calculate the limit, transfer the amount, receive the card, and the matter is closed.

There is no exemption from patient charges in private health insurance, because the statutory patient charges do not exist there. Out-of-pocket shares in private health insurance arise from the deductible you choose, from benefit limits in individual benefit areas and from plan limits on doctors' fees. You control them through your choice of plan, not through an application. The private system has no income-based upper limit.

Its relief instruments are the plan change, the no-claims refund and the cost approval before major treatments. If you compare the systems, you should know both logics: small, plannable flat charges with a cap on one side, and out-of-pocket shares set by the plan with room for design on the other.

Every day we advise people at the point between the two systems, and the exemption from patient charges is an underestimated argument in the comparison. For families with a high need for treatment and a middle income, the capped statutory patient charges are a real advantage. For high earners, the picture turns around, because the two percent limit grows with income, while out-of-pocket shares in private health insurance depend on the plan and not on the salary.

We recommend that before any change of system you look at your own reality of patient charges over the last few years. If you use the exemption regularly, you should know that in private health insurance you trade this safety net for other instruments.

Per household. The patient charges of both partners and the children go into one shared pot, and one shared burden limit applies, based on the family income minus the allowances. So it is worth collecting all receipts of the family together.

Everything that is not a statutory patient charge: out-of-pocket shares for dentures, individual health services you pay for yourself, optional services in hospital and surcharges above fixed reimbursement amounts. These items remain with the insured person even after the exemption.

Only if your need is foreseeable. If you do not reach the limit, the fund usually does not refund the unused advance amount. The option therefore suits permanent medication and long-term care cases, not caution without a clear reason.