On July 10, 2026, the Bundestag and the Bundesrat passed the Contribution Rate Stabilization Act. This extensive savings package is meant to stabilize the finances of statutory health insurance and to prevent sharp increases in the Zusatzbeitrag ZusatzbeitragThe additional contribution each statutory health insurance fund charges on top of the general rate. Its level differs from fund to fund.More about Zusatzbeitrag → where possible.
To do this, savings are planned in almost every area of the health system. People with statutory cover must also expect higher out-of-pocket costs and cuts in benefits.
We explain what really changes, what financial consequences can follow and what the reform means for people with statutory cover in the long term.
Why was the reform necessary?
The benefit spending of the statutory health insurance funds was more than €336 billion in 2025. In the first quarter of 2026, it rose again by around eight percent compared with the same period of the previous year.
For 2027, the most recent estimate put the savings needed at around €18.8 billion. The original draft law covered about €16.3 billion of this. During the parliamentary process, further measures worth around €2.5 billion therefore had to be added.
The federal government wants to link the spending of statutory health insurance more closely to the development of its income in the future. This is meant to keep the average Zusatzbeitrag as stable as possible. Whether this really works, however, also depends on how health spending develops and on the reserves of the individual statutory health insurance funds.
The most important changes for the insured
1. Out-of-pocket costs rise by 50 percent
Statutory out-of-pocket costs are generally raised by 50 percent. This affects prescription medicines, for example.
Until now, people with statutory cover usually pay at least €5 and at most €10 themselves for a prescription medicine. In future, this rises to at least €7.50 and at most €15. The automatic annual increase of these amounts that was originally planned has been dropped again.
An example: if you regularly need four medicines a month and have to pay the maximum amount for each, you paid up to €40 a month until now. In future, it can be up to €60. That is an extra burden of €20 a month or €240 a year.
The statutory limits on what you pay yourself generally remain. The insured normally pay out-of-pocket costs up to two percent of their annual gross income. For recognized chronically ill people, the limit is usually one percent.
2. The fixed subsidy for dentures falls
A very concrete cut in benefits affects dentures. The regular fixed subsidy of statutory health insurance is to fall from 60 percent to 50 percent of the cost of the relevant standard care. The existing hardship rules are to remain.
One point matters here: the statutory health insurance fund does not automatically pay a set percentage of the care you actually choose. The subsidy is based on the defined standard care. If a patient chooses a higher-quality implant instead of simpler standard care, for example, he still has to pay the additional costs himself.
A simplified example: assume the standard care defined by law costs €1,000.
| Calculation | Until now | In future |
|---|---|---|
| Regular fixed subsidy | 60% of €1,000 = €600 | 50% of €1,000 = €500 |
| Own share | €400 | €500 |
That is €100 more out of your own pocket. For standard care worth €2,000, the difference doubles: the subsidy falls from €1,200 to €1,000, and the additional cost to you is €200. With more extensive dental work, the extra costs can therefore quickly add up to several hundred euros.
What happens with the bonus booklet? The actual subsidy can be higher if you keep a bonus booklet regularly. The deciding question is therefore whether the cut also applies proportionally to the higher bonus subsidies and how the final detailed rules are put into practice.
For the insured, the bonus booklet remains important in any case. A private supplementary dental insurance can also become more relevant because of the falling statutory subsidies. Before you take one out, you should check the benefit limits in the first years, waiting periods, maximum reimbursement limits and treatments that have already been recommended, among other points. How private plans pay for dental care is shown in our article on dentures and implants.
3. Homeopathic optional benefits are dropped
In future, homeopathic services are no longer to be financed by the statutory health insurance funds. This mainly affects optional benefits under the funds’ own statutes or special care contracts of individual funds. If you want to keep using such treatments, you will generally have to pay the costs yourself in future.
4. Skin cancer screening is reviewed
Skin cancer screening for adults without specific symptoms, currently offered every two years, is to be reviewed. At first, this does not necessarily mean that it will be abolished completely. The aim is rather to examine in what form and for which groups of insured people the examination will be offered as a regular benefit of the funds in future.
5. High earners pay higher contributions
In 2027, the Beitragsbemessungsgrenze is to be raised by €300 a month on top of the regular annual adjustment. Our news item on the income thresholds for 2027 shows what this means for the Jahresarbeitsentgeltgrenze JAEG · JahresarbeitsentgeltgrenzeThe annual income threshold in Germany. Employees who earn more than this per year may leave statutory health insurance and switch to private health insurance.More about JAEG → and for a switch to private health insurance.
In 2026, the monthly Beitragsbemessungsgrenze BBG · BeitragsbemessungsgrenzeThe contribution ceiling of statutory health and long-term care insurance. Income above this amount is not used to calculate contributions.More about BBG → is €5,812.50. Contributions to statutory health insurance are calculated on income up to this level. Income above this limit stays free of contributions. Because of the additional increase, a further €300 of the monthly income of high earners becomes subject to contributions.
The general contribution rate is 14.6 percent. The officially set average Zusatzbeitrag is 2.9 percent in 2026, while many funds already charge around 3.1 percent in practice. If you calculate with a total of 17.7 percent as an example, the employee share is 8.85 percent. On the additional €300 subject to contributions, this comes to €26.55 a month or around €319 a year, in health insurance alone.
On top of this, the corresponding contribution to statutory long-term care insurance generally applies. The actual extra burden depends, among other things, on the individual Zusatzbeitrag of the fund and on the contribution rate of long-term care insurance. The insured pay more as a result, without automatically receiving additional benefits.
6. Limits on free family insurance
From 2028, a contribution surcharge of 2.5 percent is to be charged for certain spouses or civil partners who have so far been insured free of charge through family insurance.
Exceptions to this rule include parents with children up to their twelfth birthday, spouses or civil partners with care level 3, 4 or 5, people entitled to a full reduced earning capacity pension and certain recipients of basic income support who are unable to work.
Originally, the exception for parents was only to apply until the child’s seventh birthday. During the parliamentary process, it was extended to the child’s twelfth birthday. How high the actual extra burden will be for affected couples depends on the final basis used to calculate the surcharge.
7. Second opinions before certain operations
For certain planned and very common procedures, a medical second opinion is to become more of a condition for payment in future. From 2028, two further procedures are to be added each year to the mandatory second opinion procedure.
As possible areas, the Federal Ministry of Health names hip replacement, spinal surgery, removal of the gallbladder, the uterus or the tonsils, and arthroscopic shoulder surgery, among others. The aim is to avoid operations that are not medically necessary.
8. Partial sick notes become possible
For longer illnesses, partial incapacity for work is to become possible in future. Partial sick notes are planned with a workload of 25, 50 or 75 percent of regular weekly working hours. The condition is that the employee and the employer both support such a solution and that it is medically justifiable.
This is meant to make a gradual return to work easier. In practice, however, there are still open questions about continued pay, about Krankengeld KrankengeldStatutory sick pay from the statutory health insurance fund. It starts when the employer stops paying wages, usually from the seventh week of illness. and about coordination between doctor, employer and statutory health insurance fund.
Doctors, hospitals and drug companies must also save
The reform does not only affect the insured.
For hospitals, the permitted rise in costs from 2027 to 2029 is generally limited to the growth rate of contributory wages minus one percentage point. If that rate rises by three percent, for example, the relevant hospital costs could only rise by two percent. Critics fear that this could increase the financial pressure on clinics and indirectly affect staff, investment and care.
The statutory manufacturer discount for medicines is raised to 15.5 percent. For patent-protected vaccines, an additional discount rises to nine percent. In addition, a price moratorium applies to these vaccines from January 1, 2027 to December 31, 2030.
In psychotherapy, a large part of the services that were paid outside the budget so far is moved back into the regular budget for outpatient care. Spending on psychotherapy services outside the budget had risen to around €3.9 billion within ten years by 2025 and had almost doubled. Treatments that have already started are still to be paid without such deductions until they end.
What does the federal government contribute?
The federal government permanently raises its funding for the health care of recipients of basic income support: from €1 billion in 2027 to €1.25 billion (2028), €1.75 billion (2029) and €2.25 billion (2030), up to €2.75 billion a year from 2031.
At the same time, the regular federal subsidy to statutory health insurance is reduced. The previous subsidy of €14.5 billion a year falls to €13.15 billion in 2027.
What does the reform mean for statutory health insurance in the long term?
The law is meant to stabilize the average Zusatzbeitrag . There is no guarantee of this, however.
Whether the Zusatzbeitrag really stays stable depends, among other things, on how quickly health spending keeps rising, whether the planned savings are reached in full, how wages and employment develop and whether the funds have to top up their statutory reserves.
The law can ease the financing in the short term. The structural challenges of demographic change, rising treatment costs and medical progress remain, however.
What does this mean for private health insurance?
Private health insurance is not directly affected by the benefit cuts and the higher out-of-pocket costs of the statutory savings package. However, this does not mean that private cover is automatically cheaper or the better choice for everyone.
In private health insurance, the contractual scope of benefits depends on the plan you choose. Benefits cannot be removed from an individual insurance contract afterwards by a general health policy decision alone. At the same time, premiums can also be adjusted in private health insurance if the actual benefit expenditure of a plan pool differs from the original calculation.
Whether a switch to private health insurance makes sense depends mainly on income and professional situation, age and state of health, family planning, the scope of benefits you want, your financial reserves and your long-term life planning.
The cut in the subsidies for dentures shows why you should not only look at the current monthly premium. It also matters which benefits a system pays for and which costs the insured have to bear themselves.
Conclusion and outlook
The Contribution Rate Stabilization Act is meant to cover savings needs of almost €19 billion in 2027. The planned measures therefore go well beyond savings in administration alone.
For people with statutory cover, the effects will be felt in several places:
- Out-of-pocket costs for medicines rise by 50 percent.
- The regular fixed subsidy for dentures falls from 60 to 50 percent.
- For high earners, the Beitragsbemessungsgrenze rises by an additional €300 a month in 2027.
- Certain partners in family insurance have to pay a surcharge of 2.5 percent from 2028.
- Individual optional or preventive benefits are cut or reviewed.
Most savings measures take effect on January 1, 2027, including the higher out-of-pocket costs and the additional increase of the Beitragsbemessungsgrenze . The contribution surcharge for certain partners in family insurance and the extended second opinion procedures follow from 2028. The limit on out-of-pocket costs remains: out-of-pocket costs are still only due up to two percent of annual gross income, and for recognized chronically ill people the limit is usually one percent.
The privately insured are not directly affected by the cuts. The scope of benefits in private health insurance is agreed by contract and cannot be removed from a running contract by a health policy decision. Premiums can also change in private health insurance if the benefit expenditure of a plan pool differs from the calculation. For high earners with statutory cover, by contrast, the savings package will be felt twice: through lower benefits and through the higher Beitragsbemessungsgrenze . If you are already thinking about a switch to private health insurance, you should include the new conditions in your decision. Whether the cuts are enough to stabilize contributions in the long term remains to be seen.
