Maximum contribution to statutory health insurance: amount, calculation and development

The maximum contribution to statutory health insurance is the highest monthly contribution a member pays. It applies as soon as income subject to contributions reaches or exceeds the Beitragsbemessungsgrenze of €5,812.50 per month.

The assessment is governed by § 223 SGB V, the contribution rate by § 243 SGB V and the long-term care share by § 55 SGB XI. Income above the limit no longer raises the contribution. So the maximum contribution is both a protective limit and a reference value for the comparison with private health insurance.

If you want to calculate the maximum costs of statutory health insurance for 2026, apply three components to the assessment basis of €5,812.50: the general contribution rate of 14.6 percent, the average Zusatzbeitrag of 2.9 percent and the contribution to long-term care insurance.

The general maximum contribution is therefore €1,226.44. For people without children, with the higher long-term care rate of 4.2 percent, it is €1,261.32. Without entitlement to Krankengeld (i)KrankengeldStatutory sick pay from the statutory health insurance fund. It starts when the employer stops paying wages, usually from the seventh week of illness., the reduced contribution rate of 14.0 percent applies.

Employees with an income at the ceiling pay the general maximum contribution of €1,226.44. The employer pays half of it, so up to €613.22. If you switch to a private plan, you receive the same employer contribution.

The self-employed pay the contribution entirely themselves, €1,261.32 without children and €1,226.44 with a child. For them, this value is the decisive figure when they weigh voluntary statutory insurance against private health insurance.

Pensioners pay on the basis of their statutory pension and company pension, which is usually below the ceiling. On the statutory pension, the pension insurance pays half of the contribution, including the Zusatzbeitrag (i). On the company pension, they pay the full contribution alone, without an employer contribution.

From €789.53 in 2017 to €1,226.44 in 2026, the maximum contribution in statutory health insurance rose by 55.3 percent in nine years. If you have an income at the ceiling today, you pay around €440 more per month in nominal terms than nine years ago.

Three causes drive this development:

• The Beitragsbemessungsgrenze (i) grows with wages.
• The general contribution rate has been raised several times.
• The fund-specific Zusatzbeitrag (i) keeps rising.

A look at the long-term trend, however, puts the picture into perspective. According to the Association of Private Health Insurers, premiums in private health insurance rose by an average of 3.4 percent per year from 2006 to 2026, contributions in statutory health insurance by 3.9 percent. You can find out more in the article on premium stability.

We have supported over 5,000 applications with health questions. The most common question from insured people at the maximum contribution is whether a switch to private health insurance pays off at this level of contribution. With good health, a stable long-term income and no family to insure with you, the answer is yes in many cases.

When you compare the statutory maximum contribution with the private premium, we recommend that you always calculate the contribution after the employer contribution. For employees, this considerably reduces the apparent difference. Before any switch, it is also worth doing a calculation over ten to twenty years. Today's gross difference matters, but the burden over the whole insurance period decides.

Yes. All income subject to contributions is added up. The cap applies as soon as the total exceeds the Beitragsbemessungsgrenze (i) of €5,812.50 per month. Income above it is free of contributions.

The contribution is calculated on the basis of the statutory pension and company pension. Because these are usually well below the Beitragsbemessungsgrenze (i), pensioners rarely pay the maximum contribution. On the statutory pension, the pension insurance pays half of the contribution. On company pensions this share does not apply, so your own share can rise.

There is an exception if you are voluntarily insured in statutory health insurance as a pensioner. Then you pay a health insurance contribution on all types of income.

Yes. The Zusatzbeitrag (i) differs from fund to fund. In 2026 the range is from around 2.18 to 4.39 percent. At the maximum contribution, this difference amounts to up to €130 per month. So switching funds pays off for high earners as well.

With a comparable gross contribution, a private plan often offers more benefits. For employees, compare your own share after the employer contribution, because the employer pays part in both systems. The overview shows in detail what private health insurance costs.