Germany’s public health insurance system (GKV) is heading toward a financial crisis. To prevent its collapse, the German government has appointed an expert commission.
This commission is called the FinanzKommission Gesundheit. It delivered its first report on March 30, 2026.
The findings are stark: the GKV is projected to face a deficit of €15.3 billion in 2027, rising to over €40 billion by 2030. The main culprit is spending growing far faster than income.
The commission has released 66 proposals to fix the failing public health system. The goal is to prepare a legislative package for cabinet approval by late July 2026. So that the changes can take effect on January 1, 2027.
Why does Germany require a public health insurance reform?
The average additional contribution rate (Zusatzbeitrag) is 2.9% as of 2026. If nothing changes, the commission projects the additional contribution will reach 4.7% by 2030.
Additional contribution rate of different public health insurance in Germany ->
If you earn above €6,000 gross per month, the health insurance contribution increases by €720 per year for you alone.
You can check our report on the future of public health insurance here ->
Here are the main proposals that you should be aware of.
#1 No more free health insurance for your partner
Currently, a non-working spouse is covered under the employed spouse’s GKV policy at no extra cost.
The commission proposes restricting this. Free co-insurance would only remain available if you have no income and are either caring for children under six or looking after a dependent relative requiring care.
Everyone else would pay €240 per month for GKV membership. Around 1.77 million people, mostly women would be affected.
Project savings: €3.5 billion in 2027.
We have covered the reasoning and consequences of abolishing free co-insurance here ->
#2 Higher out-of-pocket costs at the pharmacy
If you take prescription medication, your current co-payment (Zuzahlung) is between €5 and €10 per medication. The reform proposes raising it to €7.50 to €15.
If you currently buy ten prescription medications a year, your annual out-of-pocket cost would rise from €100 to €150.
The existing hardship cap has not changed. This means you won’t pay any co-payment once you’ve spent 2% of your gross income (or 1% for chronically ill patients).
The commission also proposes linking the co-payment to wage growth. This means the co-payment will rise every year as wages rise.
Projected savings: €1.9 billion by 2027.
#3 Reduced dental prosthetics reimbursement
The proposal is to reduce the GKV reimbursement for Dental prosthetics (Zahnersatz) from 600€ to 520€.
Projected savings: €600 million for 2027.
#4 Reduced sick pay
When you are sick, your employer pays your complete wages up to six weeks. Afterward, your health insurance pays you sick pay.
Sick pay is 70% of your gross salary or 90% of your net income (whichever is lower). The proposal is to reduce the sick pay by 5%. This means 65% of your gross salary or 85% of your net income.
How to apply for sick pay in Germany ->
Example: Suppose your gross monthly salary is €4,000 and you get a net salary of €2,500. In this case, your sick pay would drop from €2,250 to €2,125 gross per month. This is €125 less.
Additionally, the reform proposes a partial sick pay model. This is similar to the Swedish system.
According to the partial sick pay model, you can be certified as 25%, 50%, or fully unfit for work. Based on this, you’ll receive a corresponding fraction of sick pay.
NOTE: Suppose you are a high earner with high fixed costs, such as mortgage payments. You should consider getting a daily sickness allowance insurance (Krankentagegeldversicherung) to bridge the gap.
Projected savings: €1.3 billion for 2027, plus €73 million for partial sick pay.
#5 More tax on tobacco, alcohol, and sugary drinks
The commission proposes raising taxes outside the GKV system to generate new revenue flowing into public health.
- The WHO recommends that 75% of cigarette prices should be taxed. Germany is currently at 68%. The proposal increases the cost of a pack of cigarettes by €0.50 each year. This means a €9 cigarettes pack will cost €11.50 by 2031.
- Spirits cost will rise by 10%. Beer and wine are not affected.
- A new sugar tax on soft drinks would be introduced, based on the sugar content.
Projected revenues: €1.2 billion (tobacco), €570 million (alcohol), €100 million (sugar) by 2027.
#6 No more homeopathy, skin cancer screening, and general check-ups
- The proposal ends GKV coverage for homeopathic treatments. Currently, some insurers voluntarily cover homeopathy. This will no longer be possible.
- No skin cancer screening (Hautkrebsscreening) for all adults over 35. Germany is currently the only country in the world to offer whole-body skin cancer screening as a standard benefit for healthy people. The proposal is to limit it to high-risk groups only.
- No laboratory tests during the general health check-up from age 35.
Projected savings: €200 million by 2027.
#7 Mandatory second opinions for certain surgeries
For tonsil, hip, and knee operations, you must get a second medical opinion. The goal is to reduce unnecessary surgeries.
Orthodontic treatments (Kieferorthopädie) would also be subject to closer scrutiny.
Projected savings: €200 million by 2027.
#8 Shifting the GKV cost burden of Bürgergeld recipients to the federal budget
The new reform proposes that the federal government reimburse the health insurance costs of people receiving basic income support (Bürgergeld, now Grundsicherung).
What has changed in the basic income support ->
Currently, public health insurance subsidizes these costs. This costs the public health system up to €12 billion per year. Shifting this cost fully to the federal budget would be the single largest measure in the entire package.
What happens next
Health Minister Warken aims to have a cabinet decision by the end of July 2026. A second commission report covering medium- and long-term structural reforms is due by December 2026.
The government has been clear that not all 66 proposals will become law. The coalition of CDU/CSU and SPD will negotiate which to adopt.
Politically sensitive measures, particularly the end of free family co-insurance, are already meeting resistance. For now, your contributions and benefits remain unchanged.
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References
- Bundesgesundheitsministerium — Ergebnisse der FinanzKommission Gesundheit (30.03.2026)
- ZDFheute — Krankenversicherung: 66 Vorschläge für Milliarden-Einsparungen
- Deutsches Ärzteblatt — Lob und Kritik an Sparliste der Finanzkommission Gesundheit
- Bundesgesundheitsministerium — Finanzentwicklung der GKV 2025
