The German Cabinet approved the GKV-Beitragssatzstabilisierungsgesetz (BStabG) on 29 April 2026. The law targets €15.6 billion in savings across public health insurance (gesetzliche Krankenversicherung, or GKV). It is the largest GKV reform in decades.
NOTE: The BStabG has reached Cabinet approval (Kabinettsbeschluss) but is not yet law. The Bundestag is expected to vote before the summer recess 2026. Further changes are possible in the parliamentary process.
Why Germany needs this reform
The GKV has been running a structural deficit for years. In 2024, insurers and the health fund (Gesundheitsfonds) recorded a combined deficit of nearly €10 billion. The federal government kept the system liquid using emergency loans.
The average supplementary contribution rate (Zusatzbeitrag) has more than doubled since 2022. It stood at around 1.4% in 2022 and reached 2.9% by January 2025.
Without reform, the government’s health finance commission (FinanzKommission Gesundheit, or FKG) projected the gap would hit €15 billion in 2027 and over €40 billion by 2030.
Additional contribution rates of different public health insurers in Germany ->
The BStabG implements more than three-quarters of the 66 recommendations the FKG published in March 2026. Health Minister Nina Warken (CDU) and Chancellor Friedrich Merz (CDU) called it one of the largest social reforms in decades.
The core mechanism: spending is capped at income growth
The single biggest structural change is a new rule tying all GKV expenditure growth to income growth. This means if GKV income grows by 3% in a year, fees for doctors, hospitals, etc., can rise by at most 3%.
This measure alone is projected to save €4.9 billion in 2027, growing to around €19 billion by 2030.
#1 Free spousal co-insurance ends in 2028
Until now, a non-working spouse or registered civil partner (eingetragener Lebenspartner) could be covered under their partner’s GKV membership at no cost. This is called Familienversicherung (family co-insurance).
From 1 January 2028, members whose non-working spouse is co-insured will pay a surcharge of 2.5% of their own contributory gross income. The original draft proposed 3.5%; it was reduced before the Cabinet vote.
To put that in concrete terms: on a gross salary of €4,000 per month, the surcharge is €100 per month or €1,200 per year.
Around 2.5 million spouses are currently co-insured without contributions, according to the FKG. The surcharge is paid by the working member, not by the co-insured spouse. The spouse retains full GKV coverage.
Free co-insurance remains available in four situations:
- The spouse cares for a child who has not yet turned seven
- The spouse cares for a child with a disability
- The spouse cares for a dependent relative (Pflegeperson)
- The spouse has reached statutory retirement age (Regelaltersgrenze)
NOTE: The surcharge also applies to registered civil partnerships, not only marriages.
Family co-insurance in Germany: how it works ->
Projected additional income for GKV: €1.2 billion in 2027, rising to €3.5 billion by 2030.
#2 Higher co-payments at the pharmacy from 2027
Your current co-payment (Zuzahlung) on prescription medicines is between €5 and €10 per package. From 1 January 2027, this rises to €7.50 to €15 per package. This is a 50% increase. The last time these amounts were adjusted was 2004.
If you currently buy ten prescription packages per year, your annual out-of-pocket cost rises from up to €100 to up to €150.
The existing hardship cap is unchanged. Once your annual co-payments exceed 2% of your gross income (or 1% if you have a chronic condition), you pay nothing further for the rest of the year. Apply to your Krankenkasse for an exemption certificate (Befreiungsausweis) once you approach the threshold.
Co-payments in public health insurance: everything you need to know ->
Projected savings: €1.9 billion by 2027.
#3 Dental prosthetics reimbursement cut
The GKV subsidy for dental prosthetics (Zahnersatz) will be reduced. Fixed subsidies (Festzuschüsse) are cut by 10 percentage points. Existing hardship rules (Härtefallregelungen) remain unchanged.
Dental coverage in public health insurance in Germany ->
Projected savings: €600 million for 2027.
#4 The contribution ceiling rises in 2027
The income threshold up to which GKV contributions are calculated will rise by around €300 per month from 1 January 2027. This means both you and your employer pay slightly more.
What was dropped before the Cabinet vote
- A planned 5 percentage point cut to sick pay (Krankengeld). It is not part of the BStabG.
How sick pay works in Germany ->
- Homeopathic treatments will no longer be covered as optional insurer services (Satzungsleistungen).
- Cannabis flower prescriptions (Cannabisblüten) lose GKV coverage from 2027. Extracts and active compounds (Dronabinol, Nabilon) remain reimbursed.
Timeline
| When | What |
|---|---|
| 29 April 2026 | Cabinet adopts BStabG draft |
| Before summer recess 2026 | Bundestag and Bundesrat to vote |
| 1 January 2027 | Expenditure cap, higher co-payments, contribution ceiling rise, cannabis flower exclusion take effect |
| 1 January 2028 | Spousal co-insurance surcharge of 2.5% begins |
What you should do now
- Check whether an exemption applies. If you have a child under seven, or your partner cares for a dependent relative, you may not owe the surcharge. Confirm with your Krankenkasse once the law passes.
- Consider whether part-time work makes sense for your partner. A job above the Geringfügigkeitsgrenze means the employer covers half the contributions, often cheaper than the 2.5% surcharge on a higher income.
- If you take regular prescription medication, budget for the new €7.50–€15 per-package range from January 2027. If your annual co-payments may exceed 2% of your gross income, apply for an exemption certificate early.
How to apply for an exemption certificate for public health insurance co-payments in Germany ->
- If you have a cannabis flower prescription, speak to your doctor now about alternatives before the 2027 exclusion takes effect.
