GKV reform 2027: Familienversicherung, Zuzahlungen

Updated:
05.10.2026

On 10 July 2026 the Bundestag passed the largest package of statutory health insurance reforms ever — the GKV-Beitragssatzstabilisierungsgesetz. The backdrop is grim: the deficit of the GKV (statutory health insurance) for 2027 is estimated at 15.3 billion €, and could grow to 40 billion € by 2030. Without the reform — rising contributions across the whole system. With the reform — losses as well. We go through it block by block.

Familienversicherung (family insurance): the contribution-free era is ending

The most painful item. From 1 January 2028, free family cover for spouses and partners remains only if there are children under 12 or a child with a disability in the family, or if the partner cares for someone in need of care or has reached the Regelaltersgrenze (standard retirement age). The list of exemptions in the law is broader — it also covers release from work under Pflegezeit (statutory care leave), a Pflegegrad (care level) of 3 or higher, a full reduced-earning-capacity pension, a GdB (degree of disability) of 60 or higher and receipt of Grundsicherung (basic income support) within a Bedarfsgemeinschaft (joint benefit household); stepchildren, grandchildren and foster children count as well.

In all other cases a surcharge becomes due for the spouse — 2.5 percentage points on the contribution rate, paid by the Krankenkasse member alone; the employer does not contribute. The law sets no cap on the amount: it is calculated on income up to the Beitragsbemessungsgrenze (contribution assessment ceiling), which rises every year.

What changes on 1 January 2027

Zuzahlungen (co-payments) rise by 50 per cent: for prescription medicines from €5–10 to €7.50–15, for a day in hospital or rehabilitation from €10 to €15, and for Heilmittel (physiotherapy, speech and occupational therapy) and home nursing care 10 % plus €15 per prescription instead of €10. The Belastungsgrenze (annual co-payment cap) stays the same: 2 % of the family’s annual gross income, 1 % for the chronically ill. Automatic indexation was removed from the final text
Zahnersatz (dental prosthetics): the basic Festzuschuss (fixed subsidy) drops from 60 % to 50 %; the bonus rates are cut too — from 70 % to 60 % (5 years) and from 75 % to 65 % (10 years)
Apothekenabschlag (pharmacy discount): from 1.77 € to 2.07 € per pack of a prescription medicine
Herstellerabschlag (mandatory manufacturer discount) for pharmaceutical manufacturers: the basic 7 % plus a new 8.5 % — 15.5 % in total; the dynamic surcharge from the draft was dropped
Beitragsbemessungsgrenze (BBG): an additional increase of 300 € per month on top of the usual indexation — for the BBG and for the Versicherungspflichtgrenze (compulsory insurance threshold) alike
Minijob (marginal employment): the employer’s GKV contribution is calculated as the general rate of 14.6 % plus the average Zusatzbeitrag (additional contribution)

On Zahnersatz there is a detail that is easy to miss: for Festzuschüsse approved before 1 January 2027, the previous law applies. Anyone who went to the dentist regularly and collected bonuses keeps the higher rate — but that rate too has been cut by 10 percentage points.

The reduction of the state’s share for Zahnersatz is a direct argument for supplementary dental cover: the gap between the bill and what the Krankenkasse reimburses will grow. We will look at the market’s reaction to the new rates separately.

Find out more — how the GKV (statutory health insurance) works.

Krankengeld: what changes

The reform leaves the amount of Krankengeld (sickness benefit) for employees untouched: 70 % of gross pay, but no more than 90 % of net pay, for up to 78 weeks within three years. A cut to Krankengeld was in the ministry’s first draft, but the coalition dropped it before the bill reached the Bundestag. What changes are special cases, and they are unpleasant ones.

From 1 January 2027. If your employment ends while you are unfit for work, Krankengeld from the following day will be 60 % of net pay (§ 47 Abs. 2a SGB V), or 67 % if you or your spouse or civil partner have a child who qualifies for Kindergeld (child benefit) or the Kinderfreibetrag (child tax allowance). Anyone who works and draws a Teilrente (partial old-age pension) of more than two thirds of the full pension loses entitlement to Krankengeld (§ 50 SGB V). And if the Krankenkasse asks you to apply for rehabilitation or a pension, you now have four weeks instead of ten; otherwise Krankengeld stops until you apply (§ 51 SGB V).

From 1 January 2028. Teilarbeitsunfähigkeit (partial incapacity for work) is introduced: if you are expected to be unfit for work for longer than four weeks, the doctor can certify partial incapacity of 25, 50 or 75 % of your weekly working time. If you and your employer agree, you work part of the time for your salary. For the rest of the time, your employer pays as now for the first six weeks, and after that the Krankenkasse pays partial Krankengeld. How Krankengeld works today is explained on our page about sick leave in Germany.

Understand the conditions of the GKV

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What already applies

Some of the rules came into force immediately — on 30 July 2026. Since then, homeopathic and anthroposophic medicines can no longer be prescribed at the Krankenkasse’s expense, not even for children. A Krankenkasse may reimburse them as a voluntary Satzungsleistung (optional extra benefit) only until 31 December 2026, and the same deadline applies to treatment by homeopathic doctors under its contracts. From 2027, patients pay for homeopathy and anthroposophic medicine themselves. For cannabis, the Krankenkasse now pays only for standardised extracts, dronabinol and nabilone, and only after a six-month treatment attempt with a finished medicinal product; Cannabisblüten (cannabis flowers) are excluded.

As for federal funding: the regular Bundeszuschuss (federal subsidy) is being cut from 14.5 to 13.15 billion €, while the contribution for recipients of Grundsicherung rises to 1 billion € in 2027 and grows further to 2.75 billion € by 2031. On paper, help. In practice the underfunding remains, and it is the Beitragszahler (contribution payers) who pay for it.

Find out more — how to choose dental insurance.

Find a Zahnzusatzversicherung (supplementary dental insurance)

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What this means for you

If you are insured in the GKV and your spouse is currently on free Familienversicherung — work out your family’s costs from 2028 in advance. If your income meets the conditions for PKV (private health insurance), it is worth checking whether a switch is possible: the notice period in the GKV is two months to the end of the calendar month, so a decision to switch from the start of the year is not one you take in December.

If you work and draw a partial old-age pension of more than two thirds of the full pension, decide before the end of the year what matters more to you. From 1 January 2027 there is no Krankengeld with such a pension. You can reduce your partial pension to no more than 66.66 % by applying to the Deutsche Rentenversicherung (German statutory pension insurance); for this to take effect on 1 January, your application must reach it by 31 December 2026 at the latest.

We select and arrange health insurance — statutory and private, as well as supplementary policies including dental. We run the numbers for your specific situation before the new rates take effect, not after.

Frequently asked questions

Has the law already been passed?

Yes. The Bundestag passed it on 10 July 2026, the Bundesrat approved it the same day, it was published in BGBl. 2026 I Nr. 228 of 29 July and came into force on 30 July 2026. But most of the rules only start to apply on 1 January 2027, and the spousal surcharge on 1 January 2028.

How much will I have to pay for a spouse on Familienversicherung?

The surcharge is 2.5 percentage points on the contribution rate, it is levied from 2028 and paid by the Krankenkasse member alone. The exact amount depends on income and on the Beitragsbemessungsgrenze of the relevant year; the law sets no fixed cap.

What happens to my Zahnersatz if the treatment has already been approved?

For Festzuschüsse approved before 1 January 2027, the previous law applies. The new rates — 50 % basic, 60 % and 65 % with bonuses — apply to approvals from 2027 onwards.

Will Krankengeld be cut from 2027?

If you are in work and fall ill – no: 70 % of gross pay, but no more than 90 % of net pay, for up to 78 weeks within three years. Krankengeld will be lower for people whose employment ends while they are unfit for work: from the following day 60 % of net pay, or 67 % with a child who qualifies for Kindergeld (child benefit) or the Kinderfreibetrag (child tax allowance). And anyone who works and draws a partial old-age pension of more than two thirds of the full pension loses entitlement to Krankengeld from 1 January 2027.