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When that call is made with private health insurance in hand, the conversation tends to be different. Not because the practice is being fussy, but because the German healthcare system works in a very particular way for patients with private cover, which changes day-to-day life from the very first moment.

In this article we walk through what changes for a private patient in Germany at each real step of the medical experience: from calling to book an appointment through to receiving the doctor’s invoice. With verified data and no idealising.

Booking an appointment: when you stop waiting weeks

Access to medical care in Germany is broadly designed so that the family doctor (Hausarzt) is the first point of contact and refers you to a specialist when needed. In theory, there’s free choice of doctor. In practice, getting a quick appointment with a specialist depends heavily on the insurance you have.

A study by the RWI Leibniz-Institut für Wirtschaftsforschung, based on thousands of real calls to practices across Germany, measured this difference: private patients got a specialist appointment in an average of 12 days, while those in the statutory system waited 25 days. On top of that, they were 7% more likely to be offered an appointment at all.

The reason is no secret. Practices receive higher remuneration for treating a private patient, and many set aside specific slots for them. The GKV-Spitzenverband itself has acknowledged in recent surveys that one in four patients in the statutory system waits more than 30 days for a specialist appointment.

With private insurance, alongside faster access, there’s a service many insurers offer at no cost: finding a specialist appointment within 48 hours. You call a number at your insurer, explain what you need, and they take care of locating an available practice. It’s a particularly useful service when you’re new to a city and don’t yet have trusted doctors. You’ll find it explained in more detail in the extras of private health insurance.

On referrals (Überweisung): Germany has free choice of doctor, so you can generally go straight to a specialist without going through the Hausarzt. There are exceptions, such as radiology or certain specific specialties. With private insurance this rarely poses a problem, unless you’ve taken out a tariff with the so-called Primärarztprinzip (family-doctor principle), where full reimbursement depends on going through the Hausarzt first. It’s worth checking before you sign up.

At the practice: what changes for a private patient in Germany

When you arrive at the practice, the first thing that changes is reception itself. The usual question is: “Sind Sie privat oder gesetzlich versichert?” (are you privately or statutorily insured?). Instead of handing over the electronic health card of a public fund, you present your private insurer’s card or, in many cases, simply give your details.

From there, the experience tends to differ in several respects:

• More time during the consultation. Because billing is done per service provided rather than by a fixed quarterly amount, many doctors can spend more time explaining and diagnosing without the pressure of a patient quota.
• Access to non-standard treatments. Certain therapies, diagnostic tests or methods not included in the general catalogue of the healthcare system can be covered by most private tariffs. This ranges from broader physiotherapy techniques to recognised alternative medicine (osteopathy, clinical homeopathy, acupuncture), always depending on the level you’ve taken out.
• The prescription is different. If you’re prescribed a medication, you receive a Privatrezept (private prescription) instead of the usual electronic prescription. You pay the full price at the pharmacy and then submit the invoice to your insurer for reimbursement.

The care tends to be more personalised, especially in private practices (the so-called Privatpraxen), which only treat private patients and self-payers. In many cities, these practices are the ones with the shortest waiting times.

Medications: how it works at the pharmacy

For a private patient in Germany, access to medications is broader than many people expect. Private prescriptions aren’t subject to the fixed maximum prices (Festbeträge) that cap the reimbursement of some medications in the statutory system, so in practice you can access the original version of a drug without your insurer restricting the cost to a cheaper substitute. This does, however, depend on the type of tariff you’ve taken out.

The procedure at the pharmacy is straightforward: you present your private prescription, pay the full amount, and keep the invoice. You then submit the invoice to your insurer through the app, which processes it and reimburses you within a few days. Most tariffs also cover medications prescribed without a mandatory prescription (the so-called grüne Rezepte, green prescriptions) if your doctor considers them necessary for treatment, something that doesn’t usually happen in the statutory system.

Hospital: what the stay is like

If a private patient in Germany needs to be admitted to hospital, basic medical care is the same for everyone: accredited hospitals, professionals trained in the same system, shared clinical standards. What changes with private insurance are the so-called Wahlleistungen (optional services), which are regulated in the Krankenhausentgeltgesetz.

There are three officially recognised categories, clearly explained on the portal of the Bundesministerium für Gesundheit:

• Accommodation. A single or double room instead of a shared room. If you pay out of pocket, an Einbettzimmer typically costs between 150 and 200 € per night.
• Treatment by the head of department (Chefarztbehandlung). The patient can request that the main care be provided by the senior consultant or a more highly qualified specialist at the hospital, rather than the doctor on duty. This cover is typical in Pro and Max tariffs.
• Additional medical services. Choice of certain diagnostic methods, specific implants or non-standard treatments.

In practice, you arrive at the hospital, present your private card (the so-called Card für Privatversicherte issued by your insurer), and sign a Wahlleistungen agreement with the hospital. Billing for general services usually goes directly from the hospital to the insurer, without you having to pay upfront. Special medical services (such as Chefarzt care) are billed separately and then reimbursed.

Another small but practical detail: with private insurance you don’t pay the hospital Eigenanteil of 10 € per day (up to 28 days a year) that does apply to patients in the statutory system.

The specific percentages and conditions by level (Basic, Smart, Pro, Max) are in the detailed coverage comparison.

The invoice: the moment that changes most

Here’s the most visible administrative difference for a private patient in Germany compared with the statutory system. In private healthcare, the flow is always the same: the doctor invoices you, you pay the invoice, and then you claim reimbursement from the insurer. It’s called Kostenerstattungsprinzip (the cost-reimbursement principle).

It sounds complicated at first, but the reality is quite different. Insurers have apps where you upload a photo of the invoice, and the reimbursement usually reaches your account within a few days. You’ll find the full procedure explained in how invoice payment works in private insurance.

This system has a feature many patients make the most of: the premium refund for not submitting invoices (Beitragsrückerstattung). If you don’t use your insurance in a given year, or submit few invoices, the insurer refunds part of your annual contribution as a reward. For small expenses (a one-off consultation, a routine test), it can work out better to pay out of pocket and keep the bonus.

Dental, glasses and physio: the cover you notice most day to day

Beyond major procedures, there are three areas where private insurance stands out particularly in everyday life:

• Dental. Generous reimbursements for cleanings, fillings, root canals, dentures and implants. The percentages range from 60% to 100% depending on the tariff level and type of treatment. Orthodontics, for both children and adults, is usually covered on reasonable terms too.
• Glasses and contact lenses. Annual allowances ranging from 125 € to 600 € depending on the level taken out, which for many users covers renewing their glasses every one or two years at no extra cost.
• Physiotherapy and similar treatments. A greater number of covered sessions, access to osteopathy, acupuncture and other manual therapies depending on the tariff, without the usual caps applied in other settings.

These details, which at first glance seem minor, are often the ones with the biggest impact on the real financial balance of the insurance over the year. You’ll find the exact amounts and percentages by level in the coverage comparison.

What doesn’t change

Private insurance doesn’t transform the entire German healthcare system. For a private patient in Germany, some aspects are identical to those in the statutory system:

• Emergencies. In a medical emergency, all patients are treated at the nearest hospital or emergency service, regardless of insurance. The type of cover is only looked at afterwards, for billing.
• Basic medical quality. Doctors in Germany train in the same system, accredited hospitals meet the same standards, and the medications available are the same. What changes with private insurance are the conditions of access and choice, not the technical quality of the medicine.
• Actual availability in areas with limited supply. In small towns or regions with few specialists, the difference is less noticeable. If there’s only one dermatologist within 50 kilometres, that dermatologist will see you regardless of your insurance.

Knowing where the difference is real (appointments, hospital, reimbursement, cover) and where it isn’t (emergencies, technical quality) helps you make the decision with realistic expectations.

Frequently asked questions

Do I have to say I’m a private patient when booking an appointment?

Yes, it’s worth mentioning when you call. It’s neither a trick nor a legal requirement, it simply helps the practice handle the appointment through the right channel. Many practices have slots reserved for private patients, and mentioning it avoids being given a slot several weeks away.

Can I be refused care for having private insurance?

No. Any licensed medical practice can treat private patients. In fact, there are practices (the so-called Privatpraxen) that only treat private patients or self-payers.

What happens if I go to the emergency department?

You’re treated like any other patient. The difference comes afterwards, in the billing: in a hospital emergency, the hospital invoices your insurer directly, and in an outpatient emergency consultation you receive a private invoice that you then claim back. In no case is emergency care conditional on the type of insurance.

Do I need a referral (Überweisung) to see a specialist?

Generally, no. Germany has free choice of doctor, so a patient with private insurance can go straight to a specialist in most cases. The most common exceptions are radiology and certain specific services that require a clinical referral. If your tariff includes the so-called Primärarztprinzip, you will need to go through the family doctor first for cover to be 100%.

The specific conditions (waiting times, reimbursements, included services and hospital cover) depend on the tariff level taken out and on the insurer. The data in this article comes from German studies and public regulations and reflects typical situations, not individual guarantees. For an assessment tailored to your case, the most sensible approach is to review the specific conditions of each offer.

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On Wednesday 29 April 2026, the German government approved a reform that changes this. Keeping a partner covered on the public system will come with a cost for many profiles from 2028. Not for everyone — there are important exceptions, especially where there are young children — but yes for a substantial share of the couples who currently benefit from this free cover.

Let’s look at exactly what changes, who will have to pay, how much, and why this change reopens a conversation many people considered settled.

Before the reform: the argument many people repeat

The phrase comes up in almost every conversation with clients weighing up what to do about their health insurance: “sure, but on the public system my wife (or husband) pays nothing.” And it’s true. It has been for decades, and it’s part of the emotional and financial calculation many couples make when settling in Germany.

The system works like this: if you’re on the public system (GKV) and your partner — spouse or registered partner — doesn’t work or earns very little, they’re automatically covered under your policy, without paying a contribution of their own. The same applies to children. On private insurance (PKV), by contrast, each family member pays their own individual contribution.

That difference is one of the big arguments that leads many couples to stay on the public system even when one of them has a high income and could, technically, opt for private cover. The question was simple: why pay two contributions if on the GKV I pay just one and it covers both of us?

The 29 April reform doesn’t eliminate that logic entirely, but it modifies it. And that forces anyone who made the decision on the basis of that argument to redo the maths.

How family insurance in Germany works today

Before getting into what’s changing, it’s worth being clear about what exists today.

The Familienversicherung allows the holder of a public policy (GKV) to co-insure certain family members at no cost, provided they meet certain requirements. According to the conditions set out by the Krankenkassen themselves and the official guide from the Bundesgesundheitsministerium, the basic requirements are:

• Having residence or habitual abode in Germany.
• Not having your own mandatory insurance.
• Not being a person exempt from the insurance obligation (for example, civil servants, military personnel).
• Not being self-employed as your main occupation.
• Not exceeding a certain income threshold.

The income threshold in 2026

The co-insured family member cannot have regular income above:

• 565 € a month in general (one seventh of the social security Bezugsgröße, under § 10 SGB V).
• 603 € a month if the income comes from a Minijob (this figure is tied to the statutory minimum wage, which in 2026 stands at 13,90 €/hour).

If the family member exceeds these figures, they leave family insurance and have to insure themselves.

Who can be co-insured for free today

The current system covers, at no extra cost to the policy-holder, the following groups (provided they meet the requirements above):

• Children, adopted children, foster children.
• Spouses and registered partners (eingetragene Lebenspartner).

One important clarification: the German system does not automatically recognise common-law couples or unregistered cohabiting partners. Spousal Familienversicherung applies only to marriages and to partnerships officially registered under the Lebenspartnerschaft. Anyone living together without marriage or registration has never been able to benefit from this cover, and the reform doesn’t change that.

What changes in family insurance from 2028

The healthcare reform package approved on 29 April (the GKV-Beitragssatzstabilisierungsgesetz, BStabG) introduces a significant change: from 2028, keeping a spouse or registered partner on family insurance stops being entirely free for many profiles.

According to official information from the Bundesgesundheitsministerium, the specific measure is a surcharge of 2,5% on the income of the insured spouse who co-insures their partner. In other words: if you’re on the GKV and your partner is covered through your policy, you’ll now pay a supplement of 2,5% of your own income to keep them covered.

There’s an important nuance in the legislative path. The initial draft, published on 16 April, proposed a surcharge of 3,5%. After discussions within the government, the Bundeskabinett lowered that figure to 2,5% in the version approved on 29 April. There may still be adjustments as it passes through the Bundestag, but the current official reference figure is 2,5%.

Who avoids the surcharge: the family insurance exceptions

The surcharge doesn’t apply in every case. Minister Nina Warken has stressed that “family insurance is being modified, not abolished,” and the approved text keeps spousal co-insurance free in five specific situations:

• Parents with children under 7. If the couple has a child under that age, the spouse remains co-insured with no surcharge.
• Parents of children with disabilities who cannot support themselves financially.
• Family carers of dependent people (pflegende Angehörige).
• Spouses of retirement age (from the Regelaltersgrenze).
• Spouses with recognised full occupational disability (volle Erwerbsminderung).

Free cover for children, including adopted and foster children, also stays unchanged. That isn’t affected.

The most affected profile is therefore couples without young children, without family care duties, both of working age, where one works and the other doesn’t (or earns little). That’s the typical case that will have to pay the surcharge.

How much it will cost to keep a spouse on family insurance

The 2,5% surcharge is calculated on the income of the insured spouse — the one paying contributions — and, like other GKV contributions, is capped by the Beitragsbemessungsgrenze (BBG), the ceiling up to which contributions are levied. In 2026, the BBG stands at 5.812,50 € a month (69.750 € a year), according to the Bundesregierung. That means that, however much you earn, the surcharge isn’t applied to your entire salary, only up to the ceiling.

That nuance matters: above a certain salary level, the surcharge is “capped.” The maximum surcharge in 2026 would be around 145 € a month (5.812,50 € × 2,5%), or in other words, around 1.745 € a year.

This table shows the surcharge applied at different income levels of the policy-holder, calculated on 2026 figures (the BBG will continue rising in 2027 under the reform in the same package, which we cover in another blog article):

In rough terms, the annual cost of keeping a spouse on the GKV under this new model is, for most affected profiles, between 1.250 € and 1.750 € a year.

According to calculations by the IGES Institut cited by several German media outlets, around 1,3 million spouses co-insured on the GKV will be affected by the change. The estimated additional revenue for the system is around 2.200 million euros a year, according to the government.

Why this change reopens the conversation about private insurance

This is where the maths gets interesting. Until now, the comparison between GKV family insurance and private insurance for a couple where only one works had a very clear strength in favour of the public system: the free partner. It was a conclusive argument that closed the conversation.

From 2028, that argument still holds in some cases (couples with children under 7, carers, retired spouses or those with recognised disability) but stops holding in many others. And when it stops holding, the annual cost of keeping a spouse on the GKV goes from zero to between 1.250 € and 1.750 €.

That doesn’t mean PKV is automatically the winning option. PKV has its own logic: each member of the couple pays an individual contribution based on age, health status and the level of cover taken out. For a couple where both are young and healthy, the combined contributions can be competitive; for a couple where one has pre-existing health conditions, not necessarily. And there’s a further nuance: PKV is a long-term decision, with implications that go well beyond the year-to-year (a difficult return to the public system after a certain age, how the contribution evolves over the years, plans to return to your home country).

What does change is that the question is open again. Until now, many couples in Germany had closed it with a quick calculation. The reform forces that calculation to be redone with the new numbers. If you have the option to choose between GKV and PKV (that is, if your gross salary exceeds the Versicherungspflichtgrenze, set at 6.450 €/month in 2026), it’s worth reviewing how the private insurance system works with up-to-date information before treating anything as settled.

What if my partner lives in another country?

This is a point of particular interest to many internationals in Germany. In plenty of couples, one partner lives in their home country while the other works in Germany.

The general rule for family insurance in Germany requires residence or habitual abode in the country to be co-insured. But there are exceptions where a bilateral social security agreement allows co-insurance with a family member residing outside the country. The official BMG statement expressly mentions this case, citing the agreement with Turkey as an example, and indicates that the new 2,5% surcharge will also apply to these situations.

For EU countries, European social security regulations and Community rules set particular rules that are worth reviewing in detail, case by case. There’s no universal answer: it depends on the employment status of each member of the couple, the country of residence and the type of cover the spouse already has in their country. If this is your situation, it’s worth raising it in a personalised consultation before assuming that cover does or doesn’t exist.

Timeline and what could still change

The ministry’s planned timeline is tight. The key dates:

• 16 April 2026: the ministry publishes the Referentenentwurf (initial draft) with a surcharge of 3,5%.
• 29 April 2026: the Bundeskabinett approves the final version, with the surcharge lowered to 2,5%.
• Before the 2026 summer recess: the bill is expected to pass through the Bundestag. According to the government and as reported by specialist publications, the text does not require Bundesrat approval (it isn’t a zustimmungsbedürftiges Gesetz), so the parliamentary path is more direct than in other reforms.
• 1 January 2028: the 2,5% spousal surcharge takes effect.

As already happened between the draft and the approved version, there may still be adjustments during the parliamentary debate. Some social associations such as SoVD and VdK have been highly critical of the measure and have called for it to be reviewed. It can’t be ruled out that the percentage or the exceptions may change before final approval. But the political direction is clear: free family insurance for a spouse will be, from 2028, more restrictive than it is now.

Frequently asked questions about family insurance in Germany

Are my children still covered for free?

Yes. The reform doesn’t touch the free co-insurance of children, including adopted or foster children. The change affects only the spouse or registered partner, and only in cases that don’t fall under one of the planned exceptions.

If my partner works part-time and earns little, are they affected?

It depends. If your partner’s income is below the family insurance threshold (565 € a month in 2026, or 603 € for a Minijob), they remain eligible for cover. From 2028, if they’re within that threshold but don’t fall under any of the exceptions (child under 7, care duties, retirement, disability), you’ll pay the 2,5% surcharge. If they exceed the threshold, they fall outside family insurance and will have to insure themselves — as already happens today.

Does this also apply if my partner is in another country?

If the co-insurance is based on a bilateral social security agreement, the 2,5% surcharge will apply from 2028 too, according to the ministry. For EU cases (Spain, Italy, Portugal, etc.) Community legislation introduces nuances that need to be reviewed in detail, case by case.

What happens if I switch to PKV and my partner stays on the GKV?

In that case, your partner would not be co-insured under your family insurance (because you’d no longer be on the GKV). They would have to insure themselves as a voluntary GKV member or through their own employment, and would pay their own contribution. The 2,5% surcharge doesn’t apply in this scenario, because there’s no co-insurance. It’s one of the many factors that enter the calculation when a couple considers switching to private insurance.

When exactly does it take effect?

On 1 January 2028, according to the current timeline. Until then, the rules remain those that apply today: free spousal co-insurance at no extra cost, provided the requirements are met.

This article describes a legislative project going through parliament. The figures, dates and exceptions may be adjusted during the process. For specific decisions about cover, especially for couples with one member residing outside Germany, it’s advisable to have personalised advice.

La entrada Family Insurance in Germany: What’s Changing for Couples se publicó primero en Bramex Plus.

It isn’t an increase in the contribution rate. It’s an increase in the ceiling up to which contributions are levied. The difference matters, and we’ll look at it with numbers.

What the German government approved on 29 April

The Bundeskabinett gave the green light to the Gesetz zur Stabilisierung der Beitragssätze in der gesetzlichen Krankenversicherung, known by its acronym BStabG. It’s a large package with many measures: caps on hospital spending, pharmacy cuts, removing homeopathy from the benefits catalogue, changes to sick pay, higher co-payments at the pharmacy and dentist, and other measures affecting the system as a whole. The ministry’s stated aim is to save between 16.000 and 17.000 million euros a year from 2027 to prevent the Krankenkassen from having to raise their Zusatzbeiträge again.

Of that whole package, two measures directly affect the pockets of those earning above the contribution ceiling:

• An additional increase in the Beitragsbemessungsgrenze of 300 € a month in 2027, on top of the regular annual increase.
• A surcharge of 2,5% from 2028 for those who co-insure a spouse on the GKV (this measure has its own analysis, which we cover in a separate article).

In this article we focus on the first. According to the official statement from the Bundesgesundheitsministerium, the measure aims to have employees earning above the ceiling contribute a larger share to GKV financing.

What the Beitragsbemessungsgrenze is (and why it isn’t the same as the Versicherungspflichtgrenze)

The German system has two different salary thresholds that are often confused. It’s worth being clear on them before going further.

Beitragsbemessungsgrenze (BBG): the ceiling up to which you contribute

The Beitragsbemessungsgrenze is the maximum gross salary on which contributions to the GKV and to long-term care insurance (Pflegeversicherung) are calculated. In 2026 it stands at 5.812,50 € a month (69.750 € a year), according to the data published by the Bundesregierung.

What does that mean? That if your gross monthly salary is 7.000 €, the Krankenkasse doesn’t calculate your contribution on the 7.000 €, but only on the first 5.812,50 €. The rest is left out. That’s why the GKV has a practical “ceiling” on contributions: however much you earn, you don’t pay beyond that cap.

Versicherungspflichtgrenze (JAEG): the threshold to be able to move to PKV

The Versicherungspflichtgrenze, also called the Jahresarbeitsentgeltgrenze or JAEG, is a different threshold. It marks the minimum income above which an employee is no longer required to be on the public system and can opt for private cover (PKV). In 2026 it stands at 6.450 € a month (77.400 € a year).

A quick summary to avoid confusion:

The draft the government approved in April touched only the first (BBG). But the law that finally emerged from Parliament ended up raising the second one too: from 2027, the threshold for choosing PKV will be considerably higher.

What exactly changes in 2027

The BBG is updated automatically each year in line with wage developments. That’s the regular increase. What the government approved on 29 April is something different: an extraordinary increase of an additional 300 € a month, on top of the regular increase.

In other words: in 2027 the BBG won’t rise only by what the usual wage dynamic would dictate. It will rise by that plus an extra 300 € a month. In practice, a larger share of the salary of those earning above the ceiling will become subject to contributions.

According to the ministry’s draft reported by Tagesschau and other media, the forecast is to raise around 1.200 million euros in additional annual revenue from employees, and another 1.200 million from employers (who pay the other half of the contribution).

How much more you’ll pay each month

This is where the abstract figure becomes something tangible. Let’s work it out.

The GKV contribution in 2026 is made up of the fixed general rate of 14,6% plus the average Zusatzbeitrag of 2,9%, according to the figure published by the Bundesgesundheitsministerium. In total, around 17,5% of gross salary, split equally between employee and employer. The employee’s share is therefore 8,75%.

On the additional 300 € that become subject to contributions, the calculation gives:

• 300 € × 8,75% = 26,25 € a month in additional contributions from the employee to the GKV.
• Another 26,25 € a month comes from the employer.
• In total: around 315 € a year in additional cost for the employee, and an equivalent amount for the company.

To this you have to add long-term care insurance (Pflegeversicherung), which is also calculated on the same base. For employees with children the increase is around an additional 5,40 € a month on the employee’s share; for employees without children over the age of 23, somewhat more, due to the Kinderlosenzuschlag surcharge.

To put the numbers in context, this table shows which employees are affected according to their annual gross salary:

Note a nuance: those just above the current ceiling (around 70.000 € gross a year) will see only part of the impact, because their salary doesn’t cover the full additional 300 €. From around 78.000 € a year the effect is complete.

The exact calculation will also depend on the specific Zusatzbeitrag of your Krankenkasse. Some charge below the 2,9% average and others above it. The GKV-Spitzenverband page publishes the up-to-date list.

Why this change hits close to home for many internationals in Germany

The typical professional profile of someone who moves to Germany for work often fits neatly into the salary range affected by this measure: engineers, STEM profiles, IT, technical or management positions in large industrial and technology companies. Many people who arrive in Munich, Stuttgart, Hamburg, Frankfurt or Berlin to work in sectors such as aerospace, automotive, chemicals, software or consulting already start above the ceiling or cross it within a few years.

In the consultations we see day to day, this is exactly the group that stays on the GKV thinking it’s the “neutral” or “default” option, without stopping to do the maths. They’re also the ones who feel the compound effect most when the BBG and the Zusatzbeiträge rise in the same year, as already happened in 2026 (the BBG went from 5.512,50 € to 5.812,50 €, and the average Zusatzbeitrag rose from 2,5% to 2,9%).

The 2027 reform adds another step to that dynamic. Anyone on the GKV with a salary above the ceiling will contribute more, without the benefits changing.

The package brings more changes worth knowing about

The BBG increase is just one of the BStabG measures. Others that directly affect those on the GKV:

• Co-payments for pharmacy and benefits: up by 50% on average. The minimum contribution per prescription rises from 5 € to 7,50 €, the maximum from 10 € to 15 €. Exemptions for family burden or chronic illness remain unchanged.
• Sick pay (Krankengeld): drops from 70% to 65% of gross salary from 2027.
• Dental prosthesis subsidy (Zahnersatz): the Krankenkasse’s contributions are reduced by 10%.
• Homeopathy and anthroposophic medicines: removed from the catalogue of reimbursable benefits.
• Cannabis-Blüten (cannabis flowers): no longer covered by the GKV; cover is limited to standardised extracts and finished medicines.
• Spousal co-insurance: from 2028, a 2,5% surcharge on the policy-holder’s salary for those who co-insure a spouse on the GKV (with exceptions, for instance for parents with children under 12 or people with a high care grade). We cover this topic in detail in another article.

The package as a whole represents a recalibration of the system that broadly translates into more contributions for the insured and fewer covered benefits.

What about those on PKV or considering it?

The Beitragsbemessungsgrenze doesn’t apply to PKV. In private insurance the premium isn’t calculated on salary, but on each insured person’s profile: entry age, health status, benefits taken out and other factors. So this specific increase doesn’t directly affect those already on PKV.

And with the new threshold now approved for 2027, that analysis makes more sense in 2026 than ever.

There is one aspect where there is a connection: the Arbeitgeberzuschuss (the employer’s maximum contribution towards the PKV premium) is calculated on the BBG. In 2026 it’s set at 508,59 € a month, according to the BMG data. When the BBG rises in 2027, the Arbeitgeberzuschuss will also rise proportionally. In other words: for those on PKV, this change adjusts their employer’s maximum contribution favourably.

Anyone still on the GKV with a salary above the Versicherungspflichtgrenze (6.450 €/month in 2026) legally retains the option to switch to the private system. It’s a decision that depends on many factors — age, health status, family situation, future plans in Germany or a return to your home country — and it’s worth analysing in detail, not as a reaction to a news item. But if you’ve never stopped to do that analysis and you’re in that salary range, now is probably a good time to do it.

Key dates: when it takes effect and what’s still pending

This is the reform’s timeline, now completed in its parliamentary phase:

• 16 April 2026: the ministry publishes the Referentenentwurf (initial draft).
• 29 April 2026: the Bundeskabinett approves the final version.
• 10 July 2026: the Bundestag and the Bundesrat pass the definitive law.
• 1 January 2027: most of the package takes effect, including the extra BBG increase.
• 1 January 2028: the measures on spousal co-insurance and the levy on sugary drinks take effect.

The law is now passed. There were adjustments between the initial draft and the final text (the spousal surcharge went from 3,5% to 2,5%, and the exception for children was widened to under-12s); the exact 2027 threshold figures will be fixed by government regulation in autumn 2026.

Frequently asked questions

Does this also affect those on PKV?

Not directly. The PKV premium isn’t calculated on salary and isn’t affected by the BBG. What does change is the company’s maximum Arbeitgeberzuschuss, which rises proportionally because it’s calculated on the BBG.

When will I notice it on my payslip?

From the January 2027 payslip.

What’s the difference between the Beitragsbemessungsgrenze and the Versicherungspflichtgrenze?

The BBG is the ceiling up to which you contribute within the GKV (5.812,50 € in 2026). The Versicherungspflichtgrenze is the salary threshold that allows you to opt for PKV (6.450 € in 2026). They’re two different figures — and the law passed in 2026 ended up raising both: the contribution ceiling and, through an extraordinary increase, also the PKV access threshold from 2027.

Can I switch to PKV now to avoid the increase?

Only if your gross salary exceeds the Versicherungspflichtgrenze (6.450 € a month in 2026 / 77.400 € a year). It’s a decision that depends on your situation — age, health, family, future plans — and deserves an analysis with real numbers, not a reaction to a headline. The BBG increase alone shouldn’t be the only reason to switch; it is, though, a good trigger to do that analysis now, while the access threshold is still the 2026 one.

If you’d like to look at it with real numbers, we’ll guide you with no obligation.

The law was passed in 2026. The exact 2027 threshold figures are pending the government regulation due in autumn 2026; we will update this article once it is published. For specific decisions about cover or changing insurance, it’s advisable to have personalised advice that takes your particular situation into account.

La entrada GKV Increase in 2027: What Changes If You Earn Above the Contribution Ceiling se publicó primero en Bramex Plus.