Germany’s federal cabinet approved a sweeping health insurance reform on April 29, 2026, in what Chancellor Friedrich Merz called one of the biggest welfare state reforms in decades. Officially named the GKV-Beitragssatzstabilisierungsgesetz, the law is designed to close a projected €15.3 billion deficit in the public health insurance system (GKV) and prevent further hikes in monthly contribution rates. The draft now moves to the Bundestag and is expected to pass before the summer break, with key changes rolling out from 2027 and 2028. Bundesrat approval is not required.
For the roughly 90% of residents in Germany covered by statutory health insurance — including most international workers, students, and freelancers — the reform brings three changes that directly hit the wallet. Pharmacy co-payments will rise from a maximum of €10 to €15 per prescription, the first adjustment in 22 years. Free family insurance for non-working spouses will end in 2028, replaced by a contribution of 2.5% of the working partner’s income — this also applies if the spouse lives abroad under a bilateral social security agreement. And several services will no longer be covered, including homeopathic treatments and possibly the routine skin cancer screening offered every two years to adults over 35. Children under seven and partners caring for relatives are exempt from the spousal contribution.
The reform comes on top of already-rising costs in 2026. The average Zusatzbeitrag (supplementary contribution rate) climbed to 2.9%, and the income threshold for switching to private health insurance (PKV) rose to €77,400 per year — making it harder for mid-income expats to leave the public system. Major providers like Techniker Krankenkasse (TK), DAK, and Barmer have all confirmed higher rates for 2026, although the new reform aims to prevent another round of increases in 2027. Critics including the GKV-Spitzenverband and welfare associations like Diakonie and Caritas have warned the package places too much burden on insured persons rather than the pharmaceutical industry or federal budget.
For expats weighing their options, the reform underscores how different German public insurers can be in practice. Although all 90+ Krankenkassen offer the same legally-mandated core services, they differ in their additional contribution rates, English-language support, bonus programs, and extras like osteopathy or alternative medicine coverage. Anyone reviewing their insurance situation should also know that a rate increase from a Krankenkasse triggers a special right to switch immediately — without the standard 12-month waiting period. The full reform text is available on the Federal Ministry of Health (Bundesgesundheitsministerium) website.
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