GKV Reform 2027: Rising costs, fewer services – everything you need to know

The German Federal Cabinet approved the GKV Premium Rate Stabilisation Act (GKV-Beitragssatzstabilisierungsgesetz, BStabG) on 29 April 2026. The Act is currently passing through the parliamentary process. Final figures for 2027 – in particular the contribution assessment ceiling (Beitragsbemessungsgrenze, BBG) and the annual earnings threshold (Jahresarbeitsentgeltgrenze, JAEG) – will be set by statutory order in autumn 2026. All figures cited are based on the cabinet draft.

At a glance: what changes in 2027?

Why is this reform happening?

Germany's statutory health insurance system (GKV – gesetzliche Krankenversicherung) is under structural pressure. Expenditure has been growing at nearly 8 per cent per year – twice the rate of the 2010s and significantly faster than wage growth, which drives revenues. The average supplementary contribution rate (Zusatzbeitrag) has more than doubled since 2022: from 1.3 % (2021/2022) to 2.9 % today (2026). For someone earning €3,500 gross per month, that increase alone represents around €350 more per year compared with 2022.

The FinanzKommission Gesundheit (Health Finance Commission) estimates the financing gap for 2027 at around €15 billion – rising to as much as €40 billion by 2030. The BStabG treats symptoms, not root causes. The structural problem – a pay-as-you-go system in an ageing society with persistently rising healthcare costs – remains unsolved.

Part 1: What gets more expensive?

1. Contribution assessment ceiling (BBG) rises significantly

The BBG (Beitragsbemessungsgrenze) is the monthly ceiling up to which GKV contributions are calculated. Earnings above it are not subject to contributions.

• BBG 2026: €5,812.50/month (€69,750/year)
• BBG 2027 (forecast): approx. €6,125–6,425/month (regular wage-based adjustment + extraordinary +€300)

2. Annual earnings threshold (JAEG) rises – switching to private health insurance becomes harder

The JAEG (Jahresarbeitsentgeltgrenze) is the income threshold above which employed people are free to choose between statutory and private health insurance. Only those whose regular annual earnings consistently exceed the JAEG are exempt from mandatory GKV membership (versicherungsfrei) and may switch to PKV (private Krankenversicherung).

• JAEG 2026: €77,400/year (€6,450/month)
• JAEG 2027 (forecast): approx. €81,000–84,000/year (+€3,600 extraordinary + regular adjustment)

Someone currently earning, say, €80,000 per year sits above the 2026 JAEG and can choose PKV. If the JAEG rises to ~€81,000–84,000 in 2027, that same person may fall below the new threshold and lose the right to switch.

3. Co-payments (Zuzahlungen) rise by 50 % – first increase since 2004

• Therapeutic treatments (Heilmittel) – physiotherapy, occupational therapy, speech therapy: max. €10 → max. €15 per prescription
• Home nursing care (häusliche Krankenpflege): max. €10 → max. €15
• Dental prosthetics (Zahnersatz): co-payments also raised (hardship exemption unchanged)
• Going forward: co-payments will be dynamically indexed – regular rises are now built into the system
• The annual out-of-pocket cap (2 % of household gross income; 1 % for the chronically ill) is unchanged

4. Co-insured spouses become subject to contributions – from 2028

From 1 January 2028 (not 2027), non-working spouses and civil partners who are currently covered free of charge under the family insurance (Familienversicherung) will face a contribution of 2.5 % of the working partner's gross income – unless an exemption applies.

Exemptions (remain free of charge): Children; parents of children under 7; caring relatives; those above state retirement age.

Example: €6,000 gross/month → €150/month extra for the partner's coverage.

5. Employer contribution for mini-jobs rises

The flat-rate employer contribution to health insurance for mini-job workers rises from 13 % to 17.5 %, increasing payroll costs for all employers with mini-job staff.

Part 2: What gets cut or restricted?

Homeopathy and anthroposophic medicine: no longer reimbursed

These treatments are removed from the GKV benefit catalogue entirely. Anyone wishing to continue using them pays out of pocket – or needs a supplementary private insurance policy.

Mandatory second opinion before certain operations

For certain planned surgical procedures, obtaining a specialist second opinion becomes compulsory. For patients this means: additional time and effort, and potentially longer waiting times before the procedure.

Preventive check-ups for adults under review

Adult preventive screening programmes are explicitly on the table. Specific cuts have not yet been finalised – the parliamentary process is still ongoing.

Expenditure growth capped – structural consequences

The BStabG caps permissible expenditure growth in individual benefit areas at the basic wage rate (Grundlohnrate). When medical costs rise faster than wages – as they have done consistently in recent years – structural budget shortfalls arise. These may manifest as lower doctor remuneration, slower uptake of new treatments, or de facto narrower benefit coverage, without any explicit cut being formally enacted.

Federal subsidy cut for 2027–2030

The annual federal subsidy to the GKV is reduced from €14.5bn to €12.5bn per year for the entire 2027–2030 period. The gap must be covered through contribution increases or spending cuts.

What does this mean for switching to private health insurance?

Not everyone currently in the GKV should switch to PKV. The decision depends on income, health, family situation, employment status and long-term outlook. Those who benefit from free dependant cover under the family insurance – for example, because a partner is not working and there are children under 7 in the household – have a genuine financial advantage in the GKV that PKV cannot replicate.

For others, 2027 changes the picture materially:

• No income-linked premium: In the GKV, a higher salary means higher contributions – up to the BBG. In the PKV, your premium is based on age, health and the tariff you choose, not your salary.
• Access to all doctors and specialists: The GKV offers free choice of doctor – but only among those with a GKV panel licence (Kassenzulassung). A significant share of specialists operate on a private-fee basis only. In the PKV, this restriction does not apply.
• Individually designed benefit package: The GKV operates under the principle of economic sufficiency (Wirtschaftlichkeitsgebot, § 12 SGB V) – adequate, appropriate, economical. That means standard coverage, not the optimum. In the PKV you choose what is covered.
• Capital-funded with ageing reserves (Alterungsrückstellungen): Not a pure pay-as-you-go system – contributions in younger years build reserves for higher costs later in life.
• Employer subsidy applies to PKV too: Employed people receive the same employer contribution as GKV members – capped at half the maximum GKV contribution (2026: up to €648.10/month).

Conclusion

The BStabG is not a turning point – but it accelerates a trend that has been building for years: the GKV is getting more expensive while its coverage narrows. This is not cause for alarm. The GKV remains a solid baseline – and for many people, including families with children or a non-working partner, it remains the better option.

For a specific group, however, a window is closing in concrete terms: anyone employed and currently earning between approximately €77,400 and €84,000 per year may lose the right to choose after the 2027 JAEG increase. Anyone who still has the choice will be paying more from 2027 into a system that provides less.

If you are unsure whether you are eligible to switch, whether you would be insurable, or what any of this means for your specific situation – that is exactly what I clarify as an independent broker specialising in expats in Germany: in German, English, French, Dutch or Spanish, with no product ties and no sales pressure.