Germany Plans Major Health Insurance Cuts, Higher Co-Pays from 2028
Health Minister Nina Warken unveiled sweeping reforms to statutory health insurance, including ending free spousal coverage, cutting preventive services, and raising patient co-payments to close a projected €15 billion deficit.
Germany's coalition government announced a major overhaul of the statutory health insurance system (GKV) on April 15th, 2026, with far-reaching implications for the 73 million people enrolled in public health insurance — including millions of foreign residents, students, and working expats.
What's Changing
Health Minister Nina Warken (CDU) warned that without "decisive countermeasures," the statutory system would face a €15 billion shortfall in 2027, ballooning to €40 billion by 2030. The proposed reform package targets three main areas:
Ending free spousal co-insurance: An estimated 1.6 million spouses currently insured free of charge through their partner's Krankenkasse will be required to pay contributions from 2028. Under Warken's proposal, co-insured spouses would pay 3.5 percent of the main earner's gross income — meaning a household earning €4,000 monthly would pay €140 per month (€1,680 annually) for spousal coverage. Children will remain covered free of charge.
Service reductions: Free skin cancer screenings (currently offered every two years from age 35), homeopathy treatments, and certain orthodontic benefits will be cut. Early estimates suggest these cuts will save €100–300 million annually.
Higher co-payments and reduced sick pay: Co-payment limits will rise by 50 percent, while sick pay entitlements will be reduced, expected to generate €4.1 billion in savings.
What This Means for Foreign Residents
If you're a foreign resident on public insurance — the default for employees earning under €77,400 annually — these changes will directly affect your household budget and coverage. Families with a non-working spouse should prepare for new monthly insurance costs starting in 2028. Students and employees will see reduced preventive care options and higher out-of-pocket costs for prescriptions and treatments.
The reforms still require approval by the Bundestag and Bundesrat, with heated debate expected. Opposition parties and trade unions have criticized the proposal as an attack on families, particularly women without independent income. Implementation is targeted for 2028, giving households time to plan — but contribution rate increases are already biting in 2026.
