German public health insurance changes in 2027
By Bettina Ostermann
Significant changes are coming to German health insurance in 2027, with rising income thresholds and higher contribution ceilings affecting employees and expats across the country. Bettina Ostermann, Senior Consultant at independent brokerage Myhealthcarebroker, outlines what is changing from January, what the higher costs mean for your monthly budget and who still qualifies to switch to private cover.
In 2027, there will be significant changes to the contribution assessment ceiling and the mandatory insurance threshold in Germany. For many employees, this will make health insurance more expensive and make it harder to switch to private health insurance. Here's an overview of the key facts.
Key facts at a glance
- Income threshold for private health insurance (employees): €77.400 in 2026, €84.150 in 2027, a jump of 8,7%.
- Contribution ceiling for public health insurance: €69.750 in 2026, €76.500 in 2027 (€6.375 a month).
- Average additional contribution: 2,9%, a forecast that most insurers are expected to exceed.
- Long-term care surcharge for people without children: 0,6% today, 0,9% from 2027 (planned).
- Maximum employee contribution without children: €648 a month in 2026, €730 in 2027, around €980 more a year. Self-employed: €1.261 to €1.403.
- Switching to private cover on January 1, 2027: employees need a regular salary above €84.150 in 2027. Freelancers and self-employed people can switch regardless of income.
What changes on January 1, 2027
The federal cabinet approved the new income figures on October 7, 2026, and the long-term care reform on September 30, 2026. Both still need final parliamentary approval; for the income figures, the Bundesrat vote is expected in November.
| 2026 | 2027 | |
|---|---|---|
| Income threshold for private health insurance (employees) | €77.400 | €84.150 (forecast) |
| Contribution ceiling for public health insurance | €69.750 | €76.500 (forecast) |
| Average additional contribution rate of public insurers | 2,9% | 2,9% (forecast, likely to rise) |
| Long-term care surcharge for people without children | 0,6% | 0,9% (planned) |
The increase is larger than normal because a law passed in July 2026 adds an extra €3.600 on top of the usual adjustment to both figures. For the income threshold, that is a jump of 8,7% in one year, and 46% since 2017, when it stood at €57.600.
Why all of this? Germany’s public health insurance system is facing a projected €19 billion funding gap in 2027.
What the higher ceiling costs you
In German public health insurance, what you pay rises with your income up to a set ceiling and then stays flat. Because the ceiling rises to €76.500, anyone earning above it pays more in 2027 without earning a single euro more.
Consider the maximum monthly contribution for health and long-term care insurance for someone without children. The rate of 22,0% in 2027 is made up of the general rate (14,6%), the average additional contribution (2,9%), long-term care insurance (3,6%) and the surcharge for people without children, which employees pay alone and which is set to rise from 0,6% to 0,9% under the planned long-term care reform. In Saxony, employees pay a slightly larger share of long-term care insurance.
| Monthly, at the contribution ceiling | 2026 | 2027 |
|---|---|---|
| Contribution ceiling | €5.812,50 | €6.375,00 |
| Total contribution (21,7%/22,0%) | €1.261 | €1.403 |
| Employer share | €613 | €673 |
| Employee pays | €648 | €730 |
| Self-employed person pays | €1.261 | €1.403 |
That is around €982 more a year for an employee and around €1.694 more for someone who is self-employed and pays the full amount without an employer share. Many insurers charge more than the average additional contribution, so the actual figure may be higher still.
Private health insurance works differently. Your premium is based on your age and the coverage you choose, not on your income. As an employee, your employer pays half, up to a fixed maximum.
Want to know how much you could save compared with the maximum public contribution? Calculate and see the difference for yourself.
Who can switch & who cannot
Employees
Employees who earn more than €84.150 in 2027 can switch to private health insurance.
Freelancers and self-employed people
For freelancers and self-employed people, the income threshold does not apply. You can choose private health insurance regardless of what you earn.
Students
The income threshold does not apply to students either. Within three months of enrolling, you can opt out of public health insurance and choose a private student plan, which is often cheaper. The decision is binding for the whole of your studies. From the age of 30, the discounted public student rate ends, and it might be worth reconsidering private cover.
Going back
If your salary falls below the threshold or you become unemployed, you have to return to public health insurance.
The advantages of private health insurance
Lower cost: your premium is based on your age at entry and the coverage you choose, not on your salary.
A 32-year-old employee typically pays €190 to €275 a month after the employer share, depending on coverage, compared with up to €730 in public health insurance from 2027. That is a saving of €450 to €540 a month, or more than €5.000 a year.
Better coverage: full dental, glasses and contact lenses, a single room in hospital and treatment by the senior consultant are standard in most private plans. You build your plan from modules, so you only pay for what you want.
Faster access: private patients usually get specialist appointments and MRI scans within days, not weeks.
Best time to join: private health insurance suits you best if you earn above the threshold and are under 45. The earlier you join, the lower your starting premium. Your spouse or children can be added for their own monthly premium.
Here's what to do to prepare for 2027
- Check your salary for 2027. Do you earn more than €84.150, or are you self-employed? Then you can switch. For the self-employed, there is no income threshold.
- Get independent advice. A health insurance broker can compare plans from a wide range of insurers for you, check whether switching makes sense in your case and handle the application.
- Tell your public insurer that you are leaving, and show them your new cover. Otherwise, you automatically stay on as a voluntary member. Many brokers will also handle the cancellation and paperwork for you.
Myhealthcarebroker is an independent health insurance consultancy in Germany, comparing plans from more than 40 private health insurance companies with 100-percent free advice in English.
If your salary is near the new threshold or you are deciding whether staying in public health insurance makes financial sense, book a free consultation in English with Bettina Ostermann and the team.
Bettina Ostermann is a Senior Consultant at Myhealthcarebroker with more than 20 years of experience in the health insurance sector. She advises internationals in Germany in English and stays their contact for claims and changes long after they sign.
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