German Parliament to End Free Health Coverage for Spouses as 18.8 Billion Euro Savings Plan Advances

Germany is heading toward a fundamental change in how millions of families access statutory health insurance. Starting in 2028, previously free co-insurance for spouses and life partners will carry a new cost: a 2.5 percent surcharge on the employed partner's income. The measure is part of a 18.8 billion euro stabilization package that the Bundestag will vote on July 10, 2026 — and it is only one of several deep cuts for patients.

Children remain fully exempt from the charge, as do parents with children under seven, people caring for relatives, partners with full disability, and anyone who has already reached the standard retirement age. Simone Borchardt (CDU) stressed that the reform does not abolish family insurance altogether but introduces targeted adjustments to shore up the system's finances. The free-riding principle for adult dependents is being dismantled step by step.

The legislative centerpiece, the Beitragssatzstabilisierungsgesetz (Contribution Rate Stabilization Act), targets a projected financing gap of 18.8 billion euros in 2027. To close it, lawmakers are also raising patient co-payments significantly.

Co-payments Jump 50 Percent, Homoeopathy Dropped

From 2027 onward, the out-of-pocket cost for prescription drugs will rise by half — from a range of 5–10 euros per pack to 7.50–15 euros. The daily charge for hospital stays climbs from 10 to 15 euros. Additional savings come from cutting the fixed subsidy for dental prostheses from 60 to 50 percent and ending reimbursement for homoeopathic treatments and cannabis flowers. A fixed manufacturer discount of 15.5 percent replaces the current dynamic rebate, offering the health funds more predictable income.

The burden ceiling for total co-payments stays unchanged at 2 percent of gross earnings (1 percent for the chronically ill), and patients must still proactively apply for an exemption. But for many households the actual load will increase markedly.

Health Funds Under Pressure as Costs Outrun Revenue

Oliver Blatt, head of the GKV-Spitzenverband (National Association of Statutory Health Insurance Funds), called on the Bundestag to resist lobbying against the cuts. Expenditure by the funds has been rising far faster than income, he warned: from 249 billion euros in 2020 to an estimated 312 billion euros in 2026. Employers and members are already squeezed by rising supplementary contribution rates, Blatt noted.

A long-running sore point is the federal contribution for Bürgergeld (basic income) recipients. Bundestag President Bärbel Bas (SPD) confirmed in early July that the federal government pays only 144 euros per month per insured recipient, while actual costs run between 300 and 350 euros. The gap, which reaches up to 12 billion euros annually, has to be covered by regular premium payers. The new law envisages a gradual increase in federal payments starting in 2027, but an additional 2 billion euros will not flow until 2031 — leaving contributors to shoulder the interim burden.

Sick Note Battle: Employers Want Stricter Rules, Doctors Push Back

Parallel to the fiscal package, the coalition is debating a 34-point reform that includes abolishing telephone sick notes. Under the plan, a doctor's certificate would become mandatory from the first day of illness — a sharp shift from the current threshold of day four. Doctors and health insurers are pushing back. Andreas Storm, CEO of DAK-Gesundheit, warned that the change would overrun waiting rooms and instead proposed part-time sick notes, modelled on Scandinavian practice. The Federal Health Ministry is currently reviewing viable models.

Employers have welcomed the measure, arguing it would reduce absenteeism, while unions and parts of the SPD call it bureaucratic and medically counterproductive. The debate adds a further dimension to a reform that already touches every corner of the German health system: from the family budget to the doctor’s surgery floor.

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