The German statutory health insurance stabilisation act (GKV-Beitragssatzstabilisierungsgesetz) was passed by the Bundestag and Bundesrat on 10 July 2026. From 1 January 2027 co-payments rise: for medication, insured people pay at least €7.50 and at most €15 per drug; for therapies such as physiotherapy, 10 percent plus €15 per prescription; in hospital, €15 per day. The fixed dental-prosthesis subsidy falls to 50 percent of the standard treatment (60 percent with a bonus booklet), homeopathy is no longer covered, and the general entitlement to skin-cancer screening from age 35 lapses for now.
Whether private health insurance becomes the better choice depends on the plan. We therefore ran an anonymised case: a 38-year-old employee starting on 1 January 2027, with two plan levels from a large German provider – a comfort plan (Plan A) and a premium plan (Plan B), both without deductible. The gross premium including mandatory long-term care insurance, a switching option and daily sickness benefit is about €673 (Plan A) and about €767 (Plan B) per month. After the 50 percent employer subsidy, the employee's own cost is about €336 (Plan A) and about €383 (Plan B). In a claim-free year a €600 flat-rate refund and a performance-based premium refund of about €940 (Plan A) and about €1,110 (Plan B, estimated) come on top – in the best case bringing the own cost down to about €208 and about €241 per month. Neither refund is guaranteed, and both are forfeited once claims are submitted (preventive care and vaccinations excepted).
Example 1 – outpatient
back pain with an orthopaedic specialist, an MRI, 12 physiotherapy sessions, three prescription drugs, glasses and a skin-cancer screening (total bill €1,685). Out-of-pocket cost in statutory insurance from 2027: €526. In Plan A: €481 – barely better, because therapies are only reimbursed up to fixed maximum prices and medication only at 80 percent. In Plan B: €196, because therapies are reimbursed without a price list, medication at 100 percent, and glasses are subsidised up to €300. Important: anyone who submits claims loses the €600 flat-rate refund for the whole year (check-ups and vaccinations excepted).
| Item | Statutory from 2027 | Plan A | Plan B |
|---|---|---|---|
| Skin-cancer screening | €55.00 | €0.00 | €0.00 |
| Orthopaedic specialist | €0.00 | €0.00 | €0.00 |
| MRI | €0.00 | €0.00 | €0.00 |
| Physiotherapy (12 × €40) | €48.60 | €213.12 | €96.00 |
| 3 prescription drugs | €22.50 | €18.00 | €0.00 |
| Glasses | €400.00 | €250.00 | €100.00 |
| Total | €526.10 | €481.12 | €196.00 |
Example 2 – inpatient
cruciate-ligament surgery with five days in hospital. In statutory insurance, patients pay a €75 co-payment (€50 before the reform) and stay in a multi-bed room treated by the ward doctor. Anyone who wants a two-bed room and the chief physician pays about €3,350 extra in statutory insurance – €3,425 in total. In both private plans the out-of-pocket cost is €0, chief-physician treatment included. This is where private insurance has its biggest advantage.
| Item | Statutory from 2027 | Plan A | Plan B |
|---|---|---|---|
| Co-payment (5 days) | €75.00 | €0.00 | €0.00 |
| Two-bed room surcharge (self-pay only) | €550.00 | €0.00 | €0.00 |
| Chief physician (self-pay only) | €2,800.00 | €0.00 | €0.00 |
| Total standard | €75.00 | €0.00 | €0.00 |
| Total with two-bed room and chief physician | €3,425.00 | €0.00 | €0.00 |
Example 3 – child (assumed age 6)
glasses, naturopathy with 8 sessions and a hernia operation with an accompanying parent in hospital. In statutory insurance parents pay €740 themselves, or €2,590 with chief physician and single room. In Plan A €317 remains, in Plan B €0. The advantage is real, but in private insurance the child needs its own premium, whereas in statutory insurance it is covered free of charge through family insurance – and children pay no co-payments in statutory insurance. For orthodontics, statutory insurance is often ahead in the first years because the private plans cap dental benefits initially.
| Item | Statutory from 2027 | Plan A | Plan B |
|---|---|---|---|
| Glasses | €220.00 | €130.00 | €0.00 |
| Naturopathy (8 sessions) | €520.00 | €187.20 | €0.00 |
| Hospital standard | €0.00 | €0.00 | €0.00 |
| Chief physician + single room | €1,850.00 (self-pay only) | €0.00 | €0.00 |
| Total standard | €740.00 | €317.20 | €0.00 |
| Total with optional services | €2,590.00 | €317.20 | €0.00 |
Conclusion
after the reform, private insurance pays off above all in hospital and – with the premium plan – also for outpatient care. The comfort plan is barely better than future statutory insurance for outpatient care. What matters is your income (compulsory insurance threshold 2027 according to the cabinet draft: €84,150 gross per year), your family planning and your premium in old age. Anyone who wants to switch on 1 January 2027 should observe the statutory insurer's notice period, which is usually two full months to the end of a month.
Note: all prices and quantities in the examples are freely chosen assumptions, not price lists. The reform figures reflect the status of October 2026 and should be checked before making a decision. This article is not individual advice and not tax or legal advice.
What you should do now
- Run the 2027 co-payments against your real needs, not averages
- Compare plans on detail: therapy price caps, medication coverage rate, referral rules
- Clarify premiums in old age, family planning and notice periods before switching
Frequently asked questions
Want to run these numbers for your own situation? In an initial consultation we look at your income, family planning and options together.