“Why doesn’t my colleague with the bigger salary pay more for health insurance?” Statutory health insurance (gesetzliche Krankenversicherung, GKV) follows a few clear rules. Here they are, with the 2026 figures.
Who must, who may
- Compulsory members (§ 5 SGB V): employees below the compulsory insurance threshold, trainees, students, unemployment-benefit recipients and most pensioners.
- Threshold (JAEG): 77,400 € a year in 2026 (6,450 € a month). Above it you may stay in the GKV voluntarily (§ 9 SGB V) or switch to private insurance (PKV). For 2027 the cabinet has set 84,150 € – not yet promulgated.
- Self-employed people and civil servants may choose regardless of income.
Full comparison: GKV or PKV.
How the contribution is calculated
| Component | 2026 |
|---|---|
| General rate (§ 241 SGB V) | 14.6 % |
| Fund-specific supplementary rate (§ 242 SGB V) | average 2.9 % |
| Contribution ceiling | 5,812.50 € a month (69,750 € a year) |
| Maximum health contribution | about 1,017 € a month |
| Long-term care on top | 3.6 % (4.2 % without children) |
Employer and employee each pay half (§ 249 SGB V). Income above the ceiling is contribution-free – which is why everyone above 5,812.50 € pays the same maximum. For 2027 the ceiling is set to rise to 6,375 € (cabinet decision, not yet promulgated).
Family insurance: free of charge
Spouses and children are co-insured free (§ 10 SGB V) if their own income is at most 565 € a month in 2026 (one seventh of the reference figure of 3,955 €) or 603 € with a mini-job. Children: to 18, to 23 if not working, to 25 in education, without limit if disabled.
Changing your fund
All funds provide the same statutory benefits; they differ in supplementary rate, extras and service (§ 175 SGB V):
- Binding period: at least twelve months; notice to the end of the month after next – the new fund handles the rest.
- Special right: if your fund introduces or raises its supplementary rate, you may switch until the end of the month in which the higher rate first applies. Since summer 2026, according to consumer advice centres, funds no longer have to notify increases separately (since 30 July 2026). On 15 October 2026 the Bundestag voted to reinstate that duty; the Bundesrat deliberates on 20 November 2026 – not yet in force.
- Optional tariffs (§ 53 SGB V) bind you longer: one year for refund and cost-reimbursement tariffs, three years for deductible and sick-pay tariffs.
Sick pay from week 7
Your employer pays for six weeks (§ 3 EFZG); then the fund pays sick pay (Krankengeld): 70 % of gross pay, at most 90 % of net pay, calculated only up to the ceiling – in 2026 a maximum of about 135.63 € per calendar day gross (§§ 44, 47 SGB V). Duration: at most 78 weeks within three years for the same illness, including the employer’s six weeks (§ 48 SGB V). Above the ceiling there is a gap – a matter for individual advice.
How to proceed
- Check your payslip: supplementary rate and whether you earn above the ceiling.
- Check family insurance: partner below 565 € (603 € mini-job)? Children up to 25 in education?
- Compare funds by supplementary rate and the extras you actually use.
- Calculate your sick-pay gap from week 7.
More from my practice: private clients.
General information, not legal, tax or investment advice. Sources: German Social Code Book V (§§ 5, 6, 9, 10, 44, 47, 48, 53, 175, 241, 242, 249 SGB V), Social Insurance Reference Values Ordinance 2026, Continued Remuneration Act (§ 3 EFZG), Federal Ministry of Health, GKV-Spitzenverband, consumer advice centres, vdek – as of October 2026. 2027 values are cabinet decisions, not yet promulgated. Want to know what the numbers mean for your payslip? Get in touch.
