For members


Will health insurance costs go up again in Germany?

German statutory health insurance funds are facing a historic deficit this year. Will people soon have to shell out more of their income for coverage?

Health insurance cards from AOK.
Health insurance cards from AOK. Photo: picture alliance/dpa | Karl-Josef Hildenbrand

There’s a growing financial gap in Germany’s health insurance system. The country’s ageing population means that overall healthcare costs are going up – and three years of the Covid pandemic made the problem even worse. 

According to the latest estimates, statutory health funds like TK and AOK are facing a financial black hole to the tune of around €17 billion this year. In order to tackle this looming deficit, Health Minister Karl Lauterbach (SPD) has set out a number of plans, from allowing insurance funds to hike their additional contributions to enforcing pharmaceutical discounts on medicines.

In 2023, Lauterbach also plans to inject €14.5 billion of treasury funding into the statutory insurers, as well as drawing money from a central health fund and from the insurers’ own reserves. 

However, there are signs that even this suite of measures may not be enough.

In an interview with business paper Handelsblatt on Wednesday, Lauterbach warned that a further increase in health insurance contributions was “almost impossible to avoid”.

Since the start of 2023, statutory health insurers have been given leeway to increase the premiums that they levy to customers on top of the base contributions of 14.6 percent. Normally these premiums are between 1.2 percent and 1.6 percent. 

Some – including certain regional branches of AOK – have chosen to do so, while others have kept their contributions at the previous rate.  

READ ALSO: What to know about Germany’s new health insurance fees for 2023

According to Lauterbach, however, the fact that Finance Minister Christian Lindner (FDP) wants to maintain the so-called ‘debt brake’ in 2024 means that patients will probably have to make up the shortfall – rather than the government.  

“The Finance Minister’s focus is on compliance with the debt brake and on projects such as the equity pension and the Bundeswehr,” he told Handelsblatt. “That means that rising deductions from the wage packet can hardly be avoided.” 

‘Up to €2,000 per year’

The Health Minister isn’t the only one debating the future of the health insurance funds in recent days.

In an interview with Bild on Wednesday, right-wing economist Bernd Raffelhüschen called for a drastic reform of Germany’s healthcare system – including penalising those who make unhealthy or risky choices.

“We can no longer afford the system. Patients will have to pay more out of their own pockets in the future,” Raffelhüschen said, adding that some financial relief should be offered by the state. “The subsidies for low-income earners, for example, must come from the federal budget.”

According to the economist, health insurance contributions could rise as high as 22 percent of income by 2035 if nothing is done to reverse the trend. 

READ ALSO: Reader question: How can I change my German health insurance provider?

Euro notes in a piggy bank

A saver places euro notes in a piggy bank. Photo: picture alliance/dpa/dpa-Zentralbild | Patrick Pleul

Currently, statutory contributions are around 16 percent of income on average – though employers split these half-and-half with their employer, meaning the income deduction is more like eight percent. 

Raffelhüschen – who considers himself part of the neoliberal ‘Freiburg School’ of economists – told Bild that health insurers shouldn’t have to cover the full cost of treatment.

Instead, he argued, patients should receive a bill for doctors’ visits and then forward this to their insurer, who would cover the bulk of the costs. 

Patients would then have to cover part of the costs out of their own pocket – capped at around €1,500 or €2,000 per year.

The economist also called for higher contributions for smokers and said people who voluntarily undertake risky activities such as skiing should have to cover the cost of treatment for any injuries themselves. 

Health cuts on the horizon?

Another potential solution to the growing deficit is to make cuts in healthcare services or reduce fees for doctors and dentists.

However, Lauterbach was quick to pour cold water on this idea, arguing that he had already drawn on so-called ‘efficiency reserves’ in the previous reform package. Making cuts in surgeries and hospitals would be “absurd”, he added. 

READ ALSO: ‘It works’: Your verdict on the German health insurance system

Health Minister Karl Lauterbach

Health Minister Karl Lauterbach (SPD) speaks at the German Hospital Day in Düsseldorf on November 14th. Lauterbach is against the lifting of the mask-wearing rule. Photo: picture alliance/dpa | Roberto Pfeil

In addition, he said, placing further financial pressure on pharmaceutical companies couldn’t be justified, since these companies could ultimately choose to leave Germany. 

Nevertheless, the Health Minister said he disagreed with the Association of Statutory Health Insurance Funds’ claim that the deficit stood at more than €30 billion.

“That is definitely wrong,” he said. “We’re working to make the deficit smaller.” 

Member comments

  1. Maybe the Health insurers could reduce their costs. Large offices for 3-4 staff. Maybe have an office in Hospital complexes as opposed to expensive town buildings.
    More and more health insurers use on-line facilities for Q&A, letters, form filling etc. surely they are saving there.
    Health care keeps going up, but when you are prescribed medicine the pharmacy gives the cheapest product.
    The answer is not always just to increase costs, perhaps in house work practices could be improved.

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For members


Do German employees with Covid-19 and no symptoms still have to go to work?

The Covid-19 pandemic may be officially over but the number of reported cases is going up around Germany. If an employee tests positive, but has no symptoms, do they still need to show up at work?

Do German employees with Covid-19 and no symptoms still have to go to work?

During the bulk of the Covid-19 pandemic, anyone with the virus was required to stay home for a certain period of time, whether they showed symptoms or not.

Now the pandemic may officially be over, but “Covid-19 is still with us,” as Germany’s health minister Karl Lauterbach said last week upon announcing the availability of the newest booster vaccine

There are currently three Covid-19 variants circulating around Germany, with the reported number of cases going up.

READ ALSO: Could there be a new wave of Covid-19 in Germany this autumn?

Workers around Germany may get tested – be it because a close contact had the virus or out of curiosity – and find they also have Covid-19, but are completely free of symptoms.

Does this mean they still need to show up at their workplace, if working from home isn’t possible, or should they stay home until they have officially recovered?

Employee must indicate infection

If a person infected with Covid exhibits typical signs of the virus such as a coughing, a cold or a fever, the case is usually crystal clear: they can and should rest at home, as with any sickness. 

In accordance with German law, they’ll need to get a sick note from their GP if those symptoms last for longer than three days. 

However, positive test alone “does not automatically make you unfit for work,” lawyer Alexander Bredereck told Germany’s RND editorial network. “And if you are not on sick leave, you actually have to work. Therefore, the employee is in a difficult situation here.”

He continued: “If the employee simply stays at home without a sick note, in the worst case he can risk a warning or even dismissal for not showing up for work.”

However, if someone goes to work despite the positive test result, they may endanger their colleagues – as they can become more severely infected. 

Furthermore under German labour law, the employee is usually obliged to inform their employer of the Covid-19 infection.

READ ALSO: How sick leave pay in Germany compares to other countries in Europe

Uncertain legal situation

“At the moment, there are no legal requirements that employees and employers have to adhere to,” says Bredereck. 

In February 2023 Germany’s ‘Occupational Health and Safety Ordinance’ on Covid-19 – which would have required those with an infection to stay home at least five days – came to an end.

Since then, Germany’s Ministry of Labour has simply recommended that each employer implement their own hygienic requirements to protect their employees from Covid and other infectious diseases such as the flu, which is soon expected to see a spike in cases as the autumn/winter season takes hold. 

If there is a high incidence of infection in one particular region, the Ministry of Labour recommends that, in addition to the usual hygiene measures, social distancing measures should be implemented again and people should reduce their contacts. 

This suggests that workers should not endanger other workers in this situation.

Stay transparent

To solve the dilemma and avoid conflicts, Bredereck recommended that employees simply stay transparent with their management.

“Don’t take any unnecessary risks or get into trouble with your boss,” he said. “Ask your employer what you should do.”

Alternatively, the employee could also turn to their GP for a sick note, which for regular patients is also available via phone in some cases. 

“Then the doctor has to decide what makes sense, and the employee is on the safe side,” explained Bredereck.