German statutory health contributions are open to argument; their level is not, because it is set by regulation. More interesting is what was decided on the benefit side in the summer of 2026 — and how that compares with a policy we hold for our own staff in Tbilisi. This article puts both side by side: the German figures from official sources, the Georgian contract with its premiums, caps and exclusions — and the point at which the comparison stops carrying weight.
What it costs
The arithmetic is short. For 2026 the general contribution rate is 14.6 percent, the average supplementary rate 2.9 percent, and long-term care insurance 3.6 percent — 4.2 percent for the childless over 23. The assessment ceiling stands at €5,812.50 a month, or €69,750 a year.
For a childless member above that ceiling this produces €1,261.31 a month and €15,135.75 a year — employer and employee shares combined, before a single benefit has been claimed.
The movement is in the supplementary rate. It averaged around 1.4 percent in 2022 and 2.9 percent on 1 January 2025 — a doubling within three years. That is the figure which hits contributors directly, and it is better documented than any waiting-time statistic: it appears in the government bill for the Contribution Rate Stabilisation Act. The same section records the 2024 deficit — insurers and the health fund together just under €10 billion.
That contributions are rising has a traceable cause. In 2025 expenditure grew by 7.8 percent while contribution income excluding supplementary contributions grew by only 5.3 percent — the supplementary rate is precisely the lever that had to close the gap. Hospital treatment alone rose 9.6 percent to €111.43 billion — close to a third of all spending. At the end of 2025 insurers’ financial reserves stood at roughly €5.1 billion, equal to 0.18 monthly outlays and therefore below the statutory minimum reserve of 0.2.
What is being cut from 2027
The Act on the Stabilisation of Contribution Rates in the Statutory Health Insurance is no longer a proposal. The Bundestag adopted it in a recorded vote on 10 July 2026, the Bundesrat let it pass the same day; it was executed on 24 July and promulgated on 29 July 2026 (BGBl. 2026 I No. 228) — in force since 30 July 2026. It is not a contribution-reduction act but a benefits act with the sign reversed.
The scale is set out in the government bill: relief for the statutory scheme of €16.3 billion in 2027, rising to €38.1 billion by 2030. Of the €16.3 billion, €2.5 billion falls on insured persons and patients in 2027 — €1.9 billion of it through higher co-payments.
| Measure | Effect | From |
|---|---|---|
| Co-payments (new section 61 SGB V) | 10 % of the dispensing price, minimum €7.50, maximum €15 instead of €5 to €10 | 2027 |
| Fixed subsidies for dentures | −10 % | 2027 |
| Homeopathics, anthroposophics, cannabis flower | no longer a statutory benefit | since 30 July 2026 |
| Medical remuneration | one percentage point deducted from the base wage rate | 2027–2029 |
| Extra-budgetary remuneration | folded into the global budget as a rule, with few exceptions | 2027 |
| Hospital nursing pay rises | refinanced at only 50 % | 2027 |
| Manufacturer rebate on medicines | an additional 8.5 % alongside the existing 7 %, giving 15.5 % | 2027 |
| Contribution assessment ceiling | + €3,600 a year on top of the regular indexation (new section 223 (4) SGB V) | 2027 |
| Surcharge for co-insured spouses and partners | 2.5 percentage points on the contribution rate (new section 242b SGB V) | 2028 |
The last point deserves attention because it touches a structural feature. Contribution-free family insurance was among the strongest arguments for the statutory system. It survives as long as a child under twelve is being cared for — the cabinet draft said seven — and likewise where a relative with care level 2 or above is being cared for, from statutory retirement age, and in cases of own care level 3, full reduced earning capacity or a degree of disability of at least 60. For all other co-insured spouses and partners the surcharge applies from 2028. Children remain free of charge; the act says so expressly.
On the revenue side the main lever is the assessment ceiling. The new section 223 (4) SGB V raises it for 2027 by €3,600 a year beyond the regular indexation — decoupling it from the compulsory-insurance threshold for the first time. Anyone earning above the ceiling therefore pays not only a higher rate but on a larger base.
The federal subsidy falls to €13.15 billion in 2027 and €12.95 billion from 2028 — a cut of €1.35 billion rather than the €2 billion a year foreseen in the government bill.
One widely cited source of counter-financing is not in the act: the levy on sugar-sweetened drinks is a recommendation of the health finance commission, not law. The promulgated act amends only social security codes and hospital legislation, no excise duty statute.
The number that went through the press
The National Association of Statutory Health Insurance Physicians warned on 11 May 2026 that 46 million treatment cases would go unfunded. Its chairman Andreas Gassen called the bill a “hedge-trimmer of a savings act”; the figures cited included 16.6 million cases in general medicine and 1.4 million in paediatrics, against a funding gap of €1.75 billion for 2027.
Two clarifications belong with this, and they do not weaken the point but make it durable. First, treatment cases are not appointments — a case normally covers several contacts within a quarter, so equating it with “46 million doctor appointments” is imprecise. Second, the calculation referred to the cabinet draft of 29 April 2026. The enacted law cuts the federal subsidy less, raises the family-insurance child threshold from seven to twelve years, and drops the indexation of co-payments. The order of magnitude of the warning stands; its basis has moved.
€170 million that should not have been lost
Running alongside this is a matter with less to do with demographics than with supervision. According to research by NDR, WDR and Süddeutsche Zeitung published on 17 July 2026, statutory health insurers and physicians associations placed insured persons’ money in real-estate funds of the Verius group and largely lost it.
The position on the parliamentary record is Bundestag printed paper 21/7556 of 12 August 2026: at least 17 institutions, at least €170 million. For the Baden-Württemberg physicians association it documents €50 million invested between 2019 and 2022 and a loss ratio of 96.3 percent. Follow-up research by the same team put the figure in August 2026 at close to €220 million across 28 institutions on an invested volume above €500 million — those numbers rest on informants’ accounts and are not officially confirmed.
The benchmark is unambiguous. Section 80 (1) sentence 2 SGB IV requires that the funds of social insurance institutions be invested and managed “so that a loss appears excluded, an appropriate return is achieved and sufficient liquidity is assured”. Not “security should be sought” — a loss should appear excluded.
What the private route costs in Germany
The obvious domestic alternative is not one. On 1 January 2025 roughly two thirds of privately insured people faced an adjustment, averaging 18 percent; on 1 January 2026 it hit around 60 percent at an average of 13 percent. Both figures apply to the contracts actually adjusted rather than the whole portfolio — but anyone caught by both rounds now pays well over a third more than two years earlier. The average monthly premium for full private cover in 2026 is expected to be around €617 — a figure the insurers’ association expressly ties to the increase actually feeding through to the portfolio.
This is a property of the system, not an accident. An adjustment is triggered under section 155 (3) VAG once required benefits deviate from calculated benefits by more than ten percent — which is why increases do not arrive annually in small steps but rarely and then steeply. The premium also follows entry age and health status rather than income. It does not fall when income falls, which is what makes it a problem in retirement.
There are two safety nets for that case, and their level is the real news. The basic tariff is capped in 2026 at €1,017.18 a month — precisely the maximum statutory health contribution excluding the care component — and halves to €508.59 in cases of need. The standard tariff, which requires a pre-2009 contract, is capped in 2026 at €848.62. A safety net pitched at the level of the statutory maximum is a safety net, but not a cheap one.
A look at Austria
Austria is not Germany with different numbers, and on contributions it is visibly better placed. The ASVG health insurance rate for 2026 is 7.65 percent — 3.87 percent employee and 3.78 percent employer share.
| Germany | Austria | |
|---|---|---|
| Health insurance rate Germany adds long-term care insurance of 3.6 or 4.2 % | 17.5 % (14.6 + avg. 2.9) | 7.65 % (ASVG) |
| Assessment ceiling per month Austria adds €13,860 of special payments a year | €5,812.50 | €6,930.00 |
| Maximum health contribution per month employer and employee shares combined | €1,017.19 | €530.14 |
| Contribution in retirement Austria: raised from 5.1 % on 1 June 2025 | rate applied to the pension | 6.0 % of the pension |
| Health spending as share of GDP Switzerland 11.8 %, OECD average 9.3 % | 12.3 % | 11.7 % |
| Patient charge per medicine the prescription fee is unchanged for 2026 | €7.50–15 from 2027 | €7.55 prescription fee |
Half the contribution rate does not mean half a system. Austria funds a larger share from taxation and internal cross-subsidies: on top of the amounts withheld from pensioners, the pension institution transfers a further levy of 178 percent to the health fund. The lower percentage on the payslip is therefore not a price advantage but a different way of booking the same money.
Savings are being made all the same, and on the same groups. Under the second Budget Consolidation Measures Act the pensioners’ health insurance contribution rose from 5.1 to 6.0 percent with effect from 1 June 2025; for most pension recipients the full rate applies from 2026. In return the prescription fee stays at €7.55 for 2026.
The Wahlarzt: Austria’s structural peculiarity
What distinguishes Austria structurally from Germany is the Wahlarzt arrangement — the non-contracted doctor — and it is more expensive than it sounds. Patients pay the bill themselves and are then reimbursed 80 percent of the amount the insurer would have spent on a contracted provider — expressly not 80 percent of the invoice.
The gap is quantified. In 2023, Wahlarzt invoices totalling €551.45 million were submitted to the ÖGK; €208.85 million were reimbursed. Patients carry the difference. Submitted invoices now correspond to roughly 16 percent of spending on the outpatient sector — a privately financed layer inside a compulsory system.
The background is a thinning contract network: occupied contracted posts in general medicine fell by 5.1 percent relative to population between 2019 and 2023, after a 10.2 percent fall from 2009 to 2019. No unified collective agreement between the ÖGK and the medical chamber has existed since 2019. And how long people actually wait is not reliably known: the Court of Audit recommended nationwide waiting-time monitoring back in 2021 — by its follow-up audit in 2025 it had not been implemented.
What stands on the other side
We insure our staff in Tbilisi with International Insurance Company IRAO, a Georgian joint-stock company wholly owned, according to the 2025 annual report, by the Vienna Insurance Group. With IRAO and its sister company GPI Holding, VIG describes itself as the second-largest group in the Georgian market — a 24.0 percent share across the first three quarters of 2025. Our contract runs on the Comfort tariff.
Because Georgian premiums are much guessed at and little documented, here is the structure of the tariff together with the order of magnitude of the contributions. One caveat is essential: group premiums are a negotiated outcome, not list prices. They depend on headcount, age structure, claims history and the agreed scope of benefits, and they are set afresh at every renewal. Read the figures below as an order of magnitude rather than a price list — what really carries information is the benefit side underneath:
| Standard | Comfort | Classic | Silver | |
|---|---|---|---|---|
| Monthly premium per person broadly €15 / 18 / 23 / 28 — individually negotiated, not list prices | approx. 45 GEL | approx. 55 GEL | approx. 70 GEL | approx. 85 GEL |
| Family card, one dependant premium for the card in total | approx. 90 GEL | approx. 110 GEL | approx. 140 GEL | approx. 170 GEL |
| Family card, two or more broadly €48 / 58 / 74 / 90 a month | approx. 144 GEL | approx. 176 GEL | approx. 224 GEL | approx. 272 GEL |
| Inpatient, emergency annual cap, reimbursed at 100 % | 10,000 GEL | 12,000 GEL | 15,000 GEL | 20,000 GEL |
| Inpatient, planned ten-month waiting period | 8,000 GEL | 10,000 GEL | 12,000 GEL | 15,000 GEL |
| Oncology ten-month waiting period — about €2,310 on Comfort | 5,000 GEL | 7,000 GEL | 8,000 GEL | 10,000 GEL |
| Outpatient planned, contracted clinic reimbursement rate and annual cap in GEL | 70 % / 2,000 | 80 % / 2,500 | 90 % / 3,000 | 90 % / 3,500 |
| Prescribed medicines at the contracted pharmacy | 60 % / 1,500 | 70 % / 2,000 | 80 % / 2,500 | 90 % / 3,000 |
| Travel cover USD 50,000 per insurance period, employees only | 14 days | 30 days | 60 days | unlimited |
At the Georgian National Bank rate of 19 August 2026 (3.0265 lari to the euro) the range works out at roughly €15 to €28 a month, or about €180 to €340 a year. Against €15,135.75 of maximum German contribution, even the top of the range is a factor of 45 away, and the bottom more than a factor of 80.
That order of magnitude is true — and it is nonetheless the least honest figure in this article unless what it omits is set beside it.
On the benefit side, the tariff includes a clinic network across 22 locations — from Tbilisi, Batumi and Kutaisi to Stepantsminda, Zugdidi and Oni — with unlimited outpatient emergency care, ambulance service and a personal doctor, plus preventive check-ups twice a year.
Where the comparison ends
- Annual caps instead of unlimited benefit Comfort: 10,000 GEL planned inpatient, about €3,300 — beyond that the insured pays
- Percentage co-payments 20 to 40 % outpatient, depending on clinic and tariff
- Ten-month waiting period on planned benefits applies to oncology and cardiology as well
- Mental and behavioural disorders ICD-10 F00 to F99 excluded in full, including depression and anxiety disorders
- Congenital and genetic conditions with a few named exceptions
- Rehabilitation, spa treatment, physiotherapy excluded; physiotherapy only at 30 % and only at one centre
- Palliative care excluded
- Transplants, hearing aids, glasses, contact lenses excluded; endoprostheses and stents only within the caps
- Chronic hepatitis, HIV, AIDS primary diagnostics only
- Tied to contracted clinics free choice of doctor only at a markedly lower rate
- No ageing provisions recalculated annually; entry age limits usually 65 to 70
- Emergency care, ambulance, prevention unlimited and twice yearly respectively — the policy is strong here
The German statutory scheme knows none of this. It pays without an annual cap, without waiting periods, without health underwriting and without an age limit; it covers psychotherapy, rehabilitation, palliative care and transplants; it insures children at no extra charge. That is exactly why it costs what it costs. Setting a few hundred euros of annual premium against €15,136 compares two products that resemble each other only in name.
One point belongs stated plainly: these are group premiums. They apply to a workforce that is young on average and was taken on collectively through the employer — without individual underwriting and at a contribution calculated for the collective. How far that is the exception rather than the rule shows in the supervisory statistics: of 785,361 health policies in force in Georgia on 31 December 2025, 56.8 percent ran through companies and 32.7 percent through state bodies — only 82,911 policies, or 10.6 percent, were held by individuals. In a country of roughly 3.7 million people, individual private cover is a niche market.
A private individual therefore pays different premiums, and on new business Georgian insurers regularly apply an age limit between 65 and 70. Anyone moving to Tbilisi at 68 and only then looking for a policy may find none.
A second detail belongs here for completeness: according to the same annual report, the Vienna Insurance Group holds 90 percent of the Tbilisi clinic Curatio — which also appears as a contracted clinic in the tariff’s provider list. Insurer and provider are therefore partly in the same hands. That is not unusual in the Georgian market, but it belongs on the table when comparing reimbursement rates by clinic.
What follows from this
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Work out your actual contribution, not the maximum
The ceiling is not the normal case; the contribution on your own income is. Only that figure — plus the higher co-payments from 2027 and the spousal contribution due from 2028 — gives the number that matters.
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Settle the sequence before the price
A Georgian policy does not replace German membership, because no social security agreement exists between the two countries. It makes sense when residence is moving anyway — and none at all as a savings scheme while a German residence remains.
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Set your age against section 6 (3a) SGB V
From 55, return to the statutory scheme is as a rule excluded. That check belongs before departure, not in the year you want to come back.
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Read the exclusions against your own medical history
A pre-existing diagnosis from the F chapter, a congenital condition or a foreseeable need for rehabilitation decides the policy’s suitability more than any premium. That is an examination of the actual contract, not the brochure.
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Note the proof requirement on entry
Since 1 January 2026 Georgia requires proof of health and accident insurance covering the entire stay, with minimum cover of 30,000 GEL — about €9,900. Without it, entry is refused.
The finding is less dramatic than the figures suggest. The German system is expensive, and from 2027 it becomes thinner at the edges: higher co-payments, less on dentures, a remuneration deduction at the doctor, a contribution for the spouse previously insured free. The Georgian offer is cheap, and it is narrower in precisely the measure that it is cheaper. The difference is not a verdict on quality but a question of which risk you carry yourself.
What happens to membership on departure, and why return is barred from 55, is in Leaving the Scheme Is Easy. Getting Back In Is Not. What the state costs and delivers overall is in Government Ratio 50.3% and Germany Is Quietly Falling Apart. How the lari has moved against the euro — the basis of every conversion here — is in The Lari from 2023 to 2026. The Austrian balance sheet is in Leaving Austria and Austria’s Pensions: 86.8% Replacement Rate. What a pension means at a location with a lower price level is in Retiring in Georgia.
Frequently asked questions
What is the maximum German statutory health contribution in 2026?
The contribution assessment ceiling is €5,812.50 a month in 2026, or €69,750 a year. Against it run the general rate of 14.6 percent, an average supplementary rate of 2.9 percent and long-term care insurance at 3.6 percent — 4.2 percent for the childless over 23. For a childless member above the ceiling that comes to €1,261.31 a month and €15,135.75 a year, employer and employee shares combined.
What does the Contribution Rate Stabilisation Act change?
The Bundestag passed it on 10 July 2026, it was executed on 24 July and promulgated on 29 July 2026 (BGBl. 2026 I No. 228); it has been in force since 30 July 2026. Co-payments rise from €5–10 to €7.50–15, an increase of half. Fixed subsidies for dentures fall by 10 percent. Homeopathic and anthroposophic medicines and cannabis flower are no longer covered. From 2028 insurers levy a surcharge of 2.5 percentage points on the contribution rate for a co-insured spouse or civil partner (new section 242b (1) SGB V); it is waived where there is a child under 12, where a relative with care level 2 or above is being cared for, from statutory retirement age, and at a degree of disability of 60 or more. Medical remuneration takes a one-percentage-point deduction from 2027 to 2029.
Is it true that 46 million doctor appointments will be lost?
The figure comes from the National Association of Statutory Health Insurance Physicians and is more precise than it is usually reported. It refers to 46 million unfunded treatment cases, not appointments — a treatment case normally covers several contacts within a quarter. Its chairman Andreas Gassen cited it on 11 May 2026 against a funding gap of €1.75 billion for 2027. Important context: the calculation referred to the cabinet draft of 29 April 2026. The act was subsequently softened — the federal subsidy was cut by €1.35 billion for 2027 rather than €2 billion.
What happened with the Verius funds?
According to research by NDR, WDR and Süddeutsche Zeitung published on 17 July 2026, statutory health insurers and physicians associations lost insured persons money in real-estate funds of the Verius group. The position on the parliamentary record — Bundestag printed paper 21/7556 of 12 August 2026 — names at least 17 institutions and at least €170 million; for the Baden-Württemberg physicians association it documents €50 million invested between 2019 and 2022 and a loss ratio of 96.3 percent. The benchmark is section 80 (1) sentence 2 SGB IV: social insurance institutions may invest only so that a loss appears excluded.
What does private health insurance cost in Georgia?
In the order of roughly 45 to 85 lari per person per month — about €15 to €28 — across the tariff steps of a Georgian corporate policy such as the one we hold for our staff in Tbilisi with IRAO (Vienna Insurance Group). These are expressly not list prices: group premiums are individually negotiated and depend on headcount, age structure, claims history and the agreed scope of benefits, and they are renegotiated at each renewal. Private individuals pay different premiums in any case, and Georgian insurers commonly set an entry age limit between 65 and 70. Treat the figures as an order of magnitude, not as a quotation.
Is a Georgian policy comparable to German full cover?
No, and this is the central point. The Georgian policy works with annual caps rather than unlimited benefit — on the Comfort tariff roughly 10,000 lari for planned inpatient treatment, about €3,300. It applies percentage co-payments, a ten-month waiting period on planned benefits, and ties you to contracted clinics. Exclusions include mental and behavioural disorders in full (ICD-10 F00 to F99), congenital and genetic conditions, rehabilitation, palliative care, transplants, and hearing and vision aids. Setting that against a German contribution compares two different products.
How does Austria compare?
Much better on contributions, barely on outcomes. The ASVG health insurance rate for 2026 is 7.65 percent against 17.5 percent in Germany, and the monthly maximum contribution is €530.14 against €1,017.19. That is mainly a different way of booking the money — Austria funds more from taxation and internal cross-subsidies, including a 178 percent levy the pension institution adds on top of pensioners’ contributions. Savings are being made too: the pensioners’ health contribution rose from 5.1 to 6.0 percent on 1 June 2025. Health spending runs at 11.7 percent of GDP and €4,663 per person — second in the EU — while the life expectancy advantage has shrunk from 0.8 years (2018) to 0.1 years (2023).
Who does the switch actually pay off for?
For nobody who justifies it by the premium alone. The price gap is real, but it does not measure the same benefit. Georgian cover makes sense where a change of residence is happening anyway — it then replaces no German system but closes a gap, because there is no social security agreement between Germany and Georgia. Anyone planning to leave past their mid-forties should first check section 6 (3a) SGB V: from 55, return to the statutory scheme is as a rule barred.
This article is general information and does not constitute legal, tax or insurance advice. Contribution rates, the assessment ceiling and long-term care rates for 2026 follow the social insurance parameters and the figures published by the Federal Ministry of Health; the maximum contribution is calculated from them. Details of the Contribution Rate Stabilisation Act follow the legislative record (cabinet decision 29 April 2026, Bundestag vote 10 July 2026 in the version recommended by the health committee — government bill Bundestag printed paper 21/6130, committee recommendation Bundestag printed paper 21/7016). The 2025 financial development of the statutory scheme follows the quarterly reports of the Federal Ministry of Health. Austrian contribution rates and assessment bases follow the 2026 social insurance parameters of the Federation of Social Insurance Institutions, and the rise in the pensioners’ contribution the second Budget Consolidation Measures Act; health spending, Wahlarzt data, contracted posts and waiting-time monitoring follow Statistics Austria and reports of the Austrian Court of Audit. Statements attributed to the National Association of Statutory Health Insurance Physicians refer to its comment of 11 May 2026 on the cabinet draft. The Verius figures follow Bundestag printed paper 21/7556 of 12 August 2026 and the underlying research by NDR, WDR and Süddeutsche Zeitung of 17 July 2026; the wider figures from the August 2026 follow-up are not officially confirmed. Private insurance adjustments follow the Association of Private Health Insurers. Premiums, caps and exclusions of the Georgian tariff come from the IRAO contract documents in the version available to us and apply to a group policy. The premium figures are rounded orders of magnitude, not list prices: group premiums are individually negotiated, depend on headcount, age structure, claims history and scope of benefits, and change at every renewal. Individual tariffs, age limits and underwriting rules differ. Shareholdings and market share of the Vienna Insurance Group follow its 2025 group annual report; market structure and policy counts follow the market statistics of the Insurance State Supervision Service of Georgia for 1 January to 31 December 2025. Statements on age limits rest on market observation and do not replace an insurer’s underwriting decision. Conversions use the Georgian National Bank rate of 19 August 2026, 3.0265 GEL to the euro. As at August 2026; subject to changes in the law.