Federal Minister of Health · since 29 July 2026

Economy → Work → Social Security → Health → Reform

Dr. Carsten LinnemannThe Economy of Wellbeing

Health ministry · Insurance

Statutory health insurance: how the GKV works

About 74.6 million people, nearly nine in ten residents, are covered by Germany’s statutory health insurance. It is a solidarity system run by 93 self-governing funds. Its rules explain much of the current political argument: over contribution rates, the number of funds, the future of private insurance and what members are entitled to know.

01 / In figures

The GKV at a glance

Official figures with reference period and source.

58.75mContributing membersMid-2026 · GKV-Spitzenverband
15.81mFamily members insured free of chargeMid-2026 · GKV-Spitzenverband
93Statutory health insurers1 Jan 2026 · BMG
€352.4bnSpending of the insurers2025, preliminary · BMG
02 / Explainer

How the GKV works, in eight steps

From joining a fund to receiving treatment.

  1. Compulsory membership

    Employees earning below the compulsory-insurance threshold are automatically insured, as are most pensioners, students, trainees and recipients of unemployment benefit or basic income support. Higher earners, the self-employed and civil servants can choose private insurance instead.

  2. Free choice of fund

    Members choose among the funds open to them and can switch, normally after twelve months, and at any time when their fund raises its additional contribution. This special right to switch is why notifying members of increases matters.

  3. Income-related contributions

    The general rate is 14.6% of gross earnings up to the contribution ceiling, plus a fund-specific additional contribution. The official average is 2.9% for 2026, but 3.13% was actually charged on 1 January 2026. Employers and employees each pay half. Pensions are also subject to contributions.

  4. Family co-insurance

    Children and spouses with no or low income of their own are insured at no extra cost through the member, covering 15.81 million people in mid-2026. This is one of the clearest expressions of the solidarity principle.

  5. Pooling in the health fund

    Contributions and the federal subsidy flow into the central health fund, managed by the Federal Office for Social Security (BAS).

  6. Risk adjustment (Morbi-RSA)

    The fund pays each insurer a set amount per insured person, adjusted for age, sex, reduced earning capacity, regional factors and diagnosed illnesses (since the 2021 reform the full range of diseases is taken into account). This stops funds competing to attract the young and healthy and rewards cost control instead.

  7. Uniform benefits

    What the funds pay for is defined by law and, in detail, by the Federal Joint Committee (G-BA). Around 95% of benefits are identical across all funds; differences lie in optional extras, bonus programmes and service.

  8. Benefits in kind

    Patients generally do not pay the doctor and claim money back. They show their electronic health card; providers bill the fund or the KV directly. Co-payments are limited, for example on prescriptions and hospital days, and capped at a share of income.

The solidarity principle

You pay according to your income; you are treated according to your need.

This editorial summary describes how the GKV is designed. It is not a quotation. The equivalent principle in private insurance links premiums to individual risk at entry.

Note on accuracyThe “around 95%” share of identical benefits is a widely used approximation, not an official statistic. The risk-adjustment rules are set in Social Code Book V and the BAS’s annual classification.

03 / Governance

Self-administration and social elections

The funds are public-law bodies governed by representatives of their members and employers, not government agencies.

The administrative council

Each fund has an administrative council (Verwaltungsrat) of representatives of insured people and, in most funds, employers. It adopts the budget, sets the additional contribution and appoints the full-time board. The board runs the fund day to day.

Social elections

Every six years members elect these representatives in the social elections (Sozialwahlen). In many funds a single agreed list is presented and no ballot is held, a so-called peace election, which critics say weakens democratic legitimacy. The last round, in 2023, included online voting at several large funds for the first time.

Supervision

Funds operating in more than three Länder are supervised by the BAS. Regional funds, such as most AOKs, are supervised by the Land. Supervision checks legality and financial soundness and must approve mergers.

Above the individual funds sits the GKV-Spitzenverband, the central association of all statutory health and long-term care insurers. It negotiates federal contracts with doctors and hospitals and drug prices under AMNOG, and holds the funds’ votes in the G-BA. The funds are grouped into types: the regional AOKs, the substitute funds (Ersatzkassen, represented by the vdek), company funds (BKK), guild funds (IKK), the agricultural fund and the Knappschaft. See health system.

03b / Benefits

Who decides what the GKV pays for?

The benefits catalogue is not a list in the law. It is built up step by step by the Federal Joint Committee.

Social Code Book V sets the general standard: benefits must be sufficient, appropriate and economical, and must not go beyond what is necessary. Insured people are entitled to medical and dental treatment, medicines, aids, hospital treatment, rehabilitation, preventive check-ups and sick pay from the seventh week of illness.

The Federal Joint Committee (G-BA) turns this standard into binding directives. It decides whether new examination and treatment methods may be provided in outpatient care, which screening programmes are offered and what quality requirements apply. Its procedure rests on evidence-based medicine, often supported by the independent Institute for Quality and Efficiency in Health Care (IQWiG). For new medicines the G-BA assesses the added benefit under AMNOG. The GKV-Spitzenverband then negotiates the reimbursement price with the manufacturer.

This construction keeps day-to-day benefit decisions out of party politics. It also means that the minister’s influence works mainly through legislation. Parliament can add or remove benefits directly, as the stabilisation law did when it removed homeopathy from the catalogue (In force, inherited).

Benefit decisions are also cost decisions. The AMNOG negotiations alone produced savings of €10.3 billion in 2024, according to the GKV-Spitzenverband. Critics from industry and some patient groups argue that the G-BA’s evidence requirements delay access to innovations. Defenders reply that paying only for proven benefit is what keeps a solidarity-based system affordable. Linnemann has not, so far, proposed any change to the G-BA’s role. See pharmaceutical policy.

04 / Finances

The financial challenge

Why the additional contribution has risen several years in a row.

Number of statutory health insurers

Unit: number of funds · Period: 1993 and 1 Jan 2026

  • 19931,221
  • 202693

SourceGKV-Spitzenverband (1993, via secondary source); BMG (1 Jan 2026). Some sources give about 90 funds for 2026 depending on the cut-off date.

The GKV ended 2025 with a small surplus of €3.5 billion. That was only possible because funds raised their additional contributions at the start of the year. Spending grew by 7.8% and revenue by 5.3%. The funds’ reserves, €5.1 billion or 0.18 of a month’s spending, were below the legal minimum of 0.2 (BMG). Hospitals, at about €111.5 billion, and medicines, at about €58.3 billion, were the largest and among the fastest-growing items.

The inherited stabilisation law (In force, July 2026) aims to provide about €19 billion of relief for 2027. Linnemann has announced further savings (Proposed). The 2027 average additional contribution will only be set after the estimators’ meeting on 15 October 2026 Open question. The detailed analysis is on the health financing page.

05 / Reform debate

Three open questions under the new minister

Linnemann’s documented positions, set against the arguments of his critics.

How many insurers does Germany need?

Political position

Background

The number of funds has fallen from 1,221 in 1993 to 93 at the start of 2026, mostly through voluntary mergers. Administrative costs are a frequent target of criticism, although they make up only a small share of total spending.

Linnemann’s position

When his appointment was announced, kma-online reported him as saying: „Ich finde, zehn Krankenkassen in Deutschland reichen.“ In English: “I think ten health insurance funds in Germany are enough.” It is a long-standing view; when he first said it is not established. No bill has been announced.

Criticism

Funds and many health economists argue that mergers save less than expected, that competition between funds improves service, and that fewer, larger funds would gain market power over providers. Regional funds fear losing their local roots.

Counter-argument

Supporters say that with uniform benefits and central risk adjustment, many parallel administrations, boards and IT systems add little value, and that consolidation is a way to cut costs without touching benefits.

Status

Political position only. Any statutory reduction would require legislation and would raise legal questions about the funds’ self-administration.

Should private health insurance be abolished?

Political position

Background

About 74.6 million people are in the GKV; most others are privately insured. Waiting-time differences between the two groups regularly fuel calls for a single “citizens’ insurance”, supported by the SPD, the Greens and the Left.

Linnemann’s position

In the Bundestag on 23 September 2026 he rejected abolishing the PKV. He cited constitutional concerns and argued that the dual system secures openness to innovation and quality. He suggested instead applying GKV decisions to civil servants’ Beihilfe.

Criticism

Supporters of a single system say the dual system lets higher earners and lower risks opt out of solidarity, and that differences in fees give doctors an incentive to favour private patients.

Counter-argument

Defenders point to the capital reserves built up in private insurance, the higher fees that help fund practices, and the legal protection of existing contracts. The coalition agreement does not provide for abolition.

Status

No change planned. The dual system remains.

Must funds tell members when contributions rise?

Proposed

Background

Funds used to have to write to each member before raising the additional contribution. The coalition’s savings package abolished this duty to cut printing and postage. Consumer organisations warned that members could miss their special right to switch funds.

Linnemann’s position

ZDF, 20 September 2026: „Beitragssätze sind entscheidende Informationen für die Versicherten.“ In English: “Contribution rates are crucial information for the insured.” He added: „Die Krankenkassen sollten ihre Mitglieder auch in Zukunft individuell informieren müssen, etwa digital per Krankenkassen-App oder schriftlich.“ In English: “Health insurers should continue to be required to inform their members individually, for example digitally via the insurer’s app or in writing.”

Criticism

The duty costs money. The ZDF report cited about €1–2 per letter, across tens of millions of members. Funds argue that rates are published anyway.

Counter-argument

Digital notification via apps keeps costs low while preserving transparency, which is what makes competition between funds work.

Status

He told the Health Committee on 23 September 2026 that the information duty was important. It is expected to be part of the amendments to the savings law.

06 / Structural choices

Reforming the GKV: the wider argument

Beyond individual measures, two philosophies compete.

Efficiency and steering

  • Fewer, larger funds and leaner administration (Linnemann: ten funds would be enough).
  • A primary-care system to steer patients (draft promised for November 2026, Proposed).
  • Stable or falling contribution rates as an explicit goal, to protect employment.
  • Keep competition between the GKV and PKV as a driver of innovation.

Solidarity and revenue

  • Pay fully from taxes for tasks of society as a whole, such as family co-insurance and basic-income recipients.
  • Widen the contribution base to other incomes or higher earners.
  • Integrate PKV insured people into a single risk pool.
  • Protect benefits; treat steering as an addition, not a hurdle.

The two camps overlap. The inherited stabilisation law already raises federal payments for basic-income recipients. Structural proposals are expected from the Finance Commission for health insurance in December 2026 Under review.

Sources & further reading

  1. GKV-Spitzenverband — Key figures Q1/2026 (Jun 2026)
  2. Federal Ministry of Health — GKV financial results 2025 (10 Mar 2026)
  3. GKV-Spitzenverband — Administrative costs of the funds
  4. Bundesanzeiger — Average additional contribution 2026 (10 Nov 2025)
  5. kma-online — Linnemann on the number of funds (24 Jul 2026)
  6. ZDF — Information duty on contribution increases (20 Sep 2026)
  7. Federal Ministry of Health — Government question time (PKV) (23 Sep 2026)
  8. Deutsches Ärzteblatt — Linnemann before MPs (Sep 2026)
  9. German Bundestag, hib 733/2026 — Minister in the Health Committee (23 Sep 2026)
  10. Federal Ministry of Health — GKV-Beitragssatzstabilisierungsgesetz (10 Jul 2026)

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