• In the video above: Spouses are suddenly supposed to pay for the health insurance

The change means higher costs for households. 225 euros a month is 2700 euros a year. In households with an earner at the minimum wage level, disposable income would fall by around 13 percent. For a household with an income equal to the contribution assessment limit of around 70,000 euros per year, it is still 6.5 percent.

Cash registers earn a maximum of six billion euros

Instead of free co-insurance, spouses and registered life partners should pay a flat rate contribution of 225 euros per month. This is divided into 200 euros for the Health insurance and 25 euros for nursing care insurance.

This would affect several million people in Germany. According to the Federal Ministry of Health, 15.6 million people are protected free of charge through family insurance. However, most of them are children. There should also continue to be exceptions for parents of small children under the age of six and/or people with relatives in need of care.

Therefore, the additional income for the health insurance companies is difficult to calculate. According to the GKV, around 2.5 million adults have family insurance. The optimal case would be if everyone paid the minimum rate of 225 euros. The health insurance companies would then earn around six billion euros per year. Nursing care insurance would receive an additional 750 million euros.

Revenue will be lower

However, this optimal case will not occur, as a rough estimate shows.

• First of all, all households in which small children under the age of six live are excluded. At the end of 2024, there were around 4.5 million children in this age group in Germany. Excluding single parents, these are spread across around 3.2 million households. According to a survey by the Hans Böckler Foundation, 31 percent of all families are sole earners. In these households, the partner could remain insured free of charge in the future. That would be around a million people. Without them, revenue fell to around 3.6 billion euros for health insurance companies and 450 million euros for nursing care insurance.
• They fall even further due to adult children who remain insured with their family until their 25th birthday, as well as households with relatives in need of care. Assuming that both groups together only make up ten percent of all households, income would fall to 2.7 billion euros for health insurance companies and 335 million euros for nursing care insurance. That coincides with that Handelsblatt report. He reports that the coalition is expecting revenue in the “low single-digit billion range”.

Additional income has hardly any effect

Measured against the total expenditure of health and nursing care funds, that would be a drop in the ocean. According to the Federal Ministry of Health, health insurance companies paid around 352.4 billion euros in 2025. The additional income would therefore only amount to around 0.8 percent. Nursing care insurance spent around 74 billion euros in 2025. 500 million additional income would only be 0.5 percent.

For this year, the leading association GKV expects a deficit of four to ten billion euros for the health insurance companies. The end of free co-insurance could make a significant contribution to closing this. Things look different with nursing care insurance. With an expected deficit of 2.8 to 3.5 billion euros, 335 million euros is not much.

There are also likely to be reactions. Martin Albrecht, managing director of health policy at the consulting institute IGES, says in the Handelsblatt: “What may be particularly problematic for health insurance companies, however, is that a minimum contribution increases competition with private health insurance companies.” Families with higher incomes in particular could end their previously voluntary statutory insurance. If you switch to private health insurance, this costs the statutory health insurance companies additional income.