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Co-Payment Exemption Calculator 2026

When do you stop paying co-payments? Calculate your personal burden limit with German statutory health insurance — with family allowances, the chronic illness rule and the special rule for basic income support.

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How the exemption works

People with statutory health insurance pay co-payments of at most 2% of their gross household income per calendar year, or 1% if seriously chronically ill. Once the limit is reached, the insurer issues an exemption certificate for the rest of the year on request (§ 62 SGB V).

Income & household

€
Spouse or civil partner in the household

Co-payments in 2026

€
€
Your 2026 burden limit

€600.00

per calendar year · Rate 2 %

Already paid

€150.00

Left until exemption

€450.00

Limit expected to be reached in 18 months

€25.00 / Month

25 %

Progress towards exemption

Progress towards exemption · 25 %

Forecast: co-payments over the next 12 months

How your burden limit is calculated

Gross income for living expenses€30,000.00
− Allowance spouse / dependants€0.00
− Allowance children (€9,756 each)€0.00
Relevant income€30,000.00
Burden limit (of which 2 %)€600.00

With the chronic illness rule (1%) your limit would be lower by: €300.00

Co-payments under § 61 SGB V

  • Medicines, dressings and medical aids: 10% of the price, at least €5, at most €10 — never more than the item costs.
  • Hospital: €10 per day, for at most 28 days per calendar year; inpatient rehab also costs €10 per day.
  • Therapeutic remedies and home nursing: 10% of the cost plus €10 per prescription.
  • Consumable medical aids: 10%, at most €15 for a whole month's supply.

Assumptions & notes

  • Allowances 2026: first dependant (usually the spouse or civil partner) €7,119 (15% of the reference value of €47,460), each further one €4,746 (10%), each child €9,756 (child and childcare allowances under § 32(6) EStG).
  • For recipients of basic income support, social assistance or old-age basic support, only the standard rate level 1 counts for the whole household: €6,756 per year. The limit is then €135.12, or €67.56 for the chronically ill.
  • The 1% limit requires a serious chronic illness as defined by the Federal Joint Committee's guideline. Anyone born after 1 April 1972 who skipped the scheduled health check-ups stays at 2% — unless they take part in a structured treatment programme.
  • What counts as gross income for living expenses (e.g. wages, pensions, rental income, investment income) is checked by your insurer case by case. Own shares for dentures and self-paid medicines are not co-payments. This calculation is non-binding.

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Guide: Co-Payments & Exemption

Burden limit, chronic illness rule, allowances and how to apply

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Frequently Asked Questions

The burden limit is 2% of your household's annual gross income for living expenses, or 1% for the seriously chronically ill (§ 62(1) SGB V). Allowances are deducted first: in 2026 these are €7,119 for the first dependant (usually the spouse or civil partner), €4,746 for each further dependant and €9,756 per child. A single person with €30,000 gross income has a limit of €600 per year, or €300 if chronically ill.

For recipients of basic income support under SGB II, subsistence assistance or old-age and disability basic support, only the standard rate level 1 counts as income for the entire household. In 2026 that is €563 per month, i.e. €6,756 per year. The burden limit is therefore €135.12 (2%) or €67.56 (1%) — regardless of how many people belong to the household.

The definition is set by the Federal Joint Committee in its chronic illness guideline. Simplified: you have been treated for the same illness at least once a quarter for at least a year and also meet one criterion such as care level 3 or higher, a disability degree or reduced earning capacity of at least 60, or a permanent need for care. Your doctor certifies this on a form from your health insurer.

The statutory co-payments under § 61 SGB V count: for medicines and dressings, medical aids, therapeutic remedies such as physiotherapy, home nursing, hospital stays, inpatient rehabilitation and travel costs. Own shares for dentures, self-paid over-the-counter medicines, extra costs above the reference price and private health services do not count. Co-payments of all household members are added together.

Adults pay €10 per calendar day for inpatient hospital treatment, but for no more than 28 days per calendar year (§ 39(4) SGB V) — so at most €280 per year. This co-payment also counts towards the burden limit. For longer or repeated stays in the same year, check the calculator: the limit is often already reached.

Collect all household co-payment receipts, for example in a receipt booklet from the pharmacy. As soon as the total reaches your burden limit, apply to your health insurer and enclose the receipts and proof of income for all household members. The insurer then issues a certificate stating you pay no further co-payments for the rest of the calendar year, and refunds any overpayment.

Yes. If you paid more than your burden limit in the previous year, you can submit the receipts later and have the excess refunded. Refund claims against social insurance bodies are generally subject to a four-year limitation period after the end of the calendar year in which the claim arose. Keep your receipts safe.

For medicines, therapeutic remedies, medical aids and hospital stays, co-payments only apply from the age of 18. Children and adolescents are exempt. Children in the household still count when calculating the burden limit: in 2026, €9,756 per child is deducted from gross income, which lowers the family's limit considerably.