Question 1

How high is the co-payment burden limit in 2026?

Accepted Answer

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.

Question 2

What is the burden limit for basic income support recipients?

Accepted Answer

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.

Question 3

Who counts as chronically ill for the co-payment exemption?

Accepted Answer

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.

Question 4

Which co-payments count towards the burden limit?

Accepted Answer

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.

Question 5

How much do I pay in hospital?

Accepted Answer

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.

Question 6

How do I apply for the co-payment exemption?

Accepted Answer

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.

Question 7

Can I apply for the exemption retrospectively?

Accepted Answer

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.

Question 8

Do children have to make co-payments?

Accepted Answer

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.

Guide: Co-Payment Exemption Calculator

Co-Payment Exemption 2026: Calculating the Burden Limit and Applying

Burden Limit for Families: How Partners and Children Lower Your Co-Payment Limit

The Chronic Illness Rule: When Only 1% Applies

Co-Payments at a Glance: Medicines, Hospital, Physiotherapy and More

Applying for the Co-Payment Exemption: Receipts, Documents and Deadlines

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