Co-payments have a ceiling — and many people don't know it
Anyone with German statutory health insurance regularly pays a share of the cost at the pharmacy, the physiotherapist or in hospital. Individually these amounts look small: five euros here, ten euros there. Over a year, however, they quickly add up to several hundred euros, especially with chronic illness, several medicines or a hospital stay. That is exactly why the legislator introduced a ceiling: the burden limit (Belastungsgrenze) under § 62 SGB V. Once you reach it, you pay no further co-payments for the rest of the calendar year.
This guide explains how the burden limit is calculated, which allowances apply in 2026, what applies to the chronically ill and to recipients of basic income support, and how to apply for the exemption with your health insurer. You can check your personal figures at any time with the co-payment exemption calculator.
What is the burden limit?
§ 62(1) SGB V states that insured persons only have to make co-payments up to the burden limit in each calendar year. The limit is 2% of annual gross income for living expenses. For chronically ill people in long-term treatment for the same serious illness, it is 1%. If the limit is reached during the year, the insurer must issue a certificate confirming that no further co-payments are due for the rest of the year.
What matters is not the income of one person but that of the joint household. The co-payments and income of the insured person, their spouse or civil partner and the children in the household are added together. The burden limit therefore applies to the family as a whole — and all family members' receipts count together.
Which income counts?
The basis is gross income for living expenses. This typically includes wages, pensions, occupational pensions, self-employed income, rental income and investment income. Your insurer checks which income counts in your case based on the proof you submit with your application. Under § 62(2) SGB V, certain compensation payments under social compensation law and comparable benefits for health damage are expressly excluded.
2026 allowances for partners and children
Before the 2% or 1% is applied, the insurer deducts allowances. They are linked to the social insurance reference value (Bezugsgröße) under § 18 SGB IV, which is €47,460 per year (€3,955 per month) in 2026:
- First dependant in the household (usually the spouse or civil partner): 15% of the reference value = €7,119
- Each further dependant: 10% of the reference value = €4,746
- Each child: the child allowance plus the allowance for care, upbringing or education under § 32(6) of the Income Tax Act, doubled — in 2026 (€3,414 + €1,464) × 2 = €9,756
For children only the child allowance applies; the 15% or 10% rule is not applied on top. Minor children and children covered by family insurance count, provided they live in the joint household.
Worked examples
Single, €30,000 gross per year: there are no allowances. The burden limit is 2% of €30,000 = €600. If the person is chronically ill, it is €300.
Married couple with two children, €60,000 gross per year: €7,119 is deducted for the partner and 2 × €9,756 = €19,512 for the children. That leaves €33,369. The burden limit is 2% of this = €667.38, or €333.69 under the chronic illness rule.
Single parent with one child, €28,000 gross: after deducting €9,756, €18,244 remains. The limit is €364.88.
Retired couple, €36,000 pensions per year, one partner chronically ill: after deducting €7,119, €28,881 remains. At 1% the limit for the whole household is €288.81.
Special rule for basic income support and social assistance
There is a fixed basis for people on very low incomes. For recipients of basic income support under SGB II (Grundsicherungsgeld, formerly Bürgergeld), subsistence assistance, or old-age and disability basic support under SGB XII, § 62(2) SGB V counts only the standard rate level 1 as income for the entire household. The same applies if a social assistance body pays for accommodation in a care home.
The standard rate level 1 remains €563 per month in 2026, i.e. €6,756 per year. This gives a burden limit of €135.12 (2%) or €67.56 (1% for the chronically ill). No allowances are deducted in this case, and the size of the household makes no difference.
The chronic illness rule: 1% instead of 2%
The lower 1% limit applies to insured persons in long-term treatment for the same serious illness. The details are set out in the chronic illness guideline of the Federal Joint Committee (G-BA): the illness must have been treated by a doctor at least once a quarter for at least one year. In addition, one further criterion must be met — such as care level 3 or higher, a disability degree or reduced earning capacity of at least 60, or continuous care without which a life-threatening deterioration or a lasting loss of quality of life would be expected.
One special rule affects younger people: anyone born after 1 April 1972 who did not regularly attend the scheduled health check-ups before falling ill stays at 2%. If that person takes part in a structured treatment programme for their illness, however, 1% applies again. Long-term treatment usually has to be proven to the insurer every year; the insurer can waive this if nothing has changed.
Which co-payments count
The statutory co-payments under § 61 SGB V count towards the burden limit. The main rules:
- Medicines, dressings, medical aids: 10% of the price, at least €5, at most €10 — but never more than the item costs.
- Hospital: €10 per calendar day, for at most 28 days per year (§ 39(4) SGB V). Inpatient rehabilitation also costs €10 per day.
- Therapeutic remedies and home nursing: 10% of the cost plus €10 per prescription.
- Consumable medical aids (such as incontinence products): 10%, at most €15 for a whole month's supply.
Own shares for dentures, self-paid over-the-counter medicines, surcharges above the reference price and private extra services do not count. For medicines, therapeutic remedies, medical aids and hospital stays, co-payments also only apply from the age of 18.
How to apply for the exemption
The exemption is not automatic. You have to apply to your health insurer. Here is how:
- Collect receipts: get a receipt for every co-payment. Pharmacies, practices and hospitals are legally obliged to provide one (§ 61 SGB V). A receipt booklet, available at many pharmacies, is handy.
- Keep track of the total: check regularly how close you are to your limit. The calculator shows how much is left and when you are likely to reach the limit if costs stay the same.
- Apply: as soon as the limit is reached, send your insurer the application with all receipts and proof of income for all household members, such as pension notices, payslips or the tax assessment.
- Show the certificate: the insurer issues an exemption certificate. Under § 62(3) SGB V it contains no information about your income. Show it at the pharmacy and practice so that no further co-payments are charged.
If you paid more than your limit, the insurer refunds the excess. This also works retrospectively for past years, as long as you still have the receipts. Many insurers also offer the option of paying the expected limit in advance at the start of the year and receiving the exemption straight away. This is particularly worthwhile with predictably high costs, for example with chronic illness. Ask your insurer whether and how it offers this.
Common mistakes
The most common mistake is not keeping receipts. Without proof, the insurer cannot count co-payments. Just as often, people forget that the receipts of all household members count — including the partner's. And many families underestimate the effect of the child allowances: with two children, the relevant income falls by almost €20,000, and the limit by almost €400 a year.
Conclusion
The burden limit protects against excessive co-payment costs. It is 2% of household income, or 1% for the chronically ill, after deducting generous allowances for partners and children. Collecting receipts consistently and applying in time saves real money. Calculate your personal limit now with the co-payment exemption calculator — and see what the sick pay calculator or the public vs. private health insurance calculator show for your situation.