What co-payments are
Co-payments are statutory own contributions that people with statutory health insurance pay towards certain insurer benefits. The basic rules are in § 61 SGB V; the individual benefit areas refer to it. All these amounts count towards your annual burden limit. For medicines, therapeutic remedies, medical aids and hospital stays, co-payments only apply from the age of 18.
Medicines and dressings
For every prescribed medicine or dressing you pay 10% of the pharmacy price, at least €5 and at most €10 — but never more than the item itself costs (§ 31(3) in conjunction with § 61 sentence 1 SGB V). Some examples:
- Medicine costing €4: you pay €4, because the co-payment cannot exceed the price.
- Medicine costing €30: 10% would be €3, but the minimum of €5 applies.
- Medicine costing €75: 10% = €7.50.
- Medicine costing €150: 10% would be €15, capped at €10.
Urine and blood test strips are exempt from co-payments. If a product costs more than the reference price, you also pay the difference — but these extra costs are not a co-payment and do not count towards the burden limit.
Hospital and rehab
For inpatient hospital treatment, adults pay €10 per calendar day, for at most 28 days per calendar year (§ 39(4) SGB V). So hospital co-payments never exceed €280 in a year. A 12-day stay costs €120, a 35-day stay €280. Inpatient preventive care and rehabilitation also cost €10 per day (§ 40 SGB V); for follow-up rehabilitation, days already paid in hospital are credited.
Therapeutic remedies and home nursing
For therapeutic remedies such as physiotherapy, occupational therapy or speech therapy, the co-payment is 10% of the cost plus €10 per prescription (§ 32(2) in conjunction with § 61 sentence 3 SGB V). Example: a prescription for six sessions at €25 costs €150. You pay €15 plus €10 = €25. The same rule applies to home nursing.
Medical aids
For medical aids such as walking aids, supports or hearing aids, the medicine rule applies: 10%, at least €5, at most €10 per aid (§ 33(8) SGB V). For consumable medical aids, such as incontinence products, you pay 10% of the amount covered by the insurer, at most €15 for a whole month's supply. Surcharges for a more comfortable version above the contract price do not count towards the burden limit.
Travel costs
If the insurer covers travel costs, for example for a trip to hospital, a co-payment of 10%, at least €5 and at most €10 per trip is also due (§ 60 SGB V). These co-payments belong on your list of receipts too.
What does not count
Not every health expense is a co-payment in the legal sense. The following do not count towards the burden limit:
- own shares for dentures (the insurer pays a fixed subsidy here)
- over-the-counter medicines you buy yourself
- extra costs above the reference price or for higher-quality medical aids
- private health services you pay for yourself
Keep track of your co-payments
Get a receipt for every co-payment — pharmacies, practices and hospitals are legally obliged to provide one. Enter the total regularly in the co-payment exemption calculator. That way you can see how much is left before exemption and won't miss the right moment to apply. The dentures cost calculator shows what to expect for dentures.