Health insurance: Health insurance expenses increase-contributions stable?

Politicians are increasingly under pressure in health insurance finances. The performance expenditure of around 90 health insurance companies in the first half of the year increased by 7.95 percent to 166.1 billion euros, as can be seen from new key figures of the GKV top association that the German Press Agency is available. Today, Federal Minister of Health Nina Warken (CDU) wants to inform about the financial development of statutory health insurance in the 1st half of 2025. The black and red coalition had recently issued the goal that the contributions for the insured should remain stable if possible.

What is striking is the surplus of health insurance companies, which increased to 2.8 billion euros in the first half of the year. After record deficits in 2024, a surplus of 1.8 billion euros had already arisen by the end of March.

Cash registers are responsible for higher costs

“But that shouldn’t calm anyone,” said the chairman of the GKV top association, Oliver Blatt, the dpa. “The output dynamics are unbroken in the first half of the year.” The surplus is urgently necessary to replenish the statutory minimum reserve of the health insurers. There had been a reduction in reserves in recent years. “With a view to the dynamic expenditure development, it is still open whether this can succeed,” said Blatt.

With the largest cost block, the hospital treatments alone, the plus exceeded the first half of the 2024 (7.9 percent) at 9.6 percent. 54.5 billion euros now flowed to the clinics. Expenditures for doctors rose by 7.8 percent to 27.0 billion, which for medicines 6 percent to EUR 28.9 billion. Blatt said: “It cannot go on like this, such increase rates do not endure the world’s health system in the long run.”

The health insurers in particular blame the legislation of the past few years for cost increases, as a spokesman for association explained. Existing fee lids were therefore abolished, for example, for more and more medical services – and relaxed at pharmaceutical price.

Coalition wants stable contributions for insured persons

According to the will of the coalition, the higher costs should have no effect for the insured: black and red wants to keep the contributions as stable as possible after significant increases in the coming year. CDU/CSU parliamentary group leader Jens Spahn had already announced this in August. In the coalition committee on Wednesday evening, the goal was reaffirmed.

The contributors should not continue to be burdened, the urgently hoped -for economic upturn should not be further jeopardized by premium increases.

This is how the health insurers want to avoid an increase in contributions

Blatt praised it as a “good and important signal” that the government wanted to keep the contributions stable – and has a suggestion. In principle, it must be prevented that the health insurance companies have to spend more than they take. The increase in costs must be attributed to “a normal measure”.

Specifically, sheet for the proposal of an expenditure moratorium advertised: “In the future, price and honorary growth may no longer increase faster than the actual income of the health insurance companies.”

The intention: “With such an expenditure moratorium, the contributions could remain stable at the overall turn of the year.” However, according to Blatt’s information, it would be further air for compensation for inflation and tariff developments. Services would not have to be canceled.

Blatt: “We need reforms”

In the past few days, fears have been announced in the health insurance companies that the foreseeable half -year surplus of the health insurers could reduce reform pressure.

The Association of Replacements, for example, blames “spending health legislation in recent years” as well as outstanding structural reforms for the galloping costs. This must be addressed.

The head of cash association Blatt also sees the required expenditure moratorium only as an immediate measure, as he said. “We absolutely need reforms whose good effect feel the insured in everyday life, for example through faster doctor’s appointments,” said Blatt. Quality must be preserved.

In the long term, however, Blatt also wants to prevent the gap between spending and revenue apart and “come back to stable finances”.

The situation in the articles

Around the beginning of the year, the contributors had to dig deeper into their pockets on a broad front. The additional contribution rose to an average of 2.9 percent. Every cash register sets it itself. In addition, the general sentence of 14.6 percent of gross wages applies.

In the 2025 and 2026 budget, the federal government wants to stabilize the cash finances beyond the regular annual subsidy with loans. These loans “will cushion necessary contribution sentences, they will not prevent them,” Minister of Health Warken said in the Bundestag. Reform commissions should then propose structural reforms for health and long-term care insurance.

In the summer, the Federal Audit Office had raised the alarm in a report to the budget committee: In the future, the income from the health insurance companies would continue to remain under the expenditure. The result is steadily increasing additional contributions.

Financial development GKV 1st quarter 25 report on GKV-half-year result