Exemption from additional payments in 2026: Pensioners and recipients of citizens’ benefit pay a maximum of 2 percent of their income, and only 1 percent for those with chronic illnesses. What limits apply and how to apply for exemption.
Additional payments – what do you have to pay?
Those with statutory health insurance must pay their own contribution for many services. For prescription drugs and aids, this is ten percent of the retail price, but at least five and a maximum of ten euros. In the hospital, a flat rate of ten euros per day is due, but only for a maximum of 28 days per year (Section 61 SGB V). However, an additional payment only applies from the age of 18.
Legal load limits 2026
To ensure that insured persons are not burdened excessively, the legislature has introduced fixed limits for additional payments. In principle, a maximum of two percent of the household’s annual gross income may be requested; for seriously chronically ill people, the limit is reduced to one percent (Section 62 Para. 1 SGB V). The decisive factor is the income of all people living in the household, less specified allowances (Section 62 Paragraph 2 SGB V). As soon as the load limit is reached, the health insurance company issues an exemption for the rest of the calendar year (Section 62 Paragraph 1 SGB V).
Special features for pensioner households
For pensioners, it is not just their own pension that is important, but also the gross income of the entire household. In addition to pensions, this can also include wages or rental income. Allowances for spouses and children reduce the assessment basis (Section 62 Para. 2 SGB V). In practice, the Federal Ministry of Health recommends collecting all co-payment receipts and submitting them to the health insurance company. After checking, an exemption or reimbursement can be made for the rest of the year. For small pensions, the burden limits are often in the low three-digit range, around two percent of income or one percent for those with recognized chronic illnesses, as Gegen-Hartz.de shows as an example.
Special features for citizens’ money and basic security
A special regulation applies to recipients of citizen’s benefit or basic security: “Gross income for living expenses” includes the standard needs of the entire community of needs according to standard needs level 1 (Section 62 Para. 2 SGB V). On this basis, there are clear guidelines for 2026: At 563 euros per month or 6,756 euros per year, the load limit is 135.12 euros, and for chronically ill people it is 67.56 euros, as Bürgergeld.org explains. The application for exemption can also be made retroactively, provided all supporting documents are available. If the members of a community of needs are insured with different health insurance companies, a joint application is sufficient; The issued certificate is then passed on to the other cash registers, explains Bürgergeld.org.
Chronically ill: 1 percent limit and proof
For insured persons with a serious chronic illness, a reduced burden limit of only one percent of annual gross income applies. According to the Federal Ministry of Health, such an illness occurs when those affected have received quarterly medical treatment for the same illness for at least a year and a criterion such as care level 3 to 5, a degree of disability or a reduction in earning capacity of at least 60 percent is also met. Even if without treatment a life-threatening deterioration, a shortening of life expectancy or a permanent impairment of the quality of life would be expected, chronic status is recognized (Section 62 Para. 1 SGB V). To classify the situation, the Frankfurter Rundschau lists typical diseases such as diabetes, COPD, coronary heart disease or multiple sclerosis, which often give rise to such a status.
Editorial team finanzen.net