Care reform 2027: childless to pay more

Employees without children, higher earners and, from 2028, many married couples will pay more for long-term care insurance (Pflegeversicherung) in Germany. On Thursday, 5 November, the Bundestag held its first debate on the care reform 2027, officially called the Pflegeneuordnungsgesetz (Care Reorganisation Act). The government wants most of the changes to take effect on 1 January 2027 and plans the final vote in parliament for 11 December. Until then, the bill can still change, and Health Minister Carsten Linnemann (CDU) has already promised improvements.

The reform is meant to plug a large hole in the finances of the statutory care insurance. Without it, the fund would face a deficit of around 7.6 billion euros in 2027, according to the government's figures reported by Cash and the Stuttgarter Zeitung. Linnemann himself spoke in the Bundestag of a gap of about eight billion euros and described the bill as "first aid" rather than a complete overhaul.

Care reform 2027: who pays more from January

The general contribution rate is set to stay at 3.6 percent of gross pay, shared between employers and employees. The change hits people without children. Insured people aged 23 and over who have no children already pay a surcharge, the Kinderlosenzuschlag. It is due to rise from 0.6 to 0.9 percentage points on 1 January 2027, so their total rate climbs from 4.2 to 4.5 percent. Employers do not share this surcharge, so the full increase comes out of the employee's pay. The government expects about 3.3 billion euros a year in extra income from this step alone.

Pensioners carry their care contributions entirely on their own, so childless retirees feel the increase in full. Cash calculated that a childless pensioner with a monthly pension of 1,450 euros would pay 65.25 euros a month instead of 60.90 euros. The second change concerns higher earners. The contribution ceiling (Beitragsbemessungsgrenze), the income up to which contributions are charged, is set to rise by 300 euros a month in both health and care insurance. According to Cash, that lifts the monthly ceiling from 5,812.50 to 6,112.50 euros, and the business magazine notes that an earlier plan had foreseen an increase of 1,000 euros.

Spouses and minijobs: changes from 2028

A further change follows a year later. Today, spouses and registered partners without significant income of their own are often insured free of charge through their partner's family insurance. From 1 January 2028, the bill introduces a surcharge of 0.52 percent on the contribution-liable income of the paying partner for such co-insured spouses. According to ZDF, free co-insurance will remain for children, for parents of children under twelve or of children with disabilities, for people caring for relatives and for people who have reached the standard retirement age. Other outlets, including Cash and Apotheken Umschau, confirm the exemptions for parents and family carers.

The bill also plans care insurance contributions on minijobs, the small jobs with low monthly earnings, which are currently exempt from these contributions. According to the Pharmazeutische Zeitung, employers will have to pay these contributions from 2028. dpa reported in September that this measure should bring in around 1.4 billion euros a year.

What changes for people who need care

The care reform 2027 also cuts and restructures benefits. The thresholds for the care grades (Pflegegrade) 1 to 3 are to be raised, which makes it harder for new applicants to qualify for a higher grade. Anyone who already has a care grade keeps it. For care grade 1, the monthly relief amount (Entlastungsbetrag) of up to 131 euros, which many families use for help in the household, is to be scrapped. From care grade 2, it will be replaced by a new budget for everyday support. According to the health insurer AOK, this budget will be 175 euros a month for people over 25 and 300 euros for younger people, and unused amounts can no longer be saved up.

For people cared for at home, several separate benefits are to be merged into new budgets that families can use more flexibly. Some cuts from earlier drafts have been dropped. The care fund will continue to pay full pension contributions for family members who provide care, and the subsidies for nursing home residents will still rise after 12, 24 and 36 months as they do today. From 2029, benefit amounts are to be raised every year in line with inflation. A commission is due to present proposals for a deeper reform by the end of January 2027, with the resulting changes planned from 1 July 2027.

Criticism in the Bundestag and possible changes

The first reading turned into an emotional debate, according to the Protestant news service epd. Linnemann said: "We want to improve the law." Talks with the coalition groups were already under way, he said, and there must be no hard breaks at the turn of the year. At the same time, he insisted that the planned savings must be kept. SPD parliamentary deputy leader Dagmar Schmidt spoke out against abolishing respite care (Verhinderungspflege) as a separate benefit, which steps in when a family carer is temporarily unavailable.

The opposition and social groups were critical. Green health politician Simone Fischer told the Bundestag that the government was cutting benefits without solving the funding problem, as reported by ZDF. Nicole Hess of the AfD spoke of higher hurdles and less help for those affected. The social association VdK and the Protestant welfare organisation Diakonie accused the government of saving money at the expense of families who organise care at home. The umbrella association of statutory health insurers, the GKV-Spitzenverband, said the burden was unfairly shared because the federal government is not covering costs such as pandemic-era debts to the care fund, according to Cash. An expert hearing in the Bundestag's health committee is planned for 25 November.

What the care reform 2027 means for expats

If you are 23 or older, have no children and work in Germany, check your payslip in January: if the bill passes as planned, your care insurance deduction will rise by 0.3 percent of your gross salary, up to the new contribution ceiling. Parents can avoid the surcharge, but only with proof. The AOK points out that it does not matter whether a child was born or lives in Germany or abroad. Step, adoptive and foster parents also count as parents. Without proof, you are treated as childless, so if you have children abroad, make sure your employer or care fund has their birth certificates.

Couples where one partner is co-insured without their own income should watch how the spouse rules develop before 2028, as exemptions for parents and carers may apply. Families who use the 131-euro relief amount for a relative in care grade 1 should plan for its end, and anyone applying for a care grade in 2027 should expect stricter assessments. Our earlier reports explain why the care reform was delayed and how nursing home costs reached a record. For the health insurance side of your payslip, see our article on the Zusatzbeitrag in 2027.