Wegweiser Seniors · Rights & Benefits Deutsch

🩺 Health insurance and co-payments

Co-payments for medicines, therapeutic and assistive aids are capped – if you reach the burden limit, you can be exempted from further co-payments.

health insurance for pensioners (Krankenversicherung der Rentner) burden limit (Belastungsgrenze) 62 SGB V co-payment (Zuzahlung) chronic illness rule (Chronikerregelung) exemption (Befreiung)

In brief

Pensioners are generally insured as compulsory members in the health insurance for pensioners (Krankenversicherung der Rentner, KVdR) if they meet the prior insurance period. Statutory co-payments apply for medicines, therapeutic aids and hospital stays. These are capped per calendar year at a burden limit based on gross income for living expenses; if you reach this limit, you can be exempted by your health insurer.

Step by step

  1. Collect co-payment receiptsKeep all receipts for co-payments for medicines, therapeutic and assistive aids and hospital stays.
  2. Calculate the burden limitUse your annual gross income for living expenses to work out whether the 2 percent limit, or the 1 percent limit in case of chronic illness, has been reached.
  3. Submit an exemption applicationSubmit the receipts to your health insurer and apply for exemption from further co-payments for the current calendar year.
  4. Have chronic illness status clarifiedHave it checked whether you meet the requirements of the chronic illness rule so that the lower 1 percent limit applies to you.

Deadlines

calendar year
The burden limit is always calculated for one calendar year; unused co-payments are not carried over to the following year§ 62 SGB V
Watch out – common mistakes
  • Co-payments for medicines are 10% of the price, at least €5 and at most €10, never more than the actual costs (§ 61 SGB V).
  • For hospital stays, €10 per day applies, limited to a maximum of 28 days per calendar year.
  • The lower chronic illness burden limit of 1% requires continuous medical treatment for the same serious illness as well as other requirements named in the chronic illness guideline – a high care level or degree of disability alone is not always automatically sufficient.
In depth · legal basis, figures and practice – for advisers and professionals

Co-payments (§ 61 SGB V)

Statutorily insured persons pay 10% of the dispensing price for prescribed medicines, dressings, therapeutic and assistive aids, at least €5 and at most €10, but never more than the actual cost of the item. For full inpatient hospital treatment, €10 per calendar day is charged for a maximum of 28 days per year.

Burden limit (§ 62 SGB V)

Co-payments are limited per calendar year to 2% of the household's annual gross income for living expenses, and for seriously chronically ill persons to 1%. If the limit is reached, the health insurer issues an exemption for the rest of the year on application.

Health insurance for pensioners (§ 5 Abs. 1 Nr. 11 SGB V)

Anyone who was statutorily insured for at least nine tenths of the second half of their working life is compulsorily insured in the KVdR (prior insurance period). If this period is not met, insurance is as a voluntary member, usually with higher contributions.

Who is responsible
  • Statutory health insurer (gesetzliche Krankenkasse)
Further reading
Basic income support in old ageCare benefits and care allowance

Quick questions

Worum geht es bei „Health insurance and co-payments“?
Co-payments for medicines, therapeutic and assistive aids are capped – if you reach the burden limit, you can be exempted from further co-payments.
Which deadlines and figures matter?
calendar year: The burden limit is always calculated for one calendar year; unused co-payments are not carried over to the following year (§ 62 SGB V)
What should I do first?
  • Collect co-payment receipts: Keep all receipts for co-payments for medicines, therapeutic and assistive aids and hospital stays.
  • Calculate the burden limit: Use your annual gross income for living expenses to work out whether the 2 percent limit, or the 1 percent limit in case of chronic illness, has been reached.
  • Submit an exemption application: Submit the receipts to your health insurer and apply for exemption from further co-payments for the current calendar year.
What do I need to watch out for?
  • Co-payments for medicines are 10% of the price, at least €5 and at most €10, never more than the actual costs (§ 61 SGB V).
  • For hospital stays, €10 per day applies, limited to a maximum of 28 days per calendar year.
  • The lower chronic illness burden limit of 1% requires continuous medical treatment for the same serious illness as well as other requirements named in the chronic illness guideline – a high care level or degree of disability alone is not always automatically sufficient.
Evidence
  • §§ 5, 61, 62 SGB V (gesetze-im-internet.de)
As of

As of: September 2026 · Sources and method

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