Germany’s Bundestag is beginning its first debate on a coalition bill to shore up the finances of the country’s long-term care insurance system. The proposal, put forward by Health Minister Carsten Linnemann, combines spending restraints with measures to raise revenue, with several changes intended to take effect on January 1, 2027.
The package is designed to address immediate financial pressures while a separate expert commission prepares proposals for a broader reform. Annual spending on long-term care has reached €74 billion. The insurance system covers only part of care costs, leaving people receiving care responsible for personal contributions and, in residential care, accommodation and other expenses.
The bill’s measures are projected to have a financial impact of €6.25 billion in 2027, below the estimated deficit of €7.6 billion. Among the proposed revenue measures, the additional contribution for people without children would rise from 0.6 to 0.9 percentage points on January 1, 2027. Their total contribution would reach 4.5% of gross wages, while the standard rate for people with one child is currently 3.6%. The change is expected to generate €3.3 billion. From 2028, employers would also pay care insurance contributions for people in mini-jobs.
The plans would also increase the monthly earnings threshold for care contributions by €300 in 2027, bringing more of the income of higher earners into the contribution calculation. From 2028, free coverage for spouses would be limited. It would remain available for children, parents of children under 12 and of children with disabilities, people caring for relatives, and people at the standard retirement age. For other spouses currently covered free of charge, the contributing family member would pay an additional 0.52%.
Benefits would be adjusted annually in line with inflation from 2029, replacing occasional changes made through legislation. However, an increase scheduled under current law for 2028 would be dropped. The proposal also calls for tighter criteria when assigning care levels to new applicants, following a sharp rise in the number of people receiving benefits after a 2017 reform. The ministry says people who already have an officially recognized care level would be protected from losing it under the new thresholds.
For care at home, the bill would combine some existing support into new budgets. People aged 25 and over with care levels 2 to 5 could receive up to €175 a month for everyday assistance, while younger recipients could receive up to €300. A separate budget would cover replacement care when a family caregiver is on holiday or ill. The existing respite-care benefit, known as “Verhinderungspflege,” would no longer remain a separate service.
The proposal would introduce access to professional care guidance at home to help identify declining health earlier. In exchange, the current monthly relief payment of up to €131 for people with the lowest care level, level 1, would be removed. People aged 60 and over would also be entitled to preventive screenings focused on age-related conditions.
The German Trade Union Confederation has called for changes, arguing that people receiving care and policyholders need tangible improvements and identifying a cap on personal care costs as a priority. The government’s care commissioner, Katrin Staffler, has also warned that changes to flexible respite care could put additional pressure on family caregivers.
The federal subsidy to the care insurance system, already suspended for 2024 through 2027, would also be withheld in 2028. Under the proposal, €500 million would be paid in 2029, followed by €1 billion annually from 2030.
Sources: Handelsblatt.