Summary of the proposed care reform
The federal health minister Nina Warken has put forward a draft for a care reform that uses a politically sensitive but fiscally powerful lever: raising the contribution ceiling for the social nursing insurance. The proposal would align the nursing insurance contribution ceiling with the general annual earnings limit used in statutory health insurance, currently set at 69,750 euros per year. In practical terms, this means the upper income threshold used to calculate nursing insurance contributions would be lifted significantly.
The plan foresees two steps: an immediate increase of the monthly contribution assessment ceiling from 5,812.50 euros to 6,450 euros and a further rise of 300 euros on 1 January 2027. Altogether the monthly ceiling would therefore move to more than 7,000 euros. The percentage contribution rate would remain unchanged, but people and employers who earn above today’s cap would pay more in absolute euros. The ministry frames this measure as a way to stabilize nursing insurance financing without raising the uniform contribution rate for everyone.
Financial effects and projected numbers
The ministry expects large financing gaps in the nursing insurance system if no changes are made. Estimates point to an accumulated deficit of roughly 20 to 22 billion euros in the coming years, with an expected shortfall of around 7.6 billion euros as early as next year under the current general contribution rate of 3.6 percent. Raising the contribution ceiling is projected to increase revenues by roughly 1.6 billion euros in the first year, about 1.7 billion euros in subsequent years, and roughly 1.8 billion euros annually toward 2030.
| Item | Value / Effect |
|---|---|
| Current monthly contribution ceiling | 5,812.50 EUR |
| Step 1 (immediate) | 6,450 EUR monthly |
| Step 2 (1 Jan 2027) | +300 EUR → over 7,000 EUR monthly |
| Estimated extra revenue (first year) | ~1.6 billion EUR |
| Estimated extra revenue (following years) | ~1.7–1.8 billion EUR per year |
| Projected nursing insurance deficit if unchanged | ~20–22 billion EUR over coming years; ~7.6 billion EUR next year |
| Employer sector burden (hospitality example) | ~2 billion EUR additional |
| Minijob total employer cost example | Increase from ~13% to ~21.1% of wage costs |
| Values are estimates from the draft analysis and economic assessments; percentages are contribution-rate based (rate unchanged). | |
Who will be affected?
High earners and the upper middle class
Although the measure is presented as targeting very high earners, economic analyses suggest the effect reaches far into the upper half of the middle class. One estimate indicates that more than six million employed people would be affected—roughly one in five social-insurance contributors in practice. Those above the old ceiling will see higher absolute monthly contributions even though the contribution percentage remains the same.
Childrenless contributors and the self-employed
The draft also plans to increase the surcharge for people without children by 0.1 percentage points (from 0.6 to 0.7 points), paid fully by the employee. For many contributors that is a small monthly increase, but for the self-employed it can add up. A rough example: an additional 0.1 percentage points equals about 1 euro more per 1,000 euros of monthly assessable income—roughly between 16 and 70 euros per year depending on income levels.
Minijobs, employers and sectoral effects
The reform would also include minijobs in the nursing insurance contribution base, meaning employers would have to pay the full nursing insurance share (3.6 percent) on these jobs. In sectors that rely heavily on minijobs, such as hospitality, that raises the employer-side burden substantially and increases the overall labor cost rate for marginal employment. Industry groups warn this could make low-hour employment more expensive and strain businesses that depend on flexible, low-wage staff.
Changes to benefits and cost-control measures
The draft does not only raise revenue: it also includes measures to slow expenditure growth. One notable change is a delay in the automatic reclassification into a higher care level by six months. That delay is expected to lower spending and produce savings of about 2.6 billion euros in 2027. However, critics caution that slowing upgrades to higher, more expensive care levels will directly affect some people in need of more intensive support.
To ease pressure on households, the reform introduces a mechanism to index regular nursing benefits to inflation, and it proposes better prevention for older people and a new home-care accompaniment service to detect early deterioration. Those improvements are largely financed by other cutbacks, for example by removing the current flat relief amount for the lowest care grade (a monthly allowance of up to 131 euros), which reduces benefits for some of the least dependent care recipients.
Many practitioners and researchers welcome measures that secure short-term financing but warn that revenue-side adjustments alone cannot solve structural problems: rising out-of-pocket costs, workforce shortages in care, and unclear boundaries between care and social assistance require deeper reforms of service delivery and cost structures.
Political debate and next steps
The proposal sets up a classic political trade-off: stabilize nursing insurance finances by shifting a larger share of costs to higher incomes and childless contributors, or pursue spending restraints and structural reforms that could alter services and access. Employers’ representatives and some economic voices argue the draft misidentifies the root causes of the financing gap and warn of negative effects on employment and investment if contribution burdens rise further.
Key points of contention
- Whether raising the contribution assessment ceiling is fair and whether it targets only top earners or a broader group in the upper middle class.
- The planned inclusion of minijobs in nursing insurance contributions and its impact on employers and low-hour work.
- Balancing short-term savings and revenue measures with long-term structural reforms to care delivery, workforce and spending growth.
Next steps and timeline
- The draft is discussed and amended in the ministry and by coalition partners.
- Relevant implementing laws and stabilization measures are prepared, including an expected legal change to take effect on 1 January 2027 for the additional monthly ceiling increase.
- Parliamentary debate and stakeholder consultations will determine the final balance between revenue increases and spending adjustments.
