Germany Scraps Free Spousal Health Insurance in 2028 Reform

Germany's Controversial Health Reform Ends Free Spousal Insurance by 2028

Proposal to Reform Spousal Co-Insurance Sparks Criticism

A push by the German Health Ministry to reform the currently free co-insurance for spouses has faced backlash. According to the Social Association of Germany (Sozialverband Deutschland), the changes would place a particular burden on low-income earners and families.

Online, some critics have seized on another angle: While spouses in Germany may soon lose free coverage, social security agreements—such as those between Germany and Turkey—still allow this benefit to continue. This point has been raised by AfD politicians René Springer and Miguel Klauß, as well as YouTuber Miriam Hope, a figure associated with the Querdenken movement. Hope's video on the topic has been shared multiple times via our WhatsApp chatbot, with viewers requesting clarification.

We examine the background of these agreements—and where the current debate lacks context or exaggerates key points.

How Family Insurance Works in Germany Several posts claim that spouses in Germany will soon have to pay a minimum contribution of €225. This figure originates from a Handelsblatt report in March, which cited "coalition sources." In mid-April, Health Minister Nina Warken (CDU) clarified that, starting in 2028, primary insured individuals will pay 3.5% of their income subject to contributions for previously free co-insured spouses. There is no fixed minimum amount—just an income-based fee.

Contrary to some claims, spousal co-insurance is not being abolished entirely. Minister Warken stated: "Children, parents of children under seven, parents of children with disabilities who cannot support themselves, caregivers, and individuals above the standard retirement age—meaning pensioners—will continue to be covered free of charge."

Social Security Agreements Allow Coverage for Relatives Abroad To stoke resentment against foreigners or the government, some posts reference a rule over 60 years old: "While German families face higher costs, the German-Turkish social security agreement still allows relatives in Turkey to be covered under German health insurance."

Though similar agreements exist with other countries, the focus is often on Turkey—likely because Germany has paid more into the Turkish system in recent years than to any other nation.

Under the agreement, employees insured in Germany can extend free family coverage to relatives—whether they live in Germany or Turkey. If the family resides in Turkey, Turkish law defines who qualifies. As in Germany, this includes spouses and minor children. Siblings and multiple wives (as some falsely claim) are not eligible—Turkey has banned polygamy since 1926. Unlike Germany, however, Turkish rules also extend coverage to parents.

But contrary to YouTuber Miriam Hope's assertion, relatives in Turkey are not automatically insured. They qualify only if they are not employed or already insured. For parents, additional conditions apply: they must lack their own income or assets and receive financial support from the insured person in Germany.

Turkish Healthcare Providers Receive Flat-Rate Reimbursement—Costs Far Lower Than in Germany According to the German Bundestag's Research Service, the agreement has contributed to some Turkish workers choosing not to bring their families to Germany. "Healthcare costs for insurers would be significantly higher if these family members lived in Germany rather than remaining in their home countries." Turkish healthcare providers receive a fixed reimbursement—far below German treatment costs.

A Cost Factor Often Overlooked in the Debate

One key financial aspect frequently ignored in discussions is this: regardless of how many family members are insured in Turkey, Turkish health insurers receive a fixed monthly lump sum per family. This system is designed to minimize administrative effort—meaning it makes no difference whether or how extensively medical services are actually used.

Social media posts also tend to overlook the scale of the agreement. In 2023, it applied to only around 5,000 families in Turkey, according to figures provided to us by Germany's Federal Ministry of Labor and Social Affairs (BMAS)—and that number has been steadily declining.

Germany negotiates this lump sum annually with Turkish health insurers. The amount is based on the average treatment costs for patients in Turkey. In 2024, the BMAS reported the fixed payment at roughly €43 per month. For comparison: insuring a single person in Germany cost health insurers about €350 per month in 2024.

What Family Co-Insurance in Turkey Costs German Health Funds

So how much does this actually cost Germany's statutory health insurance system? AfD politician Miguel Klauß claims the figure runs into the hundreds of millions—without specifying whether this refers to annual costs or another timeframe. In a YouTube video, Miriam Hope states that between 2020 and 2023, some €60 million flowed to Turkish health insurers alone. But this number is not only inflated—it largely includes expenses unrelated to the family insurance coverage of Turkish dependents.

The total cost of the agreement with Turkey between 2020 and 2023 amounted to approximately €48 million, as revealed in a minor parliamentary inquiry by the AfD faction in March 2026 (data covers up to 2023).

Only about €6.8 million of that sum was attributable to family insurance—a figure calculable via the lump sum and the number of families covered.

The remainder covers "benefits-in-kind based on actual expenditure." When asked for clarification, the BMAS provided two examples: costs arise, for instance, from medical treatment for German tourists in Turkey, as well as for German employees temporarily posted there. If they receive medical care in Turkey, the expenses are billed back to Germany's statutory health insurers. After all, as previously noted, the agreement also benefits German citizens.

The Agreement's Share of Total Health Insurance Costs Is Marginal and Irrelevant to Contribution Rates

The agreement's overall costs represent just a tiny fraction of health insurers' expenditures. In 2023, the Turkey agreement cost statutory health insurers roughly €13.4 million—compared to total expenditures of about €288 billion. This equates to a mere fraction of a percent (around 0.0047%), with the family insurance component accounting for only a sliver of that. As early as 2024, the federal government emphasized that these costs were "not significant enough to affect contribution rates."

Contrary to suggestions in social media posts, the savings from halting lump-sum payments to Turkish insurers would be negligible. What's more—something these posts fail to mention—costs could even rise if family members from abroad were to move to Germany instead.