Costs & health insurance · Germany

HS Costs in Germany: Your Annual Statutory Co-payment Ceiling

Paying for HS care regularly?

Prescriptions, hospital stays and other healthcare services can create repeated statutory co-payments when you live with HS.

In Germany's statutory health insurance system (GKV), these qualifying co-payments are capped according to household income. A lower cap applies to people who meet specific legal criteria for severe chronic illness.

This guide explains the rules and helps you prepare questions for your Krankenkasse. We cannot determine whether you meet the criteria — that assessment belongs to your insurer.

Check which rule may apply What payments count?

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We cannot determine whether you qualify. Your Krankenkasse makes that assessment.

The rule in 30 seconds

2%

Standard limit

For GKV-insured people, qualifying statutory co-payments are generally limited to 2% of annual gross household income available for living expenses, subject to the statutory calculation rules.

1%

Reduced chronic-disease limit

A reduced 1% limit applies if the legal criteria for a severe chronic illness are met.

Important: having a chronic diagnosis such as HS does not by itself establish eligibility for the 1% limit.

Belastungsgrenze (annual co-payment ceiling, in German)

Could the 1% rule be relevant?

The following questions reflect the general GKV criteria. They cannot determine whether you qualify. Answer three short questions — nothing you select is sent to AcneInversa.life.

Step 1 of 3

Have you been receiving medical treatment for the same illness for at least one year?

Choose one answer.

Step 2 of 3

During that period, did you generally have at least one medical appointment per quarter because of that illness?

Choose one answer.

Step 3 of 3

Does at least one of these situations apply to you?

Select everything that applies.

Your result

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My Krankenkasse checklist

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What counts toward the limit?

Usually relevant statutory co-payments include those for:

  • prescription medicines
  • hospital treatment
  • Heilmittel (remedies and therapies, e.g. physiotherapy)
  • home nursing care
  • qualifying medical aids and dressing materials

See the full list from the Federal Ministry of Health (in German)

Not every healthcare expense counts

Your Belastungsgrenze does not mean every euro you spend because of HS counts toward it. Examples the BMG says are not included cover certain

  • costs above a fixed reimbursement amount
  • products or services not covered by GKV at all
  • certain additional or upgraded services
  • specific patient-own contributions

. Buying a product privately does not automatically make that purchase a statutory Zuzahlung.

What is Muster 55?

If the reduced chronic-disease limit may apply, your doctor may need to confirm the relevant chronic-illness criteria using Muster 55.

The form documents the information your Krankenkasse needs for its assessment.

You do not need to download or complete Muster 55 yourself. Ask your Krankenkasse what it requires and your medical practice whether certification is appropriate.

What happens when I reach the limit?

Reaching the calculated limit does not automatically switch off co-payments.

Apply to your Krankenkasse. If the insurer confirms that your Belastungsgrenze has been reached, you can be exempted from further qualifying co-payments for the remainder of the calendar year.

A retrospective reimbursement may also be possible if you have already paid more than the applicable limit. The exemption applies for one calendar year and must be requested again the following year.

HS Dressings in Germany: Prescriptions, Costs and Health Insurance Prescriptions, co-payments and what to ask after a refusal — with a private conversation checklist. Cost coverage for HS in Germany Applications to your health insurer: biologics, surgery, home nursing care, rehabilitation and appeals.

Sources

Last reviewed: · Next review: · Editorial Policy

Individual co-payment amounts may change under proposed legislation; the 1% and 2% ceilings described here are, as things currently stand, expected to remain. We review this page regularly against the linked sources.

  1. Belastungsgrenze (annual co-payment ceiling, in German) Federal Ministry of Health, Germany · Link checked: 2026-09-25
  2. Chronically ill people (in German) Federal Ministry of Health, Germany · Link checked: 2026-09-25
  3. Co-payment rules of statutory health insurance (PDF, in German) Federal Ministry of Health, Germany · Link checked: 2026-09-25
  4. Rules for the severely chronically ill (in German) Federal Joint Committee (G-BA), Germany · Link checked: 2026-09-25
  5. Chroniker-Richtlinie / chronic-illness guideline, § 62 SGB V (in German) Federal Joint Committee (G-BA), Germany · Link checked: 2026-09-25
  6. Section 61 SGB V – co-payments (in German) Federal Ministry of Justice, Germany · Link checked: 2026-09-25
  7. Section 62 SGB V – annual co-payment limit (in German) Federal Ministry of Justice, Germany · Link checked: 2026-09-25
  8. Co-payments and exemption from co-payment gesund.bund.de (Federal Ministry of Health, Germany) · Link checked: 2026-09-25