The short answer on the copayment exemption
With the copayment exemption, members of statutory health insurance (gesetzliche Krankenversicherung, GKV) pay copayments only up to 2 percent of their annual gross income for living expenses. For a severe chronic illness, the limit is 1 percent. You apply for the exemption at your health insurer, and it only applies for one calendar year. From 2027, higher copayments are planned.
| Item | Detail | Status |
|---|---|---|
| Out-of-pocket limit | 2 percent of annual gross income for living expenses | § 62 para. 1 SGB V, accessed 20 October 2026 |
| Out-of-pocket limit for a chronic illness | 1 percent for continuous treatment for the same severe illness | § 62 para. 1 SGB V, accessed 20 October 2026 |
| Copayment per medicine in 2026 | 10 percent of the pharmacy sale price, at least €5, at most €10 | § 61 SGB V, accessed 20 October 2026 |
| Copayment per medicine from 2027 (planned) | 10 percent, at least €7.50, at most €15 | Contribution Rate Stabilisation Act (Beitragssatzstabilisierungsgesetz), entry into force to be checked |
| Exemption | Application to the health insurer, valid for one calendar year only | Verbraucherzentrale (consumer advice centre), status 17 December 2025 |
From when do I no longer have to pay copayments?
As soon as your copayments in a calendar year reach the out-of-pocket limit, you do not have to make any further copayments for the rest of that year. Your health insurer then issues an exemption certificate. The limit is calculated from your gross income for living expenses. Income of relatives in the same household counts, while child benefit and housing benefit do not.
Ask your insurer in advance which income it will count in your case. This matters especially for benefits such as BAföG, which do not clearly fall into one category.
How do I calculate the limit while studying?
The following example uses a minijob earning €603 per month. That makes an annual income of €7,236.
- Gross income per year: 603 × 12 equals €7,236.
- Limit at 2 percent: 7,236 × 0.02 equals €144.72.
- Limit at 1 percent, for a chronic illness: €72.36.
- At €10 per medicine, the 2 percent limit is exceeded with the 15th medicine, and the 1 percent limit already with the eighth.
- If the copayment is €5 per medicine, you need correspondingly more medicines before the limit is reached.
Does the lower limit apply to a chronic illness?
Yes, if you are in continuous treatment for the same severe illness. The limit then drops to 1 percent. Under the rules for people with a severe chronic illness, you must be treated for at least one year and at least once per quarter. In addition, one of these conditions must apply: care level 3 to 5, a degree of disability, a reduced earning capacity of at least 60 percent, or a continuously required medical supply.
People who take part in a structured disease management programme (DMP) for their condition also pay only up to the 1 percent limit under the law. A doctor’s certificate and copies of the notices are sufficient as proof.
What changes from 2027?
The Contribution Rate Stabilisation Act plans to raise copayments by 50 percent. The copayment per medicine would then be 10 percent, at least €7.50 and at most €15. For medical aids, the maximum rises from €10 to €15. The 2 and 1 percent limits remain unchanged.
These plans come from the legislative process on contribution rate stabilisation. The sources I checked do not confirm whether the Bundesrat has approved the act or when the change takes effect. The information therefore remains marked as planned until the act is published in the Federal Law Gazette.
How can illness or disability extend my studies?
BAföG has no separate allowance for illness. Instead, the maximum period of funding can be extended. A serious illness lasting less than six months counts as a serious reason under § 15 para. 3 no. 1 BAföG. If it lasts longer or is chronic, it counts as a disability under no. 5. For a disability, the extra period is funded entirely as a grant. For other reasons, it is funded half as a grant and half as a loan.
Evidence is decisive. Accepted documents include, for example, a notice of determination, a severe disability pass or a specialist medical report. The evidence alone is not enough: you must also show that the illness caused the delay. Apply before the current funding period ends. Report delays no later than before the performance certificate at the end of the fourth semester. The BAföG office (Amt für Ausbildungsförderung) decides case by case which evidence applies to your semesters.
Here is what to do now
- Collect all receipts for copayments and the income certificates for the year.
- Calculate early in the year when your copayments will reach the limit.
- Get a medical certificate confirming continuous treatment if you want to claim the 1 percent limit.
- Submit the exemption application to your health insurer as soon as the limit is reached.
- Report delays caused by illness or disability to the BAföG office before the funding period ends.
Frequently asked questions
Do I have to apply for the copayment exemption myself?
Yes. Your health insurer does not notify you automatically. You submit original receipts and proof of income. The insurer refunds any amounts overpaid.
Does the exemption apply for several years?
No. It only covers one calendar year and must be applied for again every year. An advance payment for the following year is possible. If the copayments then turn out lower, there is no refund.
Do medical aids count towards the limit?
Yes, only statutory copayments count. From 2027, the maximum for medical aids rises from €10 to €15, provided the change takes effect as planned.
What if an illness prevents me from studying?
Then an extension of BAföG funding may be possible, provided the illness is recognised as a serious reason or as a disability. You apply at the BAföG office (Amt für Ausbildungsförderung). Whether a leave semester counts for health insurance is described in our guide on the leave semester.
Related reading
- Private health insurance (PKV) for students with pre-existing conditions: what you need to know (in German)
- Accessible studies: compensation for disadvantages, advice and support (in German)
- Health insurance during a leave semester: what applies to you (in German)
- Applying for BAföG: application, deadlines and documents (in German)
- Glossary of health insurance for students (in German)
Sources and review
- § 62 SGB V (out-of-pocket limit), gesetze-im-internet.de, accessed 20 October 2026.
- § 61 SGB V (copayment per medicine), gesetze-im-internet.de, accessed 20 October 2026.
- Contribution Rate Stabilisation Act in statutory health insurance (Beitragssatzstabilisierungsgesetz), legislative status according to the Federal Ministry of Health, accessed 20 October 2026. Entry into force not confirmed.
- Apotheke Adhoc, report “Copayment rises from 2027” of 15 July 2026, accessed 20 October 2026
- Verbraucherzentrale, copayments and exemption at the health insurer, status 17 December 2025, accessed 20 October 2026
- § 15 para. 3 no. 1 and no. 5 BAföG, Studierendenwerke, accessed 20 October 2026.
Information, not individual advice.
Editorial team: Academycon · Last updated: October 2026
To review your copayments for this year, the next step is the Academycon online check.
Last updated: October 2026. This guide is general information, not individual advice. The German version is authoritative.
