Rising expenses, tight reserves and growing additional contributions are putting statutory health insurance companies under pressure. A rating shows which funds are doing particularly well financially.
Dusseldorf. Rising health expenses, tight financial reserves and higher additional contributions – the financial situation of statutory health insurance companies (GKV) remains tense. Benefit spending has been rising significantly faster than regular contribution income for years. The additional contributions continue to rise.
But Thomas Lemke goes too far to reduce the GKV to its financial problems. “Statutory health insurance is better than its reputation,” says the managing director of the DFSI German Financial Service Institute.
Around 75 million people in Germany are insured through the GKV. Regardless of age, income or health status, they have access to comprehensive medical care. “This is a strong foundation that should be maintained in the future,” says Lemke. “However, this system is becoming increasingly more expensive.”
The development is not surprising: people are getting older, chronic diseases are increasing and new treatment options are causing additional costs. Medical progress costs money. At the same time, expenses for personnel, hospitals and medicines are increasing. “It becomes problematic when expenses permanently rise significantly faster than income,” says Lemke. “That’s exactly what’s happening right now.”
In the first half of 2026, GKV service expenditure rose by 7.4 percent, while revenue only rose by 4.1 percent. The health insurance companies achieved a surplus of around 2.6 billion euros during this period. But the surplus is mainly due to higher contributions and is needed to replenish the sharply shrunken financial reserves.
An exclusive financial strength rating from the DFSI for the Handelsblatt shows how well the funds are financially positioned. As in the previous year, no health insurance company achieved the top rating of “excellent”. Among the cash registers open nationwide, Tui BKK is at the top with the only “very good” result. The DFSI rated seven health insurance companies as “good”: Techniker Krankenkasse, Barmer, Audi BKK, HKK Krankenkasse, HEK Hanseatische Krankenkasse, MKK Meine Krankenkasse and SBK.
As in the previous year, the company health insurance funds performed above average among the regional health insurance funds. The grade “very good” was given to BKK firmus, BKK SBH, BKK Public and BKK Faber-Castell & Partner.
The statutory health insurance companies had financial reserves of around 7.5 billion euros in mid-2026. “That initially sounds like a considerable sum,” says Lemke. In fact, this amount only corresponds to a good 0.2 months of expenses and therefore approximately the legally required minimum reserve. Accordingly, liquidity and assets for the financial stability of the health insurance companies are weighted together at 50 percent in the rating.
Ultimately, the funds must be able to meet their obligations at all times - regardless of fluctuations in the capital markets, interest rates and benefit expenses. Barmer, which achieved the highest score in terms of liquidity, has invested a large amount of short-term investments at numerous large financial institutions. “Since the interest rate turnaround, longer-term investments have been increasingly made again,” says company spokesman Athanasios Drougias.
The DFSI analyzed the financial strength of statutory health insurance companies based on economic stability, efficiency and solidity. The basis for the assessment is a survey by the DFSI based on the expanded accounting for the 2024 and 2025 financial years. A total of 72 nationwide or regional health insurance companies were examined, of which 40 funds filled out the complete questionnaire and thus actively submitted to the comparison.
The analysis includes 77 individual key figures that reflect various financial and structural aspects. Liquidity was weighted at 30 percent, total assets including reserves and investment funds at 20 percent. The experts weighted administrative efficiency at 15 percent and the profit and loss statement at 10 percent. Membership development (5 percent), financial transparency and contribution stability (10 percent each) were also taken into account.
The issue of safety is at the forefront. Audi BKK is also currently relying on short-term investments and primarily on overnight money from its house banks. “We are combining a security-oriented investment policy with high liquidity and at the same time taking advantage of the existing interest rate options,” says CEO Anja Schramm. In the current situation, the funds are not concerned with the highest possible returns. The money must be safe and available quickly when needed.
The insurers are currently planning their budgets for 2027. The decision on the future additional contribution is usually made by the respective board of directors in December. Each health insurance company determines the additional contribution that insured persons have to pay in addition to the general contribution rate of 14.6 percent. According to the Federal Ministry of Health, in 2026 it will be on average 2.9 percent. According to the DFSI calculation, the average is even over 3 percent.
“Of course the price also plays an important role,” says Jens Baas, CEO of the Techniker Krankenkasse. The health insurance companies strive to keep their additional contributions constant. There are at least cautiously positive signals for 2027. According to the current forecast by the GKV estimators, the calculated average additional contribution rate could remain stable.
The additional contribution at TK is currently below the market average at 2.69 percent. This is particularly successful due to the lean administrative structures and efficient processes. “At 108 euros per insured person, our administration costs are well below the average,” says Baas.
In the current DFSI study, the health insurance companies examined with more than a million insured persons had average administrative costs of around 198 euros per insured person. Funds with 500,000 to one million insured people were only around 168 euros. Smaller health insurers work more efficiently on average.
