Six Million German High Earners Face Steeper Care Contributions as Berlin Pushes 11-Billion-Euro Reform

A sweeping overhaul of Germany’s nursing-care insurance, outlined in a draft bill dated 4 June 2026, would save roughly 11 billion euros annually—but the price tag falls squarely on higher-income workers. Under the plan from Health Minister Nina Warken, the contribution ceiling for mandatory long-term care insurance would climb to 69,750 euros per year from 2027. That change, combined with a higher contribution rate of 4.3 percent for childless employees, hits more than six million top earners, according to the Institut der deutschen Wirtschaft. Without such measures, the care fund faces deficits of up to 21 billion euros by 2030.

Policymakers are simultaneously advancing a separate reform to workplace illness. A current legislative draft introduces a voluntary “partial sick note” for employees who have been off work for at least four weeks. Under the model, doctors can certify a gradual return to work in increments of 25, 50, or 75 percent capacity—subject to employer approval. The federal government expects the scheme to cut costs by around 40 million euros in 2027, rising to 160 million euros by 2030.

The economic toll of absenteeism is already heavy, and not only in Germany. Swiss data for 2026 show that sickness levels remain well above pre-crisis benchmarks. Absenteeism costs roughly 18.6 billion Swiss francs, while presenteeism—showing up to work while ill—is estimated at 33.7 billion francs. Even more worrying: the probability of permanent disability has risen about ten percent since 2020, with the sharpest increase among those under 40.

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In Germany, corporate health policy is gaining traction as a productivity lever. A strategy paper published in June 2026 notes that companies such as BMW, Deutsche Telekom and SAP are already running structured programmes to safeguard long-term workforce performance. On the cost side, employers in North Rhine-Westphalia have been able to claim surcharge rates of around 58.98 percent for ancillary wage costs since 1 January 2026.

Artificial intelligence is also reshaping HR departments. A study by SD Worx shows that 48 percent of German HR managers are investing in AI, particularly for payroll processing. Regulatory pressure from the EU AI Act is mounting—nearly half of surveyed firms have already implemented internal AI guidelines.

Medical screening is advancing too. Since April 2026, Germany offers low-dose CT lung-cancer screening to long-term smokers aged 50 to 75. Pharmacies, in a recent position paper, are calling for expanded responsibilities, including administering vaccinations and supporting the electronic patient record.

Digital health tools are entering the insurance market. HanseMerkur became the first private health insurer to integrate a pain-therapy app into its benefits package, targeting better care for the roughly 12 million Germans who suffer from chronic pain. Yet legal hurdles remain high: Germany’s Federal Administrative Court has ruled that private insurers may not evaluate diagnostic data of existing policyholders for preventive offers without explicit consent.

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