On February 20, 2025, three days before the federal election in Germany, Alice Weidel, party leader of the AfD, claimed during the “Wahl 2025 Schlussrunde” on ARD and ZDF that the reason for the steadily rising health insurance contributions are the millions of people who were allowed into the statutory health insurance system by political parties, despite never having paid into it. This statement is false.
The claim refers to current asylum policy and the number of refugees in Germany, which Weidel cites as the cause for the increase in health insurance contributions. Similar arguments have been made in the past by other politicians, including Germany’s new chancellor, Friedrich Merz, in September 2023. Verifying this statement is relevant, as it suggests a causal link between rising health insurance contributions and the admission of refugees – which cannot be substantiated by existing data or legal regulations. Moreover, the aim is to counter misinformation regarding asylum policy and dispel the associated prejudices. This fact check focuses on whether and how migrants are insured in Germany, which benefits they receive, and whether this has any impact on health insurance contributions.
How are health insurance contributions structured?
Contributions to Germany’s statutory health insurance consist of a general contribution rate of 14.6 % of the insured person’s income, which has remained unchanged since 2015. On top of that, there is an additional contribution rate specific to each health insurance fund, which in 2025 averages 2.92 %. The total contribution is split equally between employees and employers.
The starting point
In 2024, Germany’s statutory health insurance companies reported a deficit of €6.2 billion. That year, revenues amounted to €320.6 billion, while expenditures reached €326.8 billion. At the same time, the government’s financial reserves for statutory health insurance fell to €2.1 billion – well below the legally required minimum reserve.
Currently, 91 out of 93 statutory health insurance companies have increased their additional contribution rates. As a result of these increases, the new average additional contribution rate now stands at 2.92 %, in addition to the standard 14.6 %. In 2024, the average additional contribution was still 1.58 %.
Despite the steady increases, the contributions are insufficient to cover the costs of the healthcare system. Costs are rising faster than the revenue that can be generated through contributions, which means contributions will need to continue increasing in the future.
How are refugees insured in Germany?
In Germany, there are different categories of refugees who receive varying levels of medical care and insurance coverage depending on their residence status.
Asylum seekers:
Asylum seekers are individuals who have submitted an asylum application that has not yet been approved and therefore do not yet hold a legal residence status. These individuals are not insured under statutory health insurance but are entitled to medical care under the Asylum Seekers’ Benefits Act (AsylbLG). This law governs the benefits for people who have come to Germany as asylum seekers, war refugees, or for other reasons defined under immigration law. Those with tolerated status or a border crossing certificate are also eligible to receive medical care but only within the scope of the AsylbLG.
Recognized refugees:
Recognized refugees are individuals who hold a legally recognized residence permit. Since health insurance is mandatory in Germany, recognized refugees are also subject to mandatory coverage and are therefore entitled to the full range of statutory health insurance services.
Undocumented refugees:
Refugees without legal residency status are fully excluded from regular healthcare coverage via health insurers or social welfare offices. These individuals depend on voluntary medical aid.
Who receives which benefits?
The extent and financing of medical services for refugees depend on their residence status and the length of their stay.
Benefits during the first 36 months of residence:
During their first 36 months in Germany, refugees have only limited access to healthcare. This entitlement is regulated in the Asylum Seekers’ Benefits Act (§ 4 AsylbLG). This includes the following services:
- Medical and dental treatment for acute illnesses and pain
- Provision of medications and medical supplies
- Medical services aimed at recovery, improvement, or relief
- Treatment for acute illnesses
- Medical care for pregnant women
- Care for women who have recently given birth
- Preventive vaccinations
- Midwifery services
- Immunizations
- Preventive check-ups
Healthcare during this period is provided through treatment vouchers issued by social welfare offices. These vouchers are valid for three months or must be requested anew for each doctor’s visit. Affected individuals are assigned to local municipalities. In case of illness, the city or state administration covers the costs, typically via the social welfare office, although in some municipalities this responsibility lies with the public health department.
Additional services, such as physical therapy or planned hospital stays, must be approved by the social welfare office. Emergency cases, such as acute respiratory distress, severe pain, pregnancy complications, accidents, or other life-threatening conditions, are exempt from this rule.
Benefits after 36 months of residence:
After 36 months, refugees are entitled to an expanded range of healthcare services that closely resemble those provided by statutory health insurance. By this point, they receive an electronic health card for billing purposes.
“In these cases, however, individuals do not become insured members of the statutory health insurance. Rather, the benefits are reimbursed in full by state institutions in accordance with the AsylbLG, both for the benefits themselves and for the administrative costs,” explains Klaus Meesters from the National Association of Statutory Health Insurance Funds (GKV-Spitzenverband). Therefore, this does not constitute formal membership in the statutory health insurance system.
Even at this stage, additional services can be applied for. These are referred to as “discretionary benefits”. Approval is granted by the relevant authority. These benefits are often intended for individuals with special needs under the EU Reception Conditions Directive, such as victims of human trafficking, those with mental illnesses, or individuals who have experienced violence.
Benefits with a residence permit:
Once refugees obtain a legal residence permit, they are required to become members of statutory health insurance due to mandatory insurance laws. From that point forward, they are entitled to the full scope of services covered by statutory health insurance.
For recognized refugees without their own income, the government typically pays the health insurance contributions. If they receive citizens benefit (Bürgergeld), the Jobcenter covers their contributions. However, the exact amount spent annually by the government or Jobcenter on these contributions cannot be determined. This is because statutory health insurance does not separately record how many migrants enter the system each year or what proportion of them are employed in Germany.
Reasons for rising additional contribution rates
Germany’s demographic shift:
The population in Germany is aging. In 1991, there were approximately 12 million seniors over age 65; today, there are already 19 million. There is a shortage of young, working contributors to finance the growing number of older people who require more medical care. Furthermore, according to the Federal Statistical Office, life expectancy has more than doubled over time, meaning people are living longer than ever before.
Refugees help counteract the demographic shift. Young immigrants who are recognized and paying into the system generally use fewer health services than seniors, which helps stabilize contributions.
Rising expenditure in the highest expenditure areas:
Hospital care and pharmaceutical spending have increased rapidly in recent years. According to the Federal Ministry of Health, nearly one-third of every euro spent goes toward hospital treatment and is therefore the largest cost item for statutory health insurance. In 2024 alone, statutory health insurers spent €101.7 billion on hospitals, an 8.7% increase from the previous year. Additional expenditures of €7-8 billion are expected in 2025 for hospital reform.
A similar trend is seen in pharmaceuticals, the second-largest expenditure area. In 2024, statutory insurers spent €55.2 billion on medications, a 9.9% increase from the previous year. Between 2019 and 2024, pharmaceutical costs rose by approximately 40 %.
Higher personnel costs:
Health insurance companies point out that wage increases for healthcare staff have outpaced those in the general economy. From 2016 to 2024, the Federal Statistical Office reported a 26.9 % increase in healthcare wages, which corresponds to approximately 3 % per year, compared to a 24.9 % increase across all industries, which corresponds to approximately 2.8 % per year.
Recipients of citizen’s benefit (Bürgergeld):
Statutory health insurance companies also criticize the lack of adequate support for financing health coverage for recipients of citizen’s benefit (Bürgergeld), whether they are a recognized refugee or a German citizen. As mentioned earlier, the Jobcenter pays health insurance contributions for these individuals. However, the actual costs significantly exceed the paid contributions. In 2022, health insurance companies received €108.48 per month per recipient from the Jobcenter, while the actual cost was €311.40. As a result, health insurance companies are forced to cover the shortfall themselves. They are now calling for the government to provide more funding for citizen’s benefit recipients. However, due to Germany’s weak economy and shrinking tax revenues, the federal budget is increasingly tight.
Conclusion
In light of all these points, Alice Weidel’s statement is false. There is no causal link between rising health insurance contributions and the presence of refugees in Germany. The increased contributions are primarily due to demographic change, rising healthcare expenditures in areas like staffing, pharmaceuticals and hospital care, as well as structural funding issues, not the number of insured individuals in the statutory health insurance system. Refugees are not members of statutory health insurance until they receive full legal status, and thus do not contribute to higher premiums.
RESEARCH | ARTICLE © Lilli Pospischil and Lu Siegrist | Hochschule der Medien, Stuttgart , Germany
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