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Hartmut Reiners ist Volkswirt und Gesundheitsökonom. Er war viele Jahre in verantwortlichen Positionen in den Gesundheitsministerien der Länder tätig und maßgeblich an allen Reformen der gesetzlichen Krankenversicherung zwischen 1988 und 2009 beteiligt. Seit 2009 ist er freier Publizist im Bereich Gesundheitsökonomie und hat neben zahlreichen Aufsätzen auch Bücher zum Gesundheitswesen veröffentlicht.

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Hartmut Reiners ist Volkswirt, Gesundheitsökonom und freier Publizist. Er war viele Jahre in den Gesundheitsministerien der Länder tätig. Neben zahlreichen Aufsätzen hat er Bücher zum Gesundheitswesen veröffentlicht.

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ist die Anhebung der Beitragsbemessungsgrenze in der GKV problematisch?","smallTitle":"Frag‘ den MAKRONAUTEN","publishDate":"2026-05-20T00:00:00+02:00","editDate":null,"seo":{"image":{"fixed":{"src":"https://www.datocms-assets.com/19658/1758105133-makronaut.png?auto=format&fit=crop&h=627&w=1200"}}},"image":{"title":null,"fluid":{"base64":"data:image/png;base64,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Stabilisiert die geplante Reform die gesetzliche Krankenversicherung – oder verschärft sie die Probleme des dualen Systems?

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In unserer Rubrik „Frag‘ den MAKROnauten“ können Leserinnen und Leser der Redaktion Löcher in den Bauch fragen.

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Gesundheitsministerin Nina Warken sieht in ihrem dem Bundestag vorgelegten Entwurf eines „GKV-Beitragssatzstabilisierungsgesetzes“ vor, die Beitragsbemessungsgrenze in der GKV von 5.812,50 um 300 Euro auf 6.112,50 Euro pro Monat anzuheben. Damit werden freiwillig in der Gesetzlichen Krankenversicherung (GKV) versicherte Personen belastet. Dass Hartmut Reiners die Anhebung der BBG kritisierte, hat einige Makroskop-Leser irritiert, weil dadurch der GKV mehr Geld zufließen (1,2 Milliarden Euro) und mehr Beitragsgerechtigkeit geschaffen würde. 

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Liebe Leserinnen und Leser, 

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dass durch die Anhebung der Beitragsbemessungsgrenze der GKV mehr Geld zufließt, trifft zwar kurzfristig zu, ist aber mittel- bis langfristig eher ein Problem.

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Die Versicherungspflichtgrenze (VPG) ist in Europa eine deutsche Besonderheit. Allen anderen Sozialversicherungssysteme beruhen auf einer allgemeinen Versicherungspflicht – das heißt, alle Bürgerinnen und Bürger zahlen direkt oder indirekt in dieses System ein. Sogar in der Schweiz zahlen auch Millionäre in die soziale Rentenversicherung ein. 

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In Deutschland sind hingegen nur die abhängig Beschäftigten sozialversicherungspflichtig, mit Ausnahme von leitenden Angestellten in Kapitalgesellschaften, selbständigen Landwirten und Beamten. In der GKV gilt die Versicherungspflicht nur für abhängig Beschäftigte mit einem Einkommen von bis zu 6.450 Euro pro Monat. 

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Beamtinnen und Beamte haben keinen Anspruch auf eine Mitgliedschaft in der GKV, es sei denn, sie waren vor ihrer Verbeamtung Mitglied. Sie müssen dann aber auch den Arbeitgeberanteil zahlen, was natürlich kaum jemand von ihnen macht. Sie haben Anspruch auf eine Beihilfe von 50 Prozent (Pensionäre 70 Prozent) der Behandlungskosten, die wie bei Privatpatienten abgerechnet werden. Für den Rest haben fast alle Beamten eine Privatversicherung.

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Dieses duale Krankenversicherungssystem ist in Europa einmalig und einer der Gründe für die im Vergleich hohen Pro-Kopf-Ausgaben im deutschen Gesundheitswesen. 10 Prozent der Bevölkerung sind über die PKV bzw. das Beihilfesystem privat krankenversichert und haben im Schnitt für die gleichen Leistungen um etwa ein Drittel höhere Pro-Kopf-Ausgaben als die GKV.

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Die Beitragsbemessungsgrenze (BBG) liegt in der GRV bei 8.450 Euro pro Monat, in der GKV hingegen nur bei 5.812,50 Euro. Für diesen Unterschied gibt es keinen sachlichen Grund, er hat historische Wurzeln. Die GKV-Ausgaben bestanden bis Mitte des 20. Jahrhunderts vor allem aus Krankengeldzahlungen, die man mit der BBG eingrenzen wollte. Heute spielen sie mit etwa 6 Prozent der GKV-Ausgaben eine nachgeordnete Rolle.

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Effekte einer Anhebung der BBG

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Man hat an der Beitragsbemessungsgrenze (BBG) festgehalten, um die gesetzliche Krankenversicherung auch für besserverdienende Angestellte attraktiv zu halten. Denn freiwillig Versicherte zahlen oberhalb der BBG keinen einkommensabhängigen Beitragssatz mehr wie Pflichtversicherte, sondern faktisch eine gedeckelte Pauschale. Diese liegt derzeit inklusive Arbeitgeberanteil bei rund 1.017 Euro im Monat.

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Dadurch sinkt mit steigendem Einkommen die tatsächliche Belastung: Wer 10.000 Euro im Monat verdient, zahlt effektiv nur rund 10,2 Prozent seines Einkommens für die Krankenversicherung statt der regulären 17,5 Prozent, die für Pflichtversicherte gelten.

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Eine Anhebung der BBG würde deshalb zunächst für mehr soziale Gerechtigkeit sorgen, weil hohe Einkommen stärker zur Finanzierung der gesetzlichen Krankenversicherung beitragen müssten. Gleichzeitig steigt dadurch aber auch der Anreiz für freiwillig Versicherte, in die private Krankenversicherung (PKV) zu wechseln. Möglicherweise hat die von Gesundheitsministerin Nina Warken eingesetzte Finanzkommission Gesundheit (FKG) deshalb auf einen solchen Vorschlag verzichtet.

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Allerdings ist die PKV längst nicht für jeden attraktiv. Besonders für ältere Versicherte kann sie teuer werden, weil die Beiträge mit zunehmendem Alter steigen und Rückstellungen für spätere Behandlungskosten aufgebaut werden müssen. Hinzu kommt: Für Kinder und nicht erwerbstätige Partner fallen in der PKV zusätzliche Beiträge an, während sie in der gesetzlichen Krankenversicherung kostenlos mitversichert sind. Nur das Krankengeld muss in der PKV zusätzlich abgesichert werden, während die gesetzliche Krankenversicherung dieses ab der siebten Krankheitswoche automatisch zahlt.

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Vor allem für junge, kinderlose Gutverdiener mit einem Einkommen oberhalb der BBG bleibt die PKV deshalb finanziell attraktiv. Diese Gruppe wird auf rund zwei Millionen Menschen geschätzt.

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Kurzfristig könnte eine höhere BBG der gesetzlichen Krankenversicherung zwar zusätzliche Einnahmen bringen. Mittel- und langfristig droht jedoch ein gegenteiliger Effekt: Die private Krankenversicherung würde bessere Chancen erhalten, junge und einkommensstarke Mitglieder abzuwerben. Gerade diese Versichertengruppe ist für die Finanzierung des dualen Krankenversicherungssystems besonders wichtig.

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Eine Anhebung der BBG ohne gleichzeitige Reform der Versicherungspflichtgrenze wäre daher riskant für die langfristige Stabilität der solidarischen gesetzlichen Krankenversicherung. Ob Nina Warken ihre Position im parlamentarischen Verfahren durchsetzen kann, erscheint derzeit allerdings offen. In beiden Regierungsfraktionen regt sich bereits Widerstand.

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Stellen auch Sie uns Fragen, die Sie beschäftigen! Wir schauen, ob wir Antworten liefern können. Natürlich geht es um Ökonomie – aber die ist im Zweifel ein weites Feld. Vielleicht können wir, die Redaktion, Ihre Fragen direkt beantworten, vielleicht müssen wir einen unserer Autoren um Hilfe bitten. Und wenn die Frage von allgemeinem Interesse sein könnte, setzen wir uns in unsere MAKROnauten-Raumkapsel und suchen das wissenschaftliche Weltall nach einer Antwort ab. Die Frage und die Antwort werden wir im Magazin veröffentlichen (selbstverständlich wird Anonymität gewahrt).

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Fragen an: redaktion@makroskop.eu 

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