Which health and nursing care insurance contributions are deductible?

Contributions to health and nursing care insurance can be deducted as special expenses in the tax return – but only for the so-called basic cover.

For those with statutory insurance, the tax office reduces the contribution by 4% as this portion covers sickness benefit. The reduction is applied only if there is an entitlement to sickness benefit.

Privately insured individuals can also only deduct the basic contribution. Optional benefits (e.g. treatment by a head physician, two-bed room) are not included. They are only deductible as other pension expenses if the maximum amount has not been exhausted.

Maximum amounts for other pension expenses:

• 1.900 Euro per year for employees and pensioners
• 2.800 Euro per year for self-employed

As long as these amounts are not exceeded, other insurances can also be claimed – e.g. unemployment, liability, accident or disability insurance.

Example: A married couple pays a total of 4.600 Euro in contributions to health and nursing care insurance. As this is basic cover, the full contributions are deductible – even if they exceed the joint maximum amount of 3.800 Euro (2 × 1.900 Euro). Further insurances can then no longer be considered.

Which health and nursing care insurance contributions are deductible?

Can contributions to foreign insurance policies be taken into account in the tax return?

Yes, contributions to foreign insurance can also be deducted in the German tax return, but only under certain conditions.

1. Contributions to health and pension insurance

Contributions to foreign statutory pension insurance can be considered as pension expenses (§ 10 para. 2 no. 2c EStG). Contributions to other foreign insurance are also deductible if:

• they fall under the maximum amount for pension expenses, and
• the insurer is based in an EU/EEA country or is authorised to operate in Germany (§ 10 para. 2 no. 2a EStG).

2. Deduction as special expenses: restrictions

Foreign social security contributions are not deductible if they are related to tax-free foreign income, e.g. when applying the progression clause (§ 10 para. 2 no. 1 EStG).

3. Special regulation since 2019

Since 2019, contributions to pension, health, nursing care, and unemployment insurance can also be deducted if:

• the income from employment is earned in an EU/EEA country,
• this income is tax-free in Germany (double taxation agreement), and
• the foreign state does not allow the pension expenses to be taken into account for tax purposes (§ 10 para. 1 EStG).

4. Current case law

The Federal Fiscal Court (BFH) has repeatedly ruled in favour of taxpayers:

• Contributions to nursing care insurance in Luxembourg and
• Contributions to basic health insurance in the Netherlands

may be deducted as special expenses if no tax deduction is possible abroad (including BFH, X R 28/20, X R 13/20).

This does not apply to income from third countries such as China, Brazil, or India (BFH, X R 25/21 of 14.12.2022).

Note

Regularly inform yourself about current legal changes and rulings. If in doubt, tax advice is recommended.

Can contributions to foreign insurance policies be taken into account in the tax return?