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Health Insurance as a Freelancer in Germany: The Basics

As a freelancer in Germany, the topic of health insurance may not be so easy for you: private or statutory insurance? We provide an overview.

Dunja Rühl
Dunja Rühl

Apr 14, 2022

For freelancers, the issue of health insurance is more complicated than for employees. While the latter are usually insured through their employer in the statutory health insurance (in German: Gesetzliche Krankenversicherung, GKV), freelancers can choose between GKV and private health insurance (in German: Private Krankenversicherung, PKV). Find out about the differences here and see which option is better for you.

Compulsory health insurance, but freedom of choice for freelancers

Even self-employed people cannot avoid health insurance, because it is mandatory for all residents in Germany. However, it is up to you whether you want to use statutory or private health insurance. Both options have their advantages and disadvantages, and it depends on your personal preferences and your situation which one suits you better. You should make the decision carefully: Once you have chosen private insurance, it is difficult to return to statutory health insurance.

Statutory health insurance as a freelancer

If you are self-employed, you are insured voluntarily in the statutory health insurance - if you choose this path. Employees, on the other hand, are insured through their employer and can only choose private health insurance if they earn more than a certain income. Your disadvantage as a freelancer: You pay the entire insurance contribution yourself and cannot share it with your employer, because you don't have one.

The monthly contribution depends on your income. The more you earn, the more you have to pay. However, there is both a minimum and a maximum amount. So it can't happen that you don't have to pay anything or that your health insurance contribution increases indefinitely if you earn a lot. If you're just starting out as a freelancer, you'll give an estimate and may have to pay extra or get money back.

The contribution rate for the self-employed is 14 percent of their income. If you choose a tariff with sick pay (i.e. a payment in case you cannot work for health reasons), it is 14.6 percent. On top of this comes the additional contribution (in German: Zusatzbeitrag) of the respective health insurance company. So by choosing a fund with a lower additional contribution, you can save a little. Important to know: Income includes not only income from your freelance work, but also capital gains and income from rent.

One advantage of the GKV is the free family insurance. For freelancers with children or who plan to start a family this can be an attractive option.

The GKV can be interesting for you if:

  • You have a rather low or fluctuating income.
  • You are not yet sure whether your freelance business will be successful.
  • You have children or want to start a family.

Private health insurance as a freelancer

Many self-employed people opt for private health insurance. In addition to the self-employed, it is also open to employees with an income above the annual income threshold in Germany (in 2022 this will be 64,350 euros), civil servants and students. All other persons are insured in the GKV.

With private health insurance, you sign a contract with an insurance company. Your monthly contributions are not based on your income, but on the tariff you choose. For younger people, the contributions are lower. Young and healthy high-income earners often get off more cheaply in the PKV than in the GKV.

At the beginning, there is a health check, which has an influence on the amount of the contribution. It can even happen that an insurance company does not accept people with certain pre-existing conditions.

You determine the amount of your premiums by the benefits you choose. For example, you can also agree on a deductible and thereby reduce your contribution. In private health insurance, you have the possibility to cover your health very precisely and comprehensively: single room, treatment by a chief physician or particularly comprehensive benefits for dentures - it’s up to you.

If you decide to take out private health insurance as a freelancer, you will have to pay for doctor's appointments and medication in advance and will receive the money back from the insurance company later. You should therefore have a certain financial cushion so that you don't get into trouble. In the case of inpatient treatment in the hospital, however, the clinic settles directly with the insurance company. So you don't have to worry about having to pay for an operation with a hospital stay of several days completely out of your own pocket.

Unlike the GKV, there is no free family insurance in the PKV. A separate contribution is due for each child. This type of health insurance is therefore perhaps less suitable for freelancers with children or the desire to have children.

The PKV can be interesting for you if:

  • You are young and healthy and have a high income.
  • You do not have a family (or only a small one) or don’t want to start one.
  • You want to choose your health care yourself.

Special case: KSK (artists' social insurance) for some freelancers

If you are a freelancer with Freiberufler status, and work as an artist or journalist, you can save money on health insurance through the Künstlersozialkasse (KSK). You are covered by statutory health insurance and the KSK pays half of your contributions, just like an employer. This system is intended as a support for artists, so only certain freelancers can use the health insurance model. You should check if it is suitable for you.

Choose your freelancer health insurance carefully

Deciding on the right health insurance may not be that easy for you. This article provides you with an initial overview, but there are other factors to consider. The best thing to do is to seek advice on the subject. Once you have decided on one of the options, you can use comparison platforms, for example, to find the right private health insurance provider or the best statutory health insurance for you.

The decision is also important because you can often not easily revoke it: Once you have chosen PKV as your freelancer health insurance, you cannot simply switch back to GKV. This is only possible if you take on a job that is subject to compulsory insurance and where your salary is below the annual income threshold. Even then, it is not possible to switch from the age of 55.

If your main reason for taking out private health insurance is to have particularly good health care, you may also be able to achieve this by taking out supplementary insurance in addition to the statutory health insurance. For example, you can take out supplementary dental insurance or supplementary hospital insurance.

Check out our article on general freelancer insurance to learn more about other kinds of insurance you might need.

Please note: We have prepared this article to the best of our knowledge, but it is not a substitute for insurance advice and does not claim that every single aspect is up to date and correct.

Dunja Rühl

Dunja Rühl is a writer and content marketer specializing in Future of Work topics. She has worked in a content marketing agency and a software start-up before becoming a full-time freelancer.

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