Freelancers and health insurance in Germany

In Germany, health insurance is considered mandatory. Unlike company employees, freelancers (Freiberufler:innen) are not automatically covered by statutory health insurance. They are responsible for their own social security and registration to a health insurance policy.

The choice freelancers make regarding their health insurance depends on their individual situation. The differences are noticeable not only in the amount of contributions they must pay, but also in the scope of services they are entitled to. Therefore, the choice of your health insurance should be well thought out. You can learn more about this in this article.

Since health reforms carried out in 2009 in Germany, a general health insurance obligation applies to all residents living in Germany.

This insurance obligation includes the self-employed, which in turn includes freelancers. They have the option to voluntarily insure themselves with a statutory health insurance (gesetzlichen Krankenkasse, or GKV) or to take out a private health insurance (private Krankenversicherung, or PKV).

Exceptions are those engaged in agriculture, who are mandatorily insured in the social insurance for agriculture, forestry, and horticulture.

Freelancers can choose and switch between all statutory health insurance plans (GKV). The services of different providers usually differ only in small details. 

While employers contribute half of the payable contributions for their employees, freelancers must pay the entire contribution themselves. The contribution rate for freelancers who voluntarily insure themselves in a GKV is 14%.  Those who wish to receive sick pay in the event of a longer inability to work must pay a contribution rate of 14.6%. In addition to this contribution rate, an additional contribution, which the health insurance companies can set individually, is also due.

The amount of the contribution to the statutory health insurance for freelancers depends on the amount of their income. 

Here, the contribution assessment ceiling plays a significant role: For the calculation of insurance contributions, there is a upper limit of currently €66,150 per year and a lower limit of currently €1,248.33 per month. This means that you do not pay contributions on income that exceeds the upper limit. If your income is below the minimum limit, a nominal minimum income is still assumed for the calculation of your contributions.

The voluntary health insurance in the GKV is recommended for freelancers who already have a family or are planning to start one, as they benefit from the free family insurance. Since the contribution amount depends on the respective income, statutory health insurance is advantageous for freelancers with low income.

As an alternative to voluntary membership in the statutory health insurance, freelancers can also take out private health insurance (PKV). They can either use services from a private health insurance company to supplement statutory health insurance or opt entirely for private health insurance for the self-employed.

Unlike statutory health insurance, the premium in private health insurance is not based on your income level. If you wish to insure privately, factors such as your age at entry, health condition, profession, and the services to be insured play a significant role in the premium calculation. Certain risks or illnesses can lead to a surcharge, and various pre-existing conditions can even be grounds for rejection.

Only in the basic tariff do these criteria not matter, as there is an entitlement to admission. The law requires that the basic tariff must be comparable in scope, type, and amount to statutory health insurance. If there are changes in statutory health insurance, the basic tariff of private health insurance also changes accordingly.

In general, the scope of benefits in private insurance is higher than in statutory insurance. You can choose from several tariffs and select the one that suits your preferences, allowing you to claim the services that are most important to you. Various dental, outpatient, and inpatient tariffs can be easily combined to create your individual insurance package.

Freelancers who are in private health insurance benefit from the lifelong guarantee of insurance coverage. This means that contractually agreed services are guaranteed for life. However, with increasing age, insurance premiums also rise.

Deciding between statutory or private health insurance is a choice worth careful thought. Your decision should be sustainable in the long term, as switching from private to statutory health insurance is only possible under certain conditions and not possible at all above the age of 55.

The statutory health insurance will only take you back if you become subject to compulsory insurance, for example, as an employee with an income below the compulsory insurance threshold. If you give up your freelance work, become unemployed, and receive the basic security for the self-employed, you are legally required to join the statutory health insurance.

If you were previously privately insured for at least five years, you might be able to remain in the statutory health insurance under certain circumstances. However, you should carefully check whether it is financially worthwhile.

If you choose a voluntary statutory health insurance for freelancers, simply contact the statutory health insurance fund of your choice. Many health insurance funds have online application forms available on their website. Alternatively, you can obtain the documents directly from the health insurance fund. To calculate the contribution amount, you must provide the health insurance fund with proof of your income, such as a tax return document.

If you were already compulsorily insured under the statutory system before starting your freelance work, you will have a mandatory continuation of insurance and remain a member of your previous health insurance fund. However, you are free to change the health insurance fund if you wish.

If you wish to additionally take advantage of extra services from a private health insurance or fully insure yourself privately, contact the private health insurer of your choice and get a quote that meets your needs and requirements.

It is definitely worth carefully comparing several providers, as they can differ significantly in terms of contribution rates, services, and admission conditions. Since your income does not play a role in calculating the contribution amount, you do not need to provide proof of income. However, the private health insurance will require proof of your health condition. Inquire with the respective insurer about which documents you need to submit for the application.

In principle, anyone who has left the compulsory insurance in a statutory health insurance due to their self-employment can voluntarily join a statutory health insurance. However, they must meet certain previous insurance periods:

The access requirements for private health insurance depend on the respective insurer.

If you decide to become self-employed, you must join the statutory health insurance as a voluntary member within three months after ending a previous insurance relationship.

Insurance coverage begins as soon as you join the private health insurance. After this period, voluntary membership in the statutory health insurance is no longer possible. To find out if there are any deadlines for taking out private health insurance, and what they are, please contact the respective insurer. Be sure to inquire in good time to avoid being without insurance coverage during the transition period.

Whether the GKV or PKV is the right choice for you as a freelancer ultimately depends on several factors such as your age, pre-existing conditions, income, service requirements, and family status. To make the right decision, it is important to thoroughly research both health insurance systems and weigh their respective advantages and disadvantages.

The comparison of health insurance funds should not only consider the costs, but also the services those costs pay for. Remember that these are often long-term decisions, and you can only switch back to statutory health insurance under certain conditions.

If your profession is among those that can be insured through the Artists' Social Security Fund (KSK), you benefit from the partial coverage of your insurance contributions and can also optimally secure yourself with private additional services.

A business account for freelancers can also help manage insurance contributions easily and have them directly debited.