Health Insurance for Freelancers in Germany: Complete Guide 2026

Health insurance is one of the most important decisions you’ll make as a freelancer in Germany. Unlike employees, who have their insurance contributions split with their employer, freelancers must handle everything themselves. This can be overwhelming, especially if you’re new to the German system or transitioning from employment to freelancing.

The good news is that understanding your options and making the right choice doesn’t have to be complicated. This guide will walk you through everything you need to know about health insurance for freelancers in Germany, from the basics to advanced strategies for saving money.

Why Health Insurance Matters

In Germany, health insurance is mandatory for everyone. As a freelancer, you’re legally required to have health insurance coverage. Without it, you can’t register as self-employed, and you’ll face significant penalties. But beyond the legal requirement, good health insurance protects you from financial disaster if you get sick or injured.

For freelancers, health insurance costs are one of the largest monthly expenses. Understanding your options and choosing wisely can save you hundreds of euros per month while ensuring you have the coverage you need. The decision you make will affect not just your monthly budget, but also your access to healthcare and your financial security.

Public vs. Private Insurance: The Big Decision

The first and most important decision you’ll face is whether to choose public health insurance (gesetzliche Krankenversicherung, GKV) or private health insurance (private Krankenversicherung, PKV). This choice is often irreversible, so it’s crucial to understand the differences.

Public Health Insurance (GKV)

Public health insurance is the most common choice in Germany, covering about 90% of the population. It’s operated by various “Krankenkassen” (health insurance funds) like AOK, TK, Barmer, and others. All public insurers offer the same basic coverage, but they differ in service quality, additional benefits, and customer service.

Advantages of Public Insurance:

Family coverage: Your spouse and children are covered at no extra cost if they don’t have their own income
No health checks: You can’t be rejected based on pre-existing conditions
Predictable costs: Premiums are based on income, not age or health status
Comprehensive coverage: All medically necessary treatments are covered
Flexibility: You can switch between public insurers once per year

Disadvantages of Public Insurance:

Income-based premiums: You pay a percentage of your income (currently 14.6% plus a variable contribution, typically around 1.5-1.7%)
No premium reduction for low income: Even if you earn very little, you pay a minimum contribution (around 220-250 EUR per month in 2025)
Limited choice of doctors: Some specialists may prefer private patients
Longer waiting times: For non-urgent procedures, you may wait longer than private patients

Who Should Choose Public Insurance:

Freelancers with variable or low income
Those with families (spouse and/or children)
People with pre-existing health conditions
Those who want predictable, income-based costs

Private Health Insurance (PKV)

Private health insurance is available to freelancers who earn above a certain threshold (currently 69,300 EUR per year in 2025) or who were previously privately insured. Private insurance offers more flexibility and often better service, but at a different cost structure.

Advantages of Private Insurance:

Better service: Shorter waiting times, more choice of doctors, private hospital rooms
Age-based premiums: Premiums are based on your age when you join, not your current income
Potential savings: If you’re young and healthy, you may pay less than public insurance
More coverage options: You can customize your coverage to your needs
Tax benefits: Premiums are fully tax-deductible as business expenses

Disadvantages of Private Insurance:

Health checks required: You may be rejected or charged higher premiums for pre-existing conditions
Family members pay separately: Each family member needs their own policy
Rising premiums: Premiums increase with age and can become very expensive in retirement
Hard to switch back: Once you leave public insurance, it’s difficult to return
No income cap: Premiums don’t decrease if your income drops

Who Should Choose Private Insurance:

High-earning freelancers (above 69,300 EUR/year)
Young, healthy individuals without families
Those who value premium service and shorter waiting times
People who want to customize their coverage

Understanding Public Insurance Costs

If you choose public insurance, your monthly premium is calculated as a percentage of your income. The base rate is 14.6%, which is split between you and the insurance fund. Additionally, each Krankenkasse charges a “Zusatzbeitrag” (supplementary contribution), typically between 0.3% and 1.7% of your income.

How Premiums Are Calculated:

Base rate: 14.6% of your income
Supplementary contribution: 0.3-1.7% (varies by insurer)
Total: Approximately 15.9-16.3% of your income
Minimum contribution: Around 220-250 EUR/month (even if your income is lower)

Important: Your income for insurance purposes is your “Beitragsbemessungsgrenze” (contribution assessment ceiling). In 2025, this is capped at 69,300 EUR per year. Even if you earn more, you only pay premiums on the first 69,300 EUR.

Example Calculation:

Annual income: 50,000 EUR
Monthly income: 4,167 EUR
Premium rate: 15.9% (14.6% + 1.3% supplementary)
Monthly premium: 4,167 EUR × 15.9% = 662 EUR/month

Understanding Private Insurance Costs

Private insurance costs are more complex. Premiums are based on:

Your age when you join
Your health status
The level of coverage you choose
Your chosen deductible (Selbstbeteiligung)

Typical Costs:

Young, healthy freelancer (30 years old): 300-500 EUR/month
Middle-aged freelancer (45 years old): 500-800 EUR/month
Older freelancer (60 years old): 800-1,500 EUR/month

Important Considerations:

Premiums increase with age
You can choose a higher deductible to lower premiums
Family members need separate policies (often 200-400 EUR/month each)
Premiums are fixed when you join but increase over time

Making the Right Choice

The decision between public and private insurance depends on your individual situation. Here are some scenarios:

Choose Public Insurance If:

You have a family (spouse and/or children)
Your income is variable or below 69,300 EUR/year
You have pre-existing health conditions
You want predictable, income-based costs
You prefer the security of comprehensive coverage

Choose Private Insurance If:

You earn consistently above 69,300 EUR/year
You’re young and healthy
You don’t have a family
You value premium service and shorter waiting times
You’re comfortable with age-based premiums

Switching Between Insurers

If you choose public insurance, you can switch between different Krankenkassen once per year. The coverage is the same, but service quality, additional benefits, and supplementary contributions vary. Many freelancers switch to insurers with lower supplementary contributions to save money.

How to Switch:

Research different Krankenkassen and their supplementary contributions
Apply to your chosen insurer (usually online)
They’ll handle the switch automatically
The switch takes effect on January 1st of the following year

Popular Public Insurers for Freelancers:

Techniker Krankenkasse (TK): Known for good digital services, supplementary contribution around 1.2%
Barmer: Large insurer with good service, supplementary contribution around 1.5%
AOK: Regional insurers with local presence, supplementary contributions vary
hkk: Often has lower supplementary contributions (around 0.39%)

Special Considerations for Freelancers

As a freelancer, there are some special considerations when it comes to health insurance:

Income Declarations:

Public insurers require annual income declarations
You must estimate your income for the coming year
If your actual income differs significantly, your premiums will be adjusted

Low Income Periods:

If your income drops, public insurance premiums decrease automatically
Private insurance premiums remain the same regardless of income
This makes public insurance more flexible for variable income

Tax Deductions:

Health insurance premiums are tax-deductible
For public insurance, you can deduct the full premium
For private insurance, you can also deduct the full premium as a business expense

Transitioning from Employment:

If you were employed and had public insurance, you can continue with the same insurer
Your premiums will be recalculated based on your freelance income
You have 3 months after leaving employment to choose your insurance

Common Mistakes to Avoid

Many freelancers make costly mistakes with health insurance. Here are the most common:

Not Comparing Insurers:

Different public insurers charge different supplementary contributions
Switching can save you 50-100 EUR per month
Always compare before choosing

Underestimating Income:

If you underestimate your income for public insurance, you’ll owe back payments
It’s better to estimate slightly high and get a refund

Not Understanding Private Insurance:

Private insurance can become very expensive as you age
Make sure you understand the long-term costs before choosing

Ignoring Family Coverage:

If you have a family, public insurance is almost always cheaper
Private insurance requires separate policies for each family member

Planning for the Future

Health insurance is a long-term decision. Consider:

Retirement Planning:

Public insurance premiums decrease in retirement (based on pension income)
Private insurance premiums continue to increase with age
Plan for insurance costs in your retirement savings

Income Growth:

If you expect your income to grow significantly, public insurance may become expensive
Private insurance may be better for consistently high earners

Health Changes:

Public insurance covers you regardless of health changes
Private insurance premiums can increase if your health deteriorates

Getting Help

Choosing health insurance can be overwhelming. Here are resources to help:

Insurance Brokers:

Independent brokers can help you compare options
They’re paid by insurance companies, so their advice is free to you
Make sure to work with a reputable broker

Online Comparison Tools:

Websites like Check24 and Verivox allow you to compare insurers
They show costs and benefits side-by-side

Direct Contact:

Contact insurers directly to ask questions
Most have English-speaking staff
They can provide personalized quotes

Conclusion

Health insurance is one of the most important decisions you’ll make as a freelancer in Germany. The choice between public and private insurance will affect your monthly budget, your access to healthcare, and your financial security for years to come.

For most freelancers, especially those with families or variable income, public insurance is the better choice. It offers predictable costs, comprehensive coverage, and family inclusion at no extra cost. However, if you’re a high-earning, young, healthy freelancer without a family, private insurance may offer better value and service.

The most important thing is to make an informed decision based on your individual situation. Take the time to understand your options, compare costs, and consider your long-term needs. With the right choice, you’ll have peace of mind knowing you’re protected while keeping costs manageable.

Need Help?

If you have questions about health insurance or need help understanding your options, we’re here to help. Contact us by email at support@solobooks.de, chat with us in the app, or visit our Help Center for more guides.

Last updated: January 15, 2026