Contents (13 sections)
- Health insurance in Germany for freelancers: who may choose
- Can freelancers join public health insurance in Germany?
- Freelancers from outside the EU: why private is often the only option
- What public health insurance costs freelancers in 2026 and 2027
- What private health insurance costs freelancers
- Sick pay: the gap freelancers overlook
- Artists and publicists: the Künstlersozialkasse
- Self-employed with a trade business (Gewerbe): the same health insurance rules
- GmbH founders and managing directors: employee or self-employed?
- Freelance visa and health insurance: what the authorities decide
- Public or private as a freelancer: how to decide
- Five mistakes freelancers make with health insurance in Germany
- Next steps for freelancers
- Freelancers can take out private health insurance regardless of income; there is no income threshold for the self-employed.
- Public insurance is open to them only with prior insurance periods – 24 months in the last five years or 12 months immediately before (§ 9 (1) SGB V); public periods in the EU/EEA or Switzerland can count, periods in other countries don't.
- A freelancer arriving from outside the EU who was never publicly insured in Germany or the EU therefore usually has to take out private insurance (§ 193 (3) VVG) – the health insurance fund decides in each case.
- In public insurance a self-employed person pays at least €302.87 and at most €1,402.50 a month in 2027 (childless, with sick pay; scenario) – without any employer share.
- Self-employed artists and publicists are usually insured through the Künstlersozialkasse, which pays about half of the contribution (KSVG).
Freelancers in Germany may choose private health insurance whatever they earn, but public insurance is only open to them with prior insurance periods – 24 months in the last five years or 12 months immediately before (§ 9 (1) SGB V). Newcomers from outside the EU who were never publicly insured in Germany or the EU therefore usually have to go private. In public insurance a self-employed person pays up to €1,402.50 a month in 2027 (scenario, as of October 2026).
Health insurance in Germany for freelancers: who may choose
Health insurance is compulsory for everyone who lives in Germany (§ 193 (3) VVG). Employees are sorted into a system by their salary. Freelancers and the self-employed are not: there is no income threshold for them, and they are not compulsorily insured in public insurance because of their work (§ 5 (5) SGB V). That sounds like free choice. It isn't always.
The choice depends on your insurance history, not on your income:
| Your situation | Public insurance (voluntary) | Private insurance |
|---|---|---|
| Publicly insured employee in Germany, now starting as a freelancer | Continues automatically as a voluntary membership (§ 188 (4) SGB V) | Possible – exit within two weeks of the fund's notice |
| Arriving after public insurance in another EU/EEA country or Switzerland | Usually possible if the prior periods are met – foreign public periods count (proof: E 104 or S041) | Possible |
| Arriving from a non-EU country, never publicly insured in Germany or the EU | Usually not possible – no prior periods | Usually the only route |
| Self-employed artist or publicist | Usually compulsory through the Künstlersozialkasse | Only after an exemption |
If self-employment is your main occupation, a small side job does not make you compulsorily insured. If a job is your main occupation and you freelance on the side, the job usually decides. Where the line lies is for the fund to assess.
Can freelancers join public health insurance in Germany?
Public health insurance (gesetzliche Krankenversicherung, GKV) accepts self-employed people as voluntary members only if they bring prior insurance periods: at least 24 months in the five years before, or 12 months without a break immediately before (§ 9 (1) SGB V). The notification deadline is usually three months (§ 9 (2) SGB V).
- From employment in Germany: the easiest case. When your compulsory insurance as an employee ends, the fund continues it as a voluntary membership automatically – no application needed (§ 188 (4) SGB V). If you want to go private instead, you must declare your exit within two weeks of the fund's notice and prove your private cover.
- From another EU/EEA country or Switzerland: public insurance periods there count as if they were German (Art. 6 Regulation (EC) 883/2004). Ask your previous insurer for form E 104 or the electronic document S041 and contact a German fund early.
- From anywhere else: periods in countries such as the USA, India or Brazil are not counted. Private insurance abroad doesn't count either.
What about the fall-back public insurance?Germany has a fall-back public insurance for people without other cover (§ 5 (1) no. 13 SGB V). It doesn't help most new freelancers: it is meant for people last insured publicly, excludes the self-employed if they were never insured before, and covers non-EU nationals only with a settlement permit or a residence permit of more than twelve months that doesn't require proof of secured livelihood (§ 5 (11) SGB V).
Freelancers from outside the EU: why private is often the only option
Put the rules together and a common case appears. You move to Germany from a non-EU country to work as a freelance developer, designer or consultant. You were never publicly insured in Germany or the EU. Then you usually have neither the prior periods for voluntary public insurance nor access to the fall-back insurance – and you must take out a private policy that meets the legal minimum (§ 193 (3) VVG).
This is not a sales argument; it is a consequence of the law. The health insurance fund (Krankenkasse) decides in your individual case, so ask one in writing before you rule out public insurance. If you had public periods in another EU country, the door may still be open.
Mind the order: employment first can change everything.If you start in Germany with a job and become a freelancer later, your public membership simply continues. Freelancers who plan a mixed path should check this before they decide on their first insurance.
What public health insurance costs freelancers in 2026 and 2027
As a voluntary member you pay contributions on all your income up to the contribution ceiling (Beitragsbemessungsgrenze, BBG) – €6,375 a month in 2027 (draft). The minimum assessment is €1,318.33 a month in 2026 and €1,376.67 in 2027, even if you earn less (§ 240 (4) SGB V). Nobody pays half for you.
The rate is the general rate of 14.6% if you opt for sick pay with a declaration of choice, or the reduced rate of 14.0% without. On top come your fund's additional contribution (Zusatzbeitrag; 2.9% (assumption; official value due by 1 November 2026)) and long-term care insurance (Pflegeversicherung; 3.6%, childless people over 23 pay 4.2% in 2026 and 4.5% in 2027 under the draft care reform).
| Public contribution per month | 2026 | 2027 |
|---|---|---|
| Minimum (income up to the minimum assessment) | €286.08 | €302.87 |
| Profit of €70,000 a year (€5,833.33 a month) | – | €1,283.33 |
| Maximum (income at or above the ceiling) | €1,261.31 | €1,402.50 |
| Maximum with one child | – | €1,345.13 |
The upside: public contributions follow your income. In a weak year you pay less, and your spouse without income and your children are insured free of charge. Funds charge different additional contributions – in October 2026 between 2.18% to 4.39%.
What private health insurance costs freelancers
Private premiums don't depend on your income but on your entry age, tariff, deductible and health. Published anchors:
- Stiftung Warentest: full-cover tariffs for a 35-year-old self-employed person cost €649 to €1,137 a month; only 384 of 1,245 tariff combinations met the minimum standard (Finanztest 3/2025).
- Insurer's own example: ottonova states €701.42 a month for a self-employed person aged 35 in its “Business Class 100” tariff (Expat Guide, reviewed 15 June 2026).
Two points freelancers should price in. First, there is no employer contribution – you pay the full premium. Second, a deductible (Selbstbehalt) lowers the premium but is paid from your own pocket in every year with bills. For the self-employed, a higher deductible can still make sense; it should match your savings. More published examples in what private health insurance costs.
Sick pay: the gap freelancers overlook
As a freelancer nobody continues your pay when you are ill. Both systems can cover this – but only if you arrange it:
Public insurance
- Sick pay (Krankengeld) only with a declaration of choice – then the general rate of 14.6% applies
- Payments start from the seventh week of illness (§ 44 (2), § 46 SGB V)
- Without the declaration: reduced rate of 14.0%, no sick pay
Private insurance
- Sick pay insurance (Krankentagegeld) is a separate contract
- You choose the daily amount and the waiting days
- It costs extra – include it when you compare prices
A fair comparison sets a public contribution with sick pay against a private premium with sick pay. Otherwise the private offer looks cheaper than it is.
Artists and publicists: the Künstlersozialkasse
A special rule applies if you work as a self-employed artist or publicist – for example as a writer, journalist, illustrator, musician or designer in the creative sector. If you do this professionally and not just temporarily, you are usually insured in public health and long-term care insurance through the artists' social insurance fund (Künstlersozialkasse, KSK) (§ 1 KSVG). You pay about half of the contribution; the rest is covered through the KSK (§ 16 KSVG).
- Career starters can ask for an exemption within three months of the KSK's decision if they prove private health insurance; it lasts about three years (§ 6 KSVG).
- Higher earners whose income in three consecutive years exceeded the income thresholds of those years in total can apply for a permanent exemption by 31 March of the following year (§ 7 KSVG).
Whether your work counts as artistic or publicistic is decided by the KSK. For most creative freelancers the KSK route is financially attractive – check it before you sign a private contract.
Self-employed with a trade business (Gewerbe): the same health insurance rules
German tax law distinguishes liberal professions (freie Berufe, § 18 EStG) – such as many consultants, designers or developers – from trade businesses (Gewerbe), which have to be registered with the local trade office. For health insurance this difference usually doesn't matter. What counts is whether self-employment is your main occupation (hauptberuflich selbstständig, § 5 (5) SGB V). If it is, you are not compulsorily insured as an employee, and the access rules above apply in the same way – including the prior insurance periods for public insurance.
- Main occupation: according to the guidelines of the public funds' umbrella association, self-employment is your main occupation if it clearly exceeds your other work in economic importance and time. If you regularly employ at least one person more than marginally, the law presumes it (§ 5 (5) SGB V).
- Trade business next to a job: if you work as an employee for more than 20 hours a week and earn more than half of the reference value – €1,977.50 a month in 2026 – the job usually decides, and you stay insured through it.
- Registration is not insurance: registering a trade does not on its own change your health insurance. Tell your fund or insurer when you start; the fund assesses your status.
The costs are the same as for freelancers: in public insurance a contribution on all your income with the minimum assessment, in private insurance a premium independent of income – both without an employer share.
GmbH founders and managing directors: employee or self-employed?
If you found a limited company (GmbH, or its smaller form UG (haftungsbeschränkt)) and become its managing director (Geschäftsführer), your health insurance depends on whether you count as an employee of your own company. The deciding factor is usually your share of the company and your voting power under the articles of association:
| Your position | Usually treated as | Health insurance (information) |
|---|---|---|
| Managing director without shares | Employee | Compulsorily insured below the income threshold; above it, private is possible with the employer contribution |
| Shareholder below 50% without a blocking minority in the articles | Employee | As above |
| Shareholder with 50% or more, or with a comprehensive blocking minority in the articles | Self-employed | Free choice: voluntary public insurance (with prior insurance periods) or private; no statutory employer contribution |
Side agreements outside the articles, such as voting agreements, usually don't change the status. The binding decision comes from the status determination procedure of the German Pension Insurance (§ 7a SGB IV); when an employer registers a managing shareholder of a GmbH, the health insurance fund must request it. The procedure can also be started before you take up the position.
For managing directors who count as employees, the rules for private health insurance for employees apply, including the income threshold of €77,400 in 2026 and €84,150 in 2027 (draft). For self-employed managing shareholders there is no statutory employer contribution; how payments from the company are treated for tax purposes is a question for your tax adviser. In-depth information in German: health insurance for GmbH managing directors (in German).
Freelance visa and health insurance: what the authorities decide
For a residence permit as a freelancer or self-employed person, your livelihood – including adequate health insurance – must be secured without public funds (§ 2 (3) AufenthG). What counts as adequate is decided by the authorities, not by an insurer or a broker.
This is not immigration or legal advice.Whether your health insurance is sufficient for a visa or residence permit is decided by the German mission abroad or your local immigration office (Ausländerbehörde). Official information: Federal Foreign Office, BAMF and Make it in Germany.
Practical point: travel or incoming policies are often only accepted for a short time, and German missions point out that some exclude long stays. Once you live and work in Germany, you need a German health insurance – public or a full private policy.
Public or private as a freelancer: how to decide
If you actually have the choice, these questions usually decide:
- How stable is your income? Public contributions follow it; private premiums don't.
- Who else needs cover? A spouse without income and children are free in public insurance and pay in private.
- How old are you? The later you enter private insurance, the higher the premium – and from 55 the way back is usually closed (§ 6 (3a) SGB V).
- How long will you stay? A German private policy continues in the EU/EEA but usually ends if you move elsewhere; your ageing reserves stay behind. Read leaving Germany with private health insurance.
- What if you take a job later? An employee job below the threshold brings you back into public insurance – under 55.
The public vs private cost calculator compares both systems for the self-employed, including family members and ten years of increases. For an honest overall answer that includes your planned stay, use the 60-second decider – no health questions. In German, the same topic for founders and freelancers: Krankenversicherung für Freelancer (in German).
Five mistakes freelancers make with health insurance in Germany
- Relying on a travel policy for too long. Incoming and travel policies are a bridge, not German health insurance. Once you live here, you need public cover or a full private policy.
- Cancelling public cover before private acceptance. If the insurer then adds a surcharge or declines, you may be left without a good option. Get the written acceptance first.
- Comparing without sick pay. A private premium without sick pay looks cheaper than a public contribution with it. Compare the same protection.
- Forgetting the family. A partner without income and children are free in public insurance and each pay a premium in private. See private health insurance with a family.
- Assuming you can always go back. Under 55 the way back to public insurance usually needs a job below the threshold – see switching back to public health insurance. If you plan to take a salaried job soon, read private health insurance for employees first.
If you have health issues, don't send a formal application on a guess. How underwriting and an anonymous pre-check work is explained in private health insurance with pre-existing conditions.
Next steps for freelancers
1. Clarify your access to public insurance
Collect proof of prior public insurance (E 104 or S041 for EU periods) and ask a fund in writing whether you can join.
2. Compare like with like
Public with sick pay against private with sick pay and long-term care – not entry prices.
3. Get private acceptance before you leave public cover
Never cancel a public membership before the private insurer has accepted you in writing.
4. Plan your exit
Ask what happens to a private policy if you leave Germany – before you sign. All arguments: public vs private health insurance.
Frequently asked questions
Do freelancers need health insurance in Germany?
Yes. Everyone living in Germany must have health insurance – either public or a private policy that meets the legal minimum (§ 193 (3) VVG). Freelancers are not compulsorily insured in public insurance (unless they are artists or publicists), so they must arrange cover themselves.
Can freelancers get public health insurance in Germany?
Often, but not always. You need prior insurance periods: at least 24 months in the last five years or 12 months immediately before (§ 9 (1) SGB V). Public periods in the EU/EEA or Switzerland can count. If you were publicly insured as an employee in Germany, your membership usually continues automatically when you start freelancing.
Why do some freelancers in Germany have to take private health insurance?
Because they lack the prior insurance periods for public insurance. Newcomers from outside the EU who were never publicly insured in Germany or the EU are usually not covered by the fall-back public insurance either. They must take out private insurance – the health insurance fund (Krankenkasse) decides each case.
How much is public health insurance for the self-employed in Germany?
In 2027 between €302.87 and €1,402.50 a month for a childless person with sick pay (scenario with a 2.9% average additional contribution and the draft care reform). The contribution is based on all your income up to the ceiling, but at least on €1,376.67 a month.
Is private health insurance cheaper for freelancers?
Often at first, especially for young freelancers with a good income: full-cover tariffs cost €649 to €1,137 a month at age 35 (Finanztest 3/2025), against up to €1,402.50 in public insurance. But private premiums don't fall when your income does, every family member pays, and sick pay costs extra.
Is health insurance different for a trade business (Gewerbe) or a GmbH managing director?
For a trade business, usually not: what counts is whether self-employment is your main occupation, not whether you are a liberal professional or registered a trade (§ 5 (5) SGB V). GmbH managing directors are different: depending on their shares and voting rights they count as employees or as self-employed. The German Pension Insurance decides this in a status determination procedure (§ 7a SGB IV).
Is health insurance for a freelance visa decided by the insurer?
No. Whether your health insurance is sufficient for a residence permit is decided by the German mission abroad or your immigration office (Ausländerbehörde), not by an insurer or broker. This page is not immigration or legal advice.
Sources
- § 9 SGB V – voluntary insurance (prior insurance periods, deadlines)
- § 5 SGB V – compulsory insurance incl. fall-back insurance (no. 13), self-employed (para. 5) and foreigners (para. 11)
- § 193 VVG – obligation to have health insurance
- § 240 SGB V – contributions of voluntary members, minimum assessment
- § 188 SGB V – automatic continuation as voluntary member, two-week exit
- DVKA: frequently asked questions (insurance periods abroad, E 104 / S041) – as of 26 May 2026
- Künstlersozialversicherungsgesetz (KSVG) §§ 1, 6, 7, 16
- Stiftung Warentest: private health insurance compared (Finanztest 3/2025) – 19 February 2025
- ottonova Expat Guide: costs of private health insurance – insurer's own example, reviewed 15 June 2026
- § 2 AufenthG – secured livelihood including health insurance
- § 7a SGB IV – status determination procedure
- German Pension Insurance: status determination (clearing office) – retrieved 10 October 2026
- Federal Social Court, judgments of 14 March 2018 – B 12 KR 13/17 R and B 12 R 5/16 R (managing shareholders) – secondary reproduction
- Niederrheinische IHK: social insurance of GmbH managing directors (leaflet) – June 2025
- GKV-Spitzenverband: guidelines on the term “main-occupation self-employment” (Grundsätzliche Hinweise, via VIACTIV) – 20 March 2019
This article provides general information on health insurance in Germany (as of 12 October 2026). It does not replace individual advice. Which solution suits you depends on your personal situation, e.g. age, health, income, family and length of stay. Despite careful review we cannot guarantee completeness and accuracy; laws and tariffs change. It is not immigration advice: whether your insurance is sufficient for a visa or residence permit is decided by the German mission abroad or your immigration office. Publisher: German-PKV.de. German-PKV.de is not an insurance broker and does not provide insurance, legal or tax advice; individual advice is provided exclusively by specialised cooperation partners licensed under § 34d GewO.