In Germany, every person must have health insurance.

As a self-employed person, you pay the contribution in full yourself. Without an employer, there is no employer contribution.

This applies to:

• Founders
• Freelancers (liberal professions)
• Business owners
• Solo self-employed
• Part-time self-employed

Health insurance is therefore not a side issue: it is part of your entrepreneurial responsibility.

Special case Artists' Social Insurance Fund (Künstlersozialkasse / KSK)

If you are self-employed in artistic or journalistic work, you are most likely compulsorily insured through the Artists' Social Insurance Fund (Künstlersozialkasse / KSK) and thus save part of your contributions. → More on this in the guide Die Künstlersozialkasse (KSK).

In Germany, there is statutory and private health insurance. Unlike employees, self-employed people can freely decide which insurance they want to join.

Statutory health insurance (GKV)

Most self-employed people can voluntarily join statutory insurance if they were previously statutorily insured.

• The contribution is based on your income
• The GKV is a solidarity-based system with legally regulated benefits
• Family insurance is possible (for partners and children without their own income)
• Your contributions increase with higher profit

Suitable for many self-employed people, especially with:

• fluctuating income
• family planning
• desire for predictable social security

Private health insurance (PKV)

Self-employed people can alternatively also take out private insurance.

The differences to GKV:

• The contribution is based on age, health status, and the desired benefits
• Benefits are individually agreed by contract
• There is no free family insurance
• Returning to GKV later is often only possible under restricted conditions

PKV can make sense with:

• permanently high income
• very good health

The decision between statutory and private health insurance has long-term effects and is sometimes very difficult to change retrospectively. Take your time with this!

1. Select a health insurance fund — You can choose freely between most of the nearly 100 statutory funds.
2. Apply for voluntary membership — Fill out the form, state your activity.
3. Estimate and state your income — The basis for contributions is your expected profit.
4. Submit your tax assessment later — Your contributions will be adjusted later when your income is confirmed.
5. Integrate the contribution into your financial planning — Health insurance is a fixed component of your monthly costs and must be planned for.

The contribution to GKV is 14% of your employment income. The calculation basis is your income, usually found in your last tax assessment. In addition, each health insurance fund charges an individual additional amount (between 2.18% and 4.38%) – here you can save monthly if in doubt.

Important information:

• Minimum assessment basis: Even with low income under €1,316.67, you pay a minimum contribution of usually approx. €220–250.
• Contribution assessment ceiling: With an income over €5,812.50, your contribution does not increase further.
• Long-term care insurance: Additionally, you pay 3.6% long-term care insurance (or 4.2% if you are 23+ years old and childless). This is also mandatory in Germany.
• Sickness benefit tariff: For a contribution of 14.6% instead of 14%, you receive entitlement to sickness benefit if you are unable to work for longer than six weeks.

Your contribution is initially calculated provisionally and adjusted after the tax assessment is issued. So plan reserves for possible back payments.

→ Use this contribution calculator ^[2] to calculate your expected contribution.

The benefits of statutory health insurance are legally regulated and apply to all insured persons:

• Medical treatments
• Hospital stays
• Medication
• Preventive examinations
• Pregnancy and maternity protection
• Rehabilitation measures
• With sickness benefit tariff: financial security in case of inability to work > six weeks

Start-up phase

• Register with the health insurance fund immediately!
• Calculate contribution realistically
• Secure liquidity

Fluctuating income

• Your contribution can be adjusted
• Build reserves!
• Keep an eye on your income-surplus statement (Einnahmen-Überschuss-Rechnung / EÜR) and tax assessment

→ Also see the guide Vorauszahlungen anpassen

Starting a family

• Family insurance with GKV can bring financial advantages
• PKV means separate contributions for each family member

Sharply rising profit

• Check whether your current solution still fits your situation
• Bear in mind that your profit can also fall again
• Review decision regularly

Do I have to be insured as a self-employed person?

→ Yes. In Germany, health insurance and long-term care insurance are mandatory.

What happens with very low income?

→ The minimum contribution remains.

Can I switch back from PKV to GKV later?

→ For self-employed people, this is often difficult and subject to conditions.

This checklist helps you approach health insurance in a structured way — so you don't miss anything important and pay the right rate from the start.

• Review system: GKV or PKV
• Compare health insurance funds
• Apply for membership
• State income correctly
• Integrate contributions into your financial planning
• Review situation annually