Health Insurance for Freelancers in Germany (2026)

As a freelancer you pay your whole health insurance bill yourself, and you also lose employer sick pay. The right route depends on your income, your age, your family and how long you plan to stay self-employed. This guide compares the three routes with 2026 numbers.

Do freelancers need health insurance in Germany?

Yes. Health insurance is compulsory for everyone resident in Germany. Your residence permit depends on it: § 2 Abs. 3 AufenthG requires sufficient health insurance, and the immigration office decides whether a private policy meets it. Freelancers can choose public (voluntary), private or KSK cover. See also the start-a-business guide.

When your employment ends or your business starts, contact your last health insurer straight away and ask which cover applies to you. Do not wait and do not let cover lapse. If you are unsure which situation you are in, ask before you stop working.

What health insurance options do freelancers have?

Freelancers can choose voluntary public insurance, private insurance or, for artists and journalists, KSK membership. Public contributions follow your profit between a floor and a ceiling, private premiums follow age and health, and KSK members pay roughly half, as an employee would. Only public and KSK include free family cover.

How much does public health insurance cost for freelancers?

In 2026 voluntary public insurance costs freelancers roughly €270 to €1,260 a month. The minimum applies at the assessed income floor of €1,318.33 per month, the maximum at the €5,812.50 ceiling with Krankengeld and no children. Freelancers pay both the employee and employer share, based on profit after business expenses. The 2026 rates are:

• Health insurance: 14.0% reduced rate (§243 SGB V, no Krankengeld) plus the Zusatzbeitrag. The government's average Zusatzbeitrag for 2026 is 2.9%, so we use 16.9% below. With Krankengeld the rate is 14.6% plus Zusatzbeitrag, 17.5% at the average.
• Long-term care: 3.6%, or 4.2% if you are childless and 23 or older.
• Contribution ceiling: €5,812.50 per month of profit (€69,750 per year, Deutsche Rentenversicherung).
• Minimum assessed income: €1,318.33 per month, even if you earn less.

Floor and ceiling in euros

With a child the long-term care rate is 3.6%, which lowers the floor to about €270.26 and the ceiling to €1,191.56. With the Krankengeld rate of 17.5% the ceiling total is €1,261.31 childless. Your fund's own Zusatzbeitrag moves every figure up or down.

How public insurance assesses freelance income

The fund does not wait for your annual accounts. It sets a provisional contribution from the income you declare, and later corrects it against your tax assessment. Expect a back-payment if you earned more than declared, or a refund if you earned less. You can ask for a recalculation during the year if your profit changes a lot. Contributions are based on profit after business expenses, not revenue.

Check your fund's Zusatzbeitrag before you join. You can change funds after a 12-month commitment with 2 months' notice. If your fund raises its Zusatzbeitrag, you can leave earlier. The 2027 average Zusatzbeitrag has not been set yet.

The rates shift every year. See public health insurance in Germany (GKV) for the full rules and compare it in public vs private health insurance.

Can freelancers get private health insurance?

Yes. Self-employed people can join private health insurance whatever their income, because the income threshold of €84,150 per year from 2027 (€77,400 in 2026) applies to employees only. The 2027 figure still needs Bundesrat approval. In practice insurers look at your health and your application.

What decides your premium:

• Your age at entry. Younger entry means a lower starting premium, and the insurer builds ageing reserves from it.
• Your health. You answer health questions honestly (§19 VVG). Insurers can add a surcharge, exclude a condition or decline.
• Your plan. Coverage level, Krankentagegeld and the deductible (Selbstbehalt) all change the price.
• A statutory 10% surcharge on full plans from the calendar year after you turn 21 until the year you turn 60. It funds premium relief in old age.

Private premiums do not include a free family component. A non-working spouse and each child need their own policy. We do not print a premium table here, because a number without your age, health and deductible would mislead you. Ask for a written comparison from private health insurance cost or from an independent consultant. See also who qualifies for private health insurance and the best private health insurance in Germany.

Do freelancers get sick pay?

No. Freelancers have no employer sick pay, so income stops from day one unless you insured it. In private insurance you add Krankentagegeld. In public insurance you get Krankengeld only if you opt in: either by declaring that your membership should include it, which moves you from the 14.0% reduced rate to the 14.6% general rate, or through a Krankengeld option tariff from your fund (§44 SGB V, §53 SGB V). Employees differ: see how Lohnfortzahlung and Krankengeld work, or try the net salary calculator.

• Private: add Krankentagegeld, a daily amount paid while you are unable to work. You choose the waiting period, for example from day 1, 15, 30 or 43. A longer waiting period lowers the price.
• Public: the reduced 14.0% rate has no Krankengeld. Choose the 14.6% rate, or a Krankengeld Wahltarif, if you want it. Krankengeld normally starts from day 43 unless you choose an earlier start.

What is the KSK and who can use it?

The Künstlersozialkasse (KSK) is Germany's social insurance fund for self-employed creatives such as writers, journalists, musicians, designers and artists. If the KSK accepts you (§1 KSVG), it pays the employer share of your public health and long-term care contributions, and you pay roughly half, as an employee would. The start-a-business guide covers registration.

Check these before you apply:

• Your work is artistic or publishing in nature, and you work mainly on your own account.
• Your income is regular enough to estimate; the KSK asks for an annual income estimate.

Worked example with a €3,000 monthly income, childless, a fund charging the 2.9% average Zusatzbeitrag:

Simplified: the KSK assesses your declared income, and your fund's own Zusatzbeitrag changes the result. The saving here is €298.50 per month.

Can freelancers return to public insurance after going private?

Going private is easy when you are self-employed. Coming back is not. Under 55 you can return when you become compulsorily insured, for example as an employee earning below the threshold or on unemployment benefit (ALG I). From 55 a return is largely blocked.

• Under 55: you can return to public insurance when you become compulsorily insured, for example as an employee earning below €77,400 per year (planned €84,150 from 2027), or when you receive unemployment benefit (ALG I).
• From 55: under §6(3a) SGB V you stay exempt if you had no public cover in the preceding 5 years and were exempt, not insured or self-employed for at least half of that time. In practice, a return is largely blocked.
• If you take a well-paid job: above the threshold you can stay private, and your employer pays a subsidy of up to half the premium, to a maximum of €508.59 for health insurance and €104.63 for long-term care in 2026, €613.22 combined.

The government's draft for 2027 raises the employee threshold to €84,150 per year and the ceiling to €6,375 per month, but this is not yet final. Do not plan around it. For the full process see switching to private health insurance.

If you plan to return to employment, an Anwartschaft (a reduced waiting policy) can preserve your entry age and health status while you are insured elsewhere.

Should a freelancer choose public or private insurance?

Choose public if you have a non-working spouse or children, low or uncertain income, or KSK eligibility. Consider private if you are single or a couple who both earn, young and healthy, plan to stay self-employed and can carry premiums during income gaps. A middle path exists for some couples, so ask a consultant before you decide.

A middle path exists for some couples: you privately insured, a spouse in their own public membership with the children in free family cover. This only works if the spouse has their own public membership, and under §10(3) SGB V the children are excluded from family cover if you are not publicly insured and your regular monthly income is above one twelfth of the income threshold (€7,012.50 in 2027) and higher than your spouse's. Ask a consultant before you assume it.

Can freelancers deduct health insurance premiums?

Yes. Health and long-term care premiums count as Sonderausgaben. For private cover, the part that matches basic public-level cover is fully deductible (§10(1) Nr. 3 EStG). Optional extras, such as single room or dental top-ups, are only partly deductible within set caps.

The Selbstbehalt (deductible) itself is not a Sonderausgabe, though it can count as an extraordinary burden. Your actual tax saving depends on your income and your tax bracket. Ask a Steuerberater to work out the figure.

Income gaps and low income

Public contributions fall when income falls, down to the minimum. Private premiums do not. If your income drops to zero you still pay the full private premium.

• Very low income: public cover at the floor costs about €278 per month childless in 2026, and is often the safer choice.
• Anwartschaft: a reduced waiting policy that keeps your entry terms while you are away from private cover.
• Basistarif: every private insurer must accept eligible applicants with no risk surcharge. The premium is capped at the public maximum, €1,017.19 per month in 2026, and halves to about €508.59 if you need social assistance.
• Bürgergeld: if you receive it, the benefit rules decide who pays your contribution.
• Premium arrears: unpaid premiums can put you in the Notlagentarif, which covers only acute and pain treatment.

Is home-country, EHIC or travel insurance enough?

Usually not. Many new arrivals ask whether their existing cover is enough, but for long-term life and work in Germany it rarely is. The EHIC is built for temporary stays. Travel insurance is accepted for short stays or before a job starts, and authorities decide case by case whether a home-country policy is equivalent to public insurance.

• EHIC: built for temporary stays, not for living and working in Germany.
• Travel or incoming insurance: accepted for short stays, such as Schengen visas with at least €30,000 of cover, or the period before a job starts. It is generally not enough for a long-term residence permit.
• Home-country policies: authorities decide case by case whether cover is equivalent to public insurance. Confirm with your Ausländerbehörde first.

How to sign up

Common questions

Sources

Primary sources checked on 19 October 2026. Figures are the official 2026 values; 2027 values are a Bundesrat draft until approved.

• Deutsche Rentenversicherung: Sozialversicherungs-Rechengrößen 2026 (contribution ceiling €69,750, 2026 income threshold)
• §240 SGB V: contributions of voluntary members, minimum income
• §241 SGB V and §243 SGB V: general and reduced contribution rates
• Federal Ministry of Health: Beiträge der gesetzlichen Krankenversicherung: average additional contribution 2026 (2.9%)
• §6 SGB V: exemption, 55+ rule (§6(3a))
• §1 KSVG and §16 KSVG: who the KSK insures and the insured's contribution share
• §19 VVG: disclosure duty
• §10 EStG: tax deduction of health and care premiums
• §2 AufenthG: health insurance and residence permits