Selbstständige & Freiberufler

Who counts as self-employed for health insurance

The Selbstständige & Freiberufler category covers anyone whose main income comes from independent work, freelancers, consultants, creatives, tradespeople, professional self-employed (doctors, lawyers, architects), and business owners. For health insurance purposes, the key distinction is that you are not an employee: there is no employer contribution, no automatic GKV membership, no Arbeitgeberzuschuss.

German law treats self-employment as a default reason to be outside the compulsory GKV (§ 5 SGB V reverse side). You choose: GKV voluntarily, PKV, or in rare cases you remain within statutory cover through a special arrangement (artist's social insurance, certain freelance categories).

The three differences vs. employees

Three things change when you compare a self-employed person to a comparable employee:

1. No Arbeitgeberzuschuss

An employee at €70,000 gross with a €520 PKV premium pays roughly €260/month net after the employer share. A self-employed person earning the same and holding the same premium pays the full €520/month themselves. On a lifetime view, the missing employer share represents close to €100,000 in cost over 30 years (€260/month × 12 × 30 = €93,600 at this premium level, more if the gap widens with age).

2. PKV access without a threshold

Employees need to exceed the JAEG for a full calendar year before they can switch to PKV. Self-employed people face no such hurdle, you can join PKV at any income from day one of self-employment, provided you meet the insurer's underwriting.

This is both a privilege and a trap. The same flexibility that makes PKV accessible also means you can sign up at a young age on a promising income trajectory and lock in a favourable entry age. But if your income drops in bad years, the full premium still applies and no statutory substitute kicks in automatically.

3. The GKV minimum contribution

The GKV treats self-employed members differently. Instead of calculating contributions on actual earnings, it applies a minimum assessment base:

• 2026 minimum assessment base: €1,318.33/month (§ 240 SGB V, Bezugsgröße (social-insurance reference value) ÷ 90 × 30 Kalendertage)

• Resulting minimum contribution including Pflegeversicherung (long-term-care insurance): ca. €281-320 per month (variable with the individual fund's Zusatzbeitrag (fund-specific supplementary contribution))

At higher earnings the GKV contribution rises as a percentage of income, capped at the BBG max. At lower earnings you still pay the minimum, meaning the GKV does not drop to €100/month for a freelancer in a bad year. This is often the point that tips the decision toward PKV.

Krankentagegeld is essential

Self-employed people have no statutory sick pay entitlement unless they specifically sign up for a GKV Wahltarif (optional sick-pay tariff) Krankengeld. Without that, a week of illness is a week of lost income. A private Krankentagegeld (daily sickness allowance) is the standard answer:

• Typical market: day-15 or day-22 waiting period, daily rate €100-200

• Premium depends on the chosen rate and waiting period

• See the Krankentagegeld entry for the full mechanics

Without a KT policy, long-term illness is the single biggest financial risk for an independent earner in Germany.

The tax deduction advantage

Self-employed PKV members can deduct the Basisabsicherung portion of their premium (typically 80-90 % of the total) as an unlimited special expense under § 10 Abs. 1 Nr. 3 EStG. For a freelancer paying €7,500/year in PKV premiums, the typical deduction is around €6,375, worth roughly €2,678 in tax savings at a 42 % marginal rate.

This deduction partly offsets the missing Arbeitgeberzuschuss. It is also the main reason PKV is often more economically attractive for self-employed members than for employees of similar age and income.

See the Steuerliche Absetzbarkeit entry for the full deduction mechanics.

The decision framework

A practical comparison for a 32-year-old freelancer in good health at €60,000/year:

• GKV (voluntary): roughly 17.5 % on the full €60,000 = ca. €875/month, no deduction advantage, free Familienversicherung for a future family

• PKV: ca. €350-450/month for a standard tariff, tax deduction ~€2,500/year, no free family cover

At this profile, PKV wins on both monthly cost and tax. As the person ages, as they take on family, and as health changes, the math shifts. A single snapshot decision misses the trajectory, which is why the PKV-vs-GKV question for the self-employed deserves a proper projection, not a current-year calculator.