Selbstständige & Freiberufler: self-employed & freelancers

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 earning €90,000 with a €600 PKV premium pays €300 a month after the employer’s half. A self-employed person with the same premium pays the full €600 themselves. Over 30 years, the missing employer share adds up to €108,000 at this premium level (€300 × 12 × 30), more as premiums rise with age.

2. PKV access without a threshold

Employees can only choose PKV with a salary above the JAEG (€77,400 in 2026); after a pay rise, the switch takes effect on the following 1 January, and only if the salary also exceeds the next year’s limit. Self-employed people face no such hurdle: you can join PKV at any income from the first day of self-employment, provided an insurer accepts you after asking about your health.

The same flexibility that makes PKV accessible lets you 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:

• Benefit starts no earlier than day 8; common starts are day 8, 15, 22 or 43, at a daily rate of €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.

How are contributions deducted from tax?

Contributions for basic cover are deductible as a special expense without a cap under § 10 Abs. 4 Satz 4 EStG, in both systems. In the PKV, the share for extras beyond basic cover, such as a single room, is left out; your insurer works out the deductible share by a fixed statutory method and reports it each year. In the GKV, the contribution counts in full, reduced by 4% if it includes sick pay.

So the deduction does not tip the comparison: a self-employed person saves tax on either contribution, and what decides is the contribution itself.

See the Steuerliche Absetzbarkeit entry for the full deduction mechanics.

The decision framework

A practical comparison for a childless 35-year-old freelancer in good health earning €60,000 a year (€5,000 a month):

• GKV (voluntary): 17.5% health insurance plus 4.2% long-term care on €5,000 = ca. €1,085/month, with free Familienversicherung for a future family

• PKV: around €400–550/month including long-term care, with a deductible of €600–1,200 a year; Krankentagegeld on top, no free family cover

At this profile, the PKV costs about half as much each month, or less. 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.