Health insurance for the self-employed in Germany: contributions, public or private, and sickness benefit 2026

Do I have to take out health insurance as a self-employed person?

Yes. Health insurance is compulsory for everyone in Germany. As an employee you are usually automatically insured in the statutory system; when you become self-employed, this compulsory insurance ends. You then have the choice: you stay in the statutory health insurance fund (Krankenkasse) as a voluntary member or switch to private health insurance. There is no income threshold for the self-employed as there is for employees.

If you come from compulsory insurance, you do not have to actively declare that you are leaving: after your employment ends, the fund automatically continues your membership as a voluntary member (obligatorische Anschlussversicherung), unless you declare your withdrawal within two weeks of the fund’s notice, with proof of other cover. Still, report the start of your self-employment to your fund immediately – it will send you an income questionnaire.

If you move to Germany from abroad, as a self-employed person you can only join the GKV under certain conditions, such as sufficient previous insurance periods; periods in a statutory scheme of another EU country can be counted. Otherwise private insurance remains. More on the first steps in the guide self-employed in Germany as a foreigner.

What does statutory health insurance cost for the self-employed in 2026?

Voluntary members pay the full contribution themselves – there is no employer share. The contribution is based on all income used for living: above all the profit from self-employment, but also rental income, capital income or a pension. There is a lower limit (minimum assessment basis, Mindestbemessungsgrundlage) and an upper limit (contribution assessment ceiling, Beitragsbemessungsgrenze).

You pay the general contribution rate of 14.6 % if you want sickness benefit (Krankengeld) from the seventh week of incapacity for work (an election you declare to the fund). Without sickness benefit the reduced rate of 14.0 % applies. On top comes your fund’s additional contribution (Zusatzbeitrag) – 2.9 % on average in 2026, well below or above depending on the fund – and long-term care insurance (Pflegeversicherung).

How does the health insurance fund calculate my income? The tax assessment

The fund first sets your contribution provisionally – based on the latest available income tax assessment (Steuerbescheid). Once the assessment for the year in question is available, it settles finally: if you earned more, you pay extra; if you earned less, you get money back. If you do not submit the assessment within three years after the end of the year, the fund finally sets the maximum contribution for that year.

Founders do not have an assessment yet. You then estimate your income in the fund’s questionnaire; the later settlement follows as above. So plan reserves for additional payments – especially if your business is going well. How much you should set aside is shown in the guide reserves for taxes and social insurance.

What counts is the taxable profit from your cash-basis profit statement (EÜR), not revenue. So business expenses also lower your health insurance contribution. If your income drops significantly during the year, you can apply to the fund for a reduction with a current profit estimate or documents.

• Fill in the fund’s income questionnaire after starting up and whenever things change.
• Send every new tax assessment to the fund without being asked.
• Plan for additional payments from the final settlement in your reserves.
• Keep contribution notices – you also need them for your tax return.

Sickness benefit: what the self-employed need to know

As a self-employed person you do not continue to receive a salary when you are ill. With the general contribution rate (election), the statutory fund pays sickness benefit (Krankengeld) from the 43rd day of incapacity for work, amounting to 70 % of the income on which your contribution is based. The election binds you for three years.

If you need money earlier, many funds offer an optional sickness benefit tariff (Wahltarif Krankengeld) that pays, for example, from the 15th or 22nd day. It costs an additional contribution and also binds you for three years. An alternative is private daily sickness allowance insurance (Krankentagegeldversicherung), also alongside the GKV. Compare: if you can bridge six weeks without income, statutory sickness benefit from day 43 is often enough.

Public or private: the comparison for the self-employed

In the PKV the contribution does not depend on income but on age at entry, state of health and the scope of benefits chosen. Young, healthy self-employed people with high incomes often pay less there at first. But experience shows that contributions rise with age, and every family member needs their own contract.

The decision is long-term because the way back is difficult (see next section). So do not just look at today’s contribution, but also at what happens in phases with little income, with children or in old age.

Back to statutory health insurance: is that possible?

As a self-employed person you cannot simply switch back to the GKV. A return is only possible if you become compulsorily insured again – for example through employment with a salary below the compulsory insurance threshold (Versicherungspflichtgrenze, 2026: €77,400 a year), through receiving unemployment benefit or through admission to the Künstlersozialkasse.

From your 55th birthday even that is usually ruled out: anyone who has not been in statutory insurance in the last five years and was exempt from insurance or self-employed as their main occupation for at least half of that time remains privately insured (§ 6 Abs. 3a SGB V). So make the decision for the PKV deliberately and not just because of a low starting contribution.

Self-employed on the side: do I pay twice?

If you are employed and compulsorily insured and run your self-employment only on the side, you do not pay any additional health insurance contributions on the profit from the side activity. What matters is that the self-employment is not your main occupation. Funds usually assume this if you work more than 20 hours a week as an employee and your salary is more than half of the monthly reference value (Bezugsgröße, 2026: €1,977.50). Still, report the side activity to your fund.

If you are covered by family insurance, for example through your spouse, your total income in 2026 may be at most €565 a month; this includes the profit from self-employment. If you exceed it, family insurance ends and you have to insure yourself. More in the guide self-employment on the side.

Health insurance and taxes

Contributions to basic health and long-term care insurance are not business expenses but special expenses (Sonderausgaben) in your income tax return (Anlage Vorsorgeaufwand) – in full. With the general contribution rate, the share for sickness benefit is reduced by a flat 4 %; additional PKV benefits such as a single room or senior consultant treatment are only deductible to a limited extent.

If you pay the contributions from the business account, book them as a private withdrawal. They do not reduce your profit in the EÜR – otherwise profit would be shown too low and the fund would correct it later. Artists and writers can be insured through the artists’ social insurance fund (Künstlersozialkasse) and then pay only about half of the contributions.

Health insurance and Kontelio

Kontelio is not an insurer and does not compare tariffs. But it helps you with the figures the fund needs: if you pay health or long-term care insurance from the business account, choose the category “Private insurance” – Kontelio books a private withdrawal and your profit stays correct. From your income and expenses Kontelio creates the EÜR, which you send directly to ELSTER; the fund settles on the basis of the resulting tax assessment. More at Kontelio for freelancers and the self-employed.

Frequently asked questions