🏥 Health insurance for self-employed people
In brief
As a self-employed person in Germany you are not automatically subject to compulsory insurance in statutory health insurance (gesetzliche Krankenversicherung, GKV) – but only if your self-employment is carried out “as a main occupation”. People who are self-employed as their main occupation must insure themselves privately or voluntarily under the statutory scheme and bear the contribution entirely alone. People who are self-employed on the side, whose main activity is an employment relationship subject to social insurance, remain compulsorily insured as normal and may pay additional contributions on the side income.
Step by step
- Check whether it is a main occupationYour self-employment is a main occupation if, in economic importance and time spent, it exceeds every other activity and forms the centre of your working life.
- Choose between GKV and PKVIf you are self-employed as your main occupation, you can choose between voluntary statutory insurance (§ 9 SGB V) and private health insurance.
- Notify joining on timeNotify your health insurance fund of joining voluntary insurance within three months of leaving compulsory insurance (§ 9 para. 2 SGB V) to secure prior insurance periods.
- Prove your incomeSubmit your tax assessment notice or a provisional estimate to the health insurance fund – the basis for assessing contributions under § 240 SGB V.
- For PKV: choose a tariffIf you have pre-existing conditions, consider the basic tariff (Basistarif), which insurers must offer (Kontrahierungszwang) and whose maximum contribution is capped at the statutory (GKV) level (§ 152 VAG).
- Report a change of statusReport changes such as hiring staff to your health insurance fund – this can trigger the statutory presumption of self-employment as a main occupation.
Deadlines
- Confusing “main occupation” with “side occupation”: since 23 July 2015 a statutory presumption applies – anyone who regularly employs at least one employee beyond a minor level is presumed to be self-employed as a main occupation (§ 5 para. 5 sentence 2 SGB V); this presumption must be actively rebutted.
- Late joining of voluntary insurance means prior insurance periods are no longer counted.
- A switch to PKV can hardly be reversed in old age or with pre-existing conditions – there is no automatic return to GKV while self-employment as a main occupation continues.
- If you give the health insurance fund no proof of income, you are classified on the basis of the contribution assessment ceiling – not the lower minimum assessment base.
- The former “founder privilege” (a temporary reduced minimum contribution for the first years only) was abolished on 1 January 2019 by the GKV-Versichertenentlastungsgesetz. Since then the lower general minimum assessment base applies without time limit to all people who are self-employed as a main occupation – not only temporarily for founders.
In depth · legal basis, figures and practice – for advisers and professionals
Legal bases
§ 5 para. 1 no. 1 in conjunction with para. 5 SGB V excludes people who are self-employed as a main occupation from compulsory insurance as employees. § 9 SGB V regulates voluntary insurance including the three-month notification deadline. § 240 SGB V regulates the assessment of contributions for voluntarily insured people; under paragraph 4 a minimum income of one ninetieth of the monthly reference value (Bezugsgröße) per calendar day applies (arithmetically about one third of the monthly reference value per month). § 152 VAG regulates the PKV basic tariff with its obligation to contract and a contribution capped at the maximum GKV contribution.
Figures on the minimum assessment base
The actual euro amount of the minimum assessment base for voluntarily insured people changes every year with the reference value. A frequently cited benchmark for 2026 is around €1,318 per month – this value comes from secondary sources (calculation based on the reference value) and was not verified directly against a GKV-Spitzenverband publication for 2026. The calculation formula itself (one ninetieth of the reference value per day), by contrast, is confirmed in the statutory text. Likewise, a benchmark of around €1,017 per month is circulated for the maximum contribution in the PKV basic tariff for 2026, also supported only by secondary sources.
History of the reform
Until 31 December 2018, a higher special minimum assessment base applied to people who are self-employed as a main occupation, together with a separate, lower founder privilege that applied only for the first three years of self-employment. The GKV-Versichertenentlastungsgesetz unified both rules on 1 January 2019: since then the lower general minimum assessment base applies without time limit to all people who are self-employed as a main occupation.
Practice for advisers
For unclear mixed cases (main vs. side occupation), a case-by-case review by the health insurance fund is advisable. Deutsche Rentenversicherung Knappschaft-Bahn-See (KBS) publishes a catalogue of criteria, “Basic notes on the concept of self-employment as a main occupation”. The GKV-Spitzenverband specifies § 240 SGB V uniformly nationwide in the “Beitragsverfahrensgrundsätze Selbstzahler” (contribution procedure principles for self-payers) – an important reference document for advice.
From 1 January 2027
Contribution assessment ceiling (health and long-term care insurance): under the GKV-Beitragssatzstabilisierungsgesetz (Act of 24 July 2026, BGBl. 2026 I Nr. 228, issued 29 July 2026; Art. 1 no. 5 (§ 6 SGB V) applies from 1 January 2027; Art. 1 no. 61 (§ 223 SGB V) since 30 July 2026, effective for the year 2027), the annual earnings threshold (Jahresarbeitsentgeltgrenze) for 2027 is additionally raised by €3,600 (§ 6 para. 6 SGB V new), and the contribution assessment ceiling for 2027 corresponds to the annual earnings threshold under § 6 para. 7 SGB V raised by €3,600 (§ 223 para. 4 SGB V new); €3,600 per year corresponds to €300 per month. The Federal Government sets the amounts in the ordinance under § 160 SGB VI; this ordinance was not available, so no 2027 figures are given here. For people with full private insurance who were exempt from insurance on 31 December 2026 because they exceeded the threshold, the annual earnings threshold for 2027 is not raised (§ 6 para. 8; the exception applies cumulatively: exempt from insurance on 31 December 2026 because of exceeding the annual earnings threshold and insured substitutively with a private health insurer).
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