Going freelance changes three things about health insurance at once. Nobody pays half your contribution, nobody pays your wages when you are ill, and the choice between public and private cover — closed to most employees — may be open to you. Whether it is open depends on your insurance history, not on what you would prefer.
1. Which door is open to you
Everyone living in Germany must have health insurance (§ 5(1) no. 13 SGB V, § 193(3) VVG). The self-employed are not compulsorily insured in the public system the way employees are, so how you are covered depends on where you are coming from:
- From public insurance. If you were publicly insured until now — as an employee, for example — your membership continues automatically as a voluntary one (freiwillige Versicherung), unless you opt out within two weeks of the fund's notice and prove other cover (§ 188(4) SGB V).
- Joining from outside. Joining voluntarily requires earlier public insurance: 24 months in the last five years, or 12 months without a break immediately before (§ 9 SGB V), with the application made within three months of that insurance ending. Periods in the public system of another EU or EEA country or Switzerland can count (Article 6, Regulation 883/2004).
- No public history. Someone who arrives from elsewhere and goes straight into self-employment generally cannot join the public system, which leaves private insurance. Private insurers must accept such applicants in their basic tariff (Basistarif, § 152 VAG), so nobody is left without cover.
A publicly insured spouse is not a way in either: free family insurance (Familienversicherung) is closed to anyone whose main occupation is self-employment, however low the income (§ 10(1) SGB V).
2. What public insurance costs a freelancer
As a voluntary member you pay the whole contribution yourself, and it is based on all your income — business profit, but also rent and investment income — up to a ceiling (§ 240 SGB V). The 2026 figures, which are adjusted every year (Federal Ministry of Health):
- Minimum assessment base (Mindestbemessungsgrundlage): €1,318.33 a month. Earn less, and you pay as if you earned this.
- Ceiling (Beitragsbemessungsgrenze): €5,812.50 a month, or €69,750 a year. Income above it is not charged.
- Rates: 14.0% without sick pay (§ 243 SGB V) or 14.6% with it (§ 241 SGB V, section 5), plus your fund's additional contribution (Zusatzbeitrag) — 2.9% on the official 2026 average — plus long-term care insurance (section 6).
At the average additional contribution, the minimum works out at about €223 a month for health cover without sick pay, or €231 with it, before care insurance.
Contributions are first set provisionally from your latest income tax assessment (Einkommensteuerbescheid); when you are just starting out, an estimate of your expected income is used instead. Once the tax assessment for the year arrives, the fund recalculates, and you pay the difference or get it back. If you do not send proof of income when asked, the fund charges the maximum (§ 240(4a) SGB V). For 2027, a 2026 reform raises the ceiling by an extra €3,600 a year on top of the usual adjustment (§ 223(4) SGB V).
3. Private insurance
A private premium is set by your age at entry, your health and the benefits you choose — not by your income. That can make it cheaper than public cover while you are young, healthy and earning well, and dearer later: premiums rise over time, do not fall when your income does, and every family member needs a policy of their own.
When premiums start to bite, your rights sit mainly with the insurer you already have (more in what to do about a private premium increase). You can move to another of its tariffs and keep your ageing reserve (§ 204 VVG), and its basic tariff is capped at the maximum public contribution — halved if paying it would leave you needing state support (§ 152(3) and (4) VAG). Getting back into public insurance is hard for a freelancer, and from 55 generally closed; our guide to switching health insurance explains why.
4. The Künstlersozialkasse for artists and writers
Self-employed artists and publicists — musicians, visual and performing artists, writers, journalists — have their own route. The Künstlersozialkasse (KSK), a public institution, insures them in public health, long-term care and pension insurance much as if they were employees (§ 1 KSVG). Members pay roughly half the contributions; the other half comes from a federal subsidy and a levy on businesses that use creative and journalistic work (§ 14 KSVG).
The KSK is not an insurer itself: you choose a public fund, and the KSK registers you and passes on the contributions, which are based on the income you estimate in advance for the year (KSK). The creative work has to be carried on as a business and be your main self-employed activity, with expected profit of more than €3,900 a year — a limit that does not apply in your first three years, and that you may miss twice within six years (§ 3 KSVG). Newcomers (§ 6 KSVG), and members whose income over three years in a row added up to more than the threshold for private cover for those years (§ 7 KSVG), can opt for private insurance instead, with a KSK subsidy.
5. Sick pay: nobody else pays your wages
An employee who falls ill keeps their pay for six weeks (§ 3 EntgFG) and then receives sick pay (Krankengeld) from their fund. A freelancer has no employer, so the income simply stops unless it is insured. The options:
- Public, by declaration. A voluntary member can declare that their membership should include Krankengeld (Wahlerklärung, § 44(2) SGB V). The rate rises from 14.0% to 14.6%, and Krankengeld is paid from the 43rd day of incapacity for work (§ 46 SGB V): 70% of the business income your contributions were last based on, capped at the ceiling (§ 47 SGB V), for up to 78 weeks for the same illness within three years (§ 48 SGB V). The declaration binds you for three years (§ 53(8) SGB V). From 1 January 2027 a declaration takes effect only three months after your fund receives it, unless it arrives within 14 days of first joining as a voluntary member or of losing sick pay by going self-employed; the wait doesn't apply when an accident causes the incapacity (2026 reform).
- Public, earlier. Funds offer optional sick-pay tariffs (Wahltarife) for an earlier start or a higher amount. They tie you to that fund for three years, and a rise in its additional contribution does not release you (§ 53(6) and (8) SGB V).
- Through the KSK, Krankengeld is included from the seventh week, and an optional tariff can bring the start forward (§ 46 SGB V).
- Private daily sickness benefit (Krankentagegeld), open to publicly and privately insured freelancers alike: you choose the daily amount and the day it starts, and the later the start, the lower the premium (§ 192(5) VVG). Under the industry's standard model terms, the amount you can insure is limited to your net earnings, and the cover ends once you are found occupationally disabled.
That last point is where sick pay stops and disability insurance begins.
6. Long-term care insurance
Long-term care insurance (Pflegeversicherung) follows your health insurance. A voluntary public member pays the care contribution on the same income as the health contribution (§ 57 SGB XI): 3.6% in 2026, 4.2% for anyone aged 23 or over without children, and less for parents of two or more children under 25 (Federal Ministry of Health) — and as a freelancer, you pay all of it yourself. A privately insured freelancer must take out private long-term care insurance alongside the health policy (§ 23 SGB XI).
7. If you fall behind with payments
Freelance income is uneven, and contributions fall due regardless. In public insurance, late contributions attract a late-payment surcharge (Säumniszuschlag) of 1% a month (§ 24 SGB IV). Once the arrears reach two months' contributions and a reminder has gone unpaid, your cover shrinks to treatment for acute illness and pain, pregnancy and screening — until the debt is paid or an instalment plan is agreed. The membership and the debt both remain. If you would qualify for basic income support, the restriction does not apply (§ 16(3a) SGB V).
In private insurance the surcharge is also 1% a month. After two reminders the contract is suspended, and you are treated as insured in an emergency tariff (Notlagentarif) that covers acute illness, pain and pregnancy; the insurer cannot cancel. Once everything is paid, the old tariff resumes (§ 193(6) to (9) VVG, § 153 VAG, § 206 VVG).
Gaps cost money too. Someone who takes out private cover late pays a one-off surcharge that grows with each month they were uninsured (§ 193(4) VVG), and someone who falls back into the public system after a gap owes contributions back to the day the obligation began (§ 186(11) SGB V).
The short version
As a freelancer you pay the whole contribution yourself. In the public system it is based on all your income, between a 2026 minimum base of €1,318.33 and a ceiling of €5,812.50 a month; in the private system it follows your age and health instead, for each person separately. Artists and writers who qualify for the Künstlersozialkasse pay roughly half. Outside the KSK, sick pay is not automatic in either system — it takes a declaration, an optional tariff or a private daily benefit — and arrears shrink your cover to emergencies until they are paid.
Primary sources checked on 15 October 2026: the statutes and official pages linked above.