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  • Alison Rhoades

Best Health Insurance for Freelancers in Germany | LeX-Wealth

As a freelancer in Germany, you have a lot on your plate. Whether keeping track of your expenses or sorting through exhaustive tax returns, health insurance might be the furthest thing from your mind. And yet, a quality health insurance plan can save you (and your business) a great deal of money and stress down the line. 

Though individual situations may vary, private health insurance is generally the best bang for your buck as a single freelancer in Germany (earning above €30,000 per year). The exception to this may be for freelance artists or publishers, who can take advantage of the public Künstlersozialkasse (KSK) programme. And if you’re a freelancer with a large family, public health insurance could also be the better option.

This topic is even more complex than meets the eye, but we’re here to help. Let’s explore the ins and outs of health insurance for freelancers in Germany. 

Contents covered in this article:

Do freelancers in Germany need health insurance?

Yes. Everyone, including freelancers, needs health insurance in Germany. This isn’t just a suggestion — it’s mandated by the government.

The good news is that, thanks to Germany’s dual system, there’s a lot of choice when it comes to health insurance. While salaried employees are often automatically placed into the public scheme, freelancers can choose between private and public health insurance, and a wide variety of different providers. 

Do I need health insurance as a freelancer from outside Germany?

Even expats are required to have health insurance while living in Germany. The kind of health insurance you need, and how quickly you need to secure it, depends on a lot of factors. 

For example, if you’re a freelance expat from another EU country that’s part of the EU-wide health insurance scheme, and you have an EHIC card, you will be covered by your home country’s insurance in Germany for up to six months from when you left that country. If you plan to stay in Germany beyond those six months, you’ll need to switch to a German health insurance plan. 

If you’re a freelancer entering Germany from outside the EU, you’ll likely need health insurance to qualify for your visa. Note that freelancers from non-EU member countries can’t opt into the public system — they must purchase private health insurance. However, if you secure a full-time job later on or are accepted to the KSK, you can enter the public system at that point. 

A word to the wise: select your providers carefully! There are some exploitative international health insurance plans out there that don’t offer the coverage needed to qualify for a German freelance visa. When in doubt, get in touch with a professional to help you find the plan that fits you best. 

What does health insurance cover in Germany?

When shopping for health insurance, your coverage will depend on the type of insurance (private or public) and the plan you choose. However, many insurers cover the following basic healthcare services: 

  • Doctor visits

  • Hospital care and visits

  • Prescription drugs 

  • Medical checkups

  • Rehabilitation

  • Basic dental care

  • Pregnancy and birth

  • Ambulatory assistance

  • Psychotherapy

The basic point is that all your emergency, standard, and preventative care should be covered. This means you’re covered for all medical emergencies, visits, and basic healthcare treatments, including physical therapy or rehabilitation. Psychotherapy is also covered by the public health insurance scheme.

It’s worth noting that Germany has excellent prenatal care, and most health insurers cover midwife care, prenatal and postnatal sports courses, and even some alternative treatments like acupuncture. 

What isn’t covered?

Although health insurance coverage in Germany is quite expansive, your plan won’t pay for everything. Treatments that are considered elective, cosmetic, or naturopathic in nature are generally not covered. This includes certain dental procedures, such as crowns or cleanings, as well as glasses and vision care. 

Some private health insurance plans cover more expansive dental or skincare treatments, and you can also get supplementary private healthcare (Zusatzversicherung in German) to cover these extras, should you need to stay with the public healthcare system.

Freelancers can be at a disadvantage when it comes to certain types of coverage, like sick leave. As an employee, you’re generally entitled to full pay when you’re sick. This is usually covered by your employer for at most six weeks, provided you’ve been continuously employed with the company for four weeks or more. After that, you’ll receive sick pay from your health insurance company that covers 70% of your last regular earnings until you’re fit to work again.  

When you’re freelance, your health insurance plan will typically only cover this if you have an additional insurance plan. However, public health insurance will give you 65% of your post-tax earnings (based on your last tax return) when your children are sick, provided you have a doctor’s note. 

What does health insurance cost for freelancers in Germany?

When it comes to calculating costs for health insurance, the main factors are your income and whether you opt for private or public health insurance

The most important difference between freelancers and their employed counterparts is that employees typically split the cost of their health insurance with their employer. This means that, whether they choose public or private health insurance, they’ll only have to shoulder half of the costs. 

Freelancers, on the other hand, must pay for their entire health insurance plan themselves (unless they are members of the KSK, but more on that later). 

Public health insurance cost for freelancers

Public health insurance contributions are calculated with a minimum monthly income of €1038.33. This means that, even if you earn less than this, your contributions will be based on this threshold. This works out as a minimum payment of 160 per month for those on the lower end of the earning spectrum. But that’s just the starting rate. Premiums can rise as high as €1,050 per month for higher earners.

Basically, your contributions go up based on your income, and include health insurance, nursing care insurance, and an additional contribution rate. Premiums are calculated on a maximum monthly income of €5,175 and the percentages that determine the price of your coverage are calculated as follows: 

  • Health insurance = 14.6%

  • Additional contribution rate = 1.7% (on average)

  • Nursing care insurance = 2.4 - 4% 

Public health insurance also provides coverage for your spouse for no additional cost (if they earn less than €485 per month) and for your children up to when they turn 23 (or 25, if they’re a student).

Private health insurance cost for freelancers

Premiums for private health insurance in Germany are based on individual risk assessments, and not on your income. Therefore, the younger and healthier you are upon entry, the lower your premiums will be for life. 

Depending on how old you are when you sign up, your state of health upon entry, and the level of coverage, private health insurance premiums would cost between €350 - €650 per month, assuming a basic or mid-range tariff has been selected. This would be significantly cheaper than what a mid-range or higher earner would pay for public healthcare. 

Another advantage is you can tailor your coverage to suit your needs — an option that is not available with public coverage. If you’re a low-income earner, you may be able to find private insurance options for around €350 (for basic care). 

Note that your family won’t be covered under your private insurance, so it’s worth calculating the costs of a given policy with all your family members to see if it makes sense for you.  

Learn more about how public and private health insurance costs are calculated here.

Do freelancers pay more for health insurance than those with salaried jobs?

Because salaried employees split their health insurance costs with their employer, generally speaking, freelancers pay more for their health insurance than their employed counterparts. 

But there are a number of caveats to this. First off, freelancers in some industries are able to charge a great deal more for their services than salaried employees. That’s because the companies that hire them don’t have to pay any of their social insurance costs, including health insurance, unemployment insurance, and pension contributions.

Furthermore, they don’t have the job protection that salaried employees have, which means they need to make up for that lack of security on their invoices. Freelancers can then turn around and spend this money on a health insurance plan that fits them best.

Here, the question of private vs. public health insurance also comes into play. For single freelancers or salaried employees earning €69,300 per year, private insurance can save both parties significant money compared to public insurance. 

Freelancers in the arts or publishing industries can also apply for the Künstlersozialkasse (KSK), where their pension payments are split between themselves and the government. Let’s learn more about this type of insurance. 

What is the KSK (Künstlersozialkasse) and do I qualify as a freelancer?

The KSK is a public, government-run insurance programme for artists and publishers to subsidise these professions and promote cultural capital. 

The program functions like an employer/employee relationship. When artists or publishers are accepted to the programme, they will pay roughly half of their social contributions (health and pension insurance) and the government will pay the other half. This is an excellent deal for those who want to maintain a freelance career in the arts and also get some generous pension contributions from the state. 

However, getting accepted to the KSK is no easy task. You’ll have to submit an exhaustive application showing that you earn your money almost exclusively as a practising artist (of nearly any kind), journalist, or publicist. The minimum income to start is €3,900 a year, and you’ll need to earn the majority of your income with jobs that fit into the KSK’s scope. 

It’s worth noting that if you’re a very high earner, the KSK can cost more money than the standard public health insurance, and significantly more than private insurance. However, with the extra pension boost, it’s still a good deal — especially if you plan to stay in Germany. 

Is health insurance tax-deductible if I’m freelance or self-employed?

Health insurance contributions are tax-deductible in Germany. However, unlike other business expenses like your office or client lunches, these deductions are made from your “gewinn” — a.k.a your income minus your expenses. 

You’ll make these deductions on your income tax return (Einkommensteuererklärung) in order to find your net income — from which your taxes will be calculated. 

Private vs. public: What’s the best health insurance for freelancers?

As you can see, the decision of whether or not to choose private or public insurance as a freelancer is a complex one. To wrap up, we’ll look at some advantages and disadvantages of each. 

Pros and cons of public health insurance for freelancers

Public health insurance is a great choice for freelancers with dependents or families. It’s also an excellent choice for those who qualify for the KSK programme, including artists, publishers, and journalists.  

It has some disadvantages for other types of freelancers. Thanks to the income thresholds, low-income and high-income earners may both pay more than they’d like to. Freelancers also won’t get sick-leave insurance without extra costs, and may need to go through a lot of red tape to get accepted — especially when coming to Germany from a non-EU country. 

Is private health insurance a better option for freelancers?

Because private health insurance is not income-dependent, it may be a much more cost-effective choice for freelancers. Furthermore, the policy can be catered to your unique needs and preferences — meaning you can pay less for basic coverage and more for a comprehensive package. 

Another advantage of private health insurance is that you’ll have shorter waiting times to see doctors and even access to better medical institutions, which can help out a lot when you’re feeling ill. 

Find the best health insurance for you with LeX-Wealth

Whether you’re weighing up the best health insurance options for freelancers, or trying to learn the language and set up your business, we know how tough expat life can be in Germany.

At LeX-Wealth, we specialise in financial and wealth planning services for expats, from securing the right insurance, to building wealth for your future. Our English-speaking specialists offer continuous support, no matter how diverse your goals are. Contact us today to learn more.

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