Freelancer health insurance in Germany: private cover for self-employed expats

This page is for expats moving to Germany as freelancers or self-employed people who need to sort out health insurance before or shortly after arrival. It covers the three types of cover available, what the immigration office expects to see, and two benefits many expats overlook: sick pay and the right deductible.

It is not aimed at employees. If your employer handles the contribution split, your situation is different. It is also not aimed at people on short tourist or visitor stays, for whom travel insurance may be sufficient temporarily.

Three types of cover are available to you in Germany.

GKV (gesetzliche Krankenversicherung) is statutory public health insurance. Contributions are income-based and set by law. Children and partners without their own income can be covered under your membership at no extra cost, which is a real advantage for families.

PKV (private Krankenversicherung) is German private health insurance. Premiums depend on your age, health status and the benefits you choose, not on your income. Every family member needs a separate contract. You can read a full overview of private health insurance in Germany to understand how the system works in detail.

IPMI (international private medical insurance) is designed for people who live and work across multiple countries. It can suit short or highly mobile stays, but whether an immigration office accepts it as adequate cover for a residence permit has to be checked case by case.

IPMI can work well for very international careers, but for most expats settling in Germany as freelancers, the choice comes down to GKV or PKV.

Employees pay roughly half their GKV contribution because the employer covers the other half. As a self-employed person, you carry the whole contribution on your own: the general rate of 14.6 % plus the average additional rate of 2.9 %, a combined 17.5 %, if you opt for sick pay, or the reduced rate of 14.0 % plus the additional rate without it.

Contributions apply to your income up to the contribution ceiling, which is €69,750 in 2026 and €76,500 from 2027 (the 2027 figure still requires Bundesrat approval). At the 2026 ceiling, that works out to roughly €1,017 per month in GKV contributions at 17.5 % before long-term care insurance (3.6 %, plus 0.6 points if you have no children) is added.

One thing that catches many expats off guard: GKV contributions are also charged on income beyond your freelance fees. Rental income and investment returns count too, up to the same ceiling.

Sick pay is not automatically part of public insurance for self-employed people. You have to opt in explicitly through a Wahlerklärung (declaration of choice), which raises your rate from 14.0 % to 14.6 % plus the additional rate; statutory sick pay then starts from the 43rd day of illness. Miss that step and you receive nothing if illness keeps you from working.

PKV premiums are calculated differently. Because they are based on your age, health and chosen benefits rather than your income, they can be easier to budget when your earnings fluctuate. To understand who can get private health insurance as a freelancer or self-employed expat, the eligibility rules are worth reading before you compare policies.

A residence permit for freelance or self-employed work requires adequate health insurance. In plain terms, that means comprehensive cover without significant gaps: a policy that pays for outpatient treatment, hospital stays and prescriptions in Germany.

A PKV policy or GKV membership is generally accepted by the Ausländerbehörde (immigration office). Travel insurance usually is not, because it is designed for short trips and excludes pre-existing conditions and long-term treatment. IPMI is reviewed case by case.

The documents you typically need to show are an insurance certificate in German or English, the start date of your cover, and confirmation that the cover is comprehensive and not time-limited.

If you are arriving in Germany to look for work before committing to a specific freelance activity, a job seeker visa is a separate route, and health cover is required for that application too.

Krankentagegeld is a fixed daily payment your insurer makes when you cannot work because of illness. It replaces the income you stop earning the moment you stop working.

Employees usually receive their salary from their employer for the first six weeks of illness. Freelancers receive nothing from anyone unless they have insured this risk. A two-week flu or a minor surgery can leave a gap in your income that takes months to recover.

The waiting period (Karenzzeit) is the number of days you are ill before payments start. A three-day waiting period means you pay the first three days yourself; a 43-day waiting period means you rely on your own savings for six weeks. Match the waiting period to how long your savings and any emergency fund could realistically cover your fixed costs.

The daily amount you insure may not exceed your actual net income, so review it whenever your earnings change significantly.

In PKV, sick pay is a separate building block you add to your policy. In GKV, it works through the Wahlerklärung mentioned earlier.

The deductible (Selbstbeteiligung) is the amount you pay yourself each year before your insurer steps in. Choosing it well is a financial planning decision, not just a premium optimisation exercise.

The trade-off is straightforward: a higher deductible lowers your monthly premium but increases your out-of-pocket cost in any year you need significant treatment.

Some PKV policies include a Beitragsrückerstattung (premium refund) for claim-free years. If your deductible is low and you submit small bills, you may lose a refund worth more than the bills themselves. Factor this into your decision.

Premiums for basic health cover can generally be deducted from your German tax return as special expenses (Sonderausgaben). The deductible itself is not deductible in the same way. A tax adviser can confirm what applies to your specific situation.

The practical rule: choose a deductible you could pay in full from your savings without putting your business cash flow at risk.

Before you request a comparison, run through the key planning points below. A well-structured request gives you more useful results and avoids back-and-forth.

Answer the health questions on your application honestly. Incorrect or incomplete answers can give the insurer grounds to reduce or refuse a payout later, which defeats the purpose of having cover.

One more term worth knowing: Alterungsrückstellungen (ageing reserves). PKV insurers set aside part of your premium while you are young to offset higher costs later in life. This is one reason switching insurers in your fifties is harder than switching in your thirties. It is a long-term commitment.

André Disselkamp, co-founder of Insurancy, advises freelancers and self-employed expats in English and compares policies across insurers. Request a personal comparison for freelancers and self-employed expats to see which policies fit your income, health profile and visa requirements.