PKV for self-employed people and freelancers: tariffs, deductible and daily sickness allowance

PKV options for self-employed people

Anyone who is self-employed as their main occupation is exempt from statutory health insurance and can insure privately. There is no employer subsidy: you pay the contribution alone, whether statutory or private. If you also work as an employee alongside self-employment, you are classified by time spent and income. Your status then depends on which activity predominates.

In PKV the contribution does not depend on income but, among other things, on age and state of health at entry, the scope of benefits and the agreed deductible. Before you take out a policy, the insurer asks health questions. Whether and on what terms it accepts you depends on your answers. It is best to clarify the tax treatment of contributions with your tax adviser.

Anonymous preliminary risk assessment: process, benefits and limits

Choosing tariffs and benefits

In PKV you agree the insurance cover by contract. This gives you freedom, but it also requires care: two tariffs with a similar contribution can differ considerably in benefits, reimbursement limits and terms. Compare the benefit descriptions, not just the price.

• Which benefits matter to you, for example outpatient, inpatient, dental or remedies and medical aids?
• Are there reimbursement limits or exclusions that could affect you in everyday life?
• How is the tariff built for changes, for example if your income, your family or your needs change?
• How has the insurer handled contribution adjustments so far?

Deductible: lowering the contribution, bearing the risk

With a deductible (Selbstbehalt) you bear part of the costs yourself and can thereby lower the ongoing contribution. This only pays off if you can actually afford the amount in an emergency. With fluctuating income this is especially important: a high deductible can become a burden in a weak business year.

Please also note that when contributions are raised, insurers can also adjust deductibles (BaFin). Therefore do not plan the deductible too tightly, and build up a reserve for treatment costs.

Daily sickness allowance: protection against loss of earnings

If you are ill and cannot work, your income falls away. For privately insured self-employed people, daily sickness allowance insurance (Krankentagegeldversicherung) is therefore particularly important. It pays an agreed daily allowance if you are unable to work.

• Amount: the daily sickness allowance may be at most as high as your net income. As a rule, the average of the last twelve months is decisive.
• Deferral period (Karenzzeit): the allowance is only paid after an agreed deferral period has passed. Depending on the tariff, this can be as early as the fourth day of illness. A shorter deferral period generally leads to a higher contribution.
• Waiting period (Wartezeit): for certain benefits, for example during maternity protection, the model terms provide for a waiting period of eight months.
• Adjustment: if your net income falls permanently, you should tell your insurer so that the allowance and your income match.

Contributions with fluctuating income

In statutory health insurance the contribution is based on income subject to contributions up to the contribution assessment ceiling (Beitragsbemessungsgrenze; 2026: €69,750 per year). In PKV, by contrast, you pay a contractually agreed contribution, regardless of how well a year goes. This gives you predictability, but it also means: the contribution is due in a weak year just as in a strong one.

Long-term financial planning

• Contribution in old age: contributions can rise and do not fall automatically when you work less or retire. Build up reserves for this (Verbraucherzentrale).
• Contribution adjustments: insurers may adjust contributions if costs have risen permanently and an independent trustee agrees (BaFin).
• Family: children and partners without income need their own contracts with contributions.
• Return to GKV: this is often difficult. From the age of 55, special restrictions apply (§ 6 para. 3a SGB V).
• Self-employment and protection: besides health insurance, also consider cover for occupational disability and retirement provision.

PKV or GKV: differences and decision criteria

PKV for employees: switching, threshold and employer subsidy

PKV for civil servants (Beamte): Beihilfe, residual-cost insurance and family

This page is general information and does not replace personal advice. Figures such as the contribution assessment ceiling change every year; the values given apply to 2026.