Requirements for private health insurance for the self-employed

Your insurance status comes first. Under § 5 (5) SGB V, self-employment as your main occupation rules out the compulsory insurance set out there. The law also contains a presumption rule for people who, in connection with their self-employment, regularly employ at least one employee beyond a marginal job.

A business registration or individual freelance assignments are therefore not enough on their own. If you still work mainly as an employee subject to compulsory insurance and do self-employed work on the side, this side activity does not automatically give you access to private health insurance.

For a switch to private health insurance, your job title does not count. Your actual insurance status does. If you combine employment and self-employment, this status should be settled before you submit an application for private health insurance.

For people who are self-employed as their main occupation, there is no Jahresarbeitsentgeltgrenze as an entry requirement for private health insurance. In 2026, the Federal Ministry of Health expressly distinguishes between employees, for whom the Jahresarbeitsentgeltgrenze (i)JAEG · JahresarbeitsentgeltgrenzeThe annual income threshold in Germany. Employees who earn more than this per year may leave statutory health insurance and switch to private health insurance.More about JAEG → can be decisive, and self-employed people, who can choose between voluntary statutory and private health insurance once compulsory insurance no longer applies.

You therefore do not have to reach a certain turnover or a certain profit to gain access to private health insurance for that reason alone. But no statutory income threshold does not mean that every self-employed person should switch to private health insurance as soon as the business starts. Different requirements apply to employees. For them, the regular annual pay decides.

We do not use a fixed turnover threshold or a minimum profit from which we advise self-employed people to choose private health insurance. For us, what matters is how predictable the income already is. The private premium must stay affordable even if an assignment starts later, a client drops out or the business year turns out weaker than expected.

In the year you start your business in particular, the smallest premium difference should not decide the change of system. For a saving of, for example, €50 per month in 2026, we would not bring forward a switch to private health insurance while income is still hardly predictable (PKV-Welt advice principle 2026).

Voluntary statutory insurance takes your financial capacity into account within the statutory contribution limits. An agreed private premium, on the other hand, does not automatically fall in a weaker business year, as the Federal Ministry of Health explains in 2026 on the contribution assessment of voluntarily insured people. We work through a specific example to show how the two systems differ in the costs for the self-employed.

Our benchmark is therefore not a particular income level. We want to be able to see that your self-employment is predictable enough in financial terms.

The right to choose private health insurance does not yet mean that you can take out any plan you want on the advertised terms. Under § 19 (1) of the Insurance Contract Act, applicants must disclose the circumstances known to them that are relevant to the risk and that the insurer has asked about in text form.

Pre-existing conditions can affect the terms of acceptance. The insurer in question decides on the actual acceptance and the contract terms.

This is why we prepare your health history before a formal application and first check your insurability anonymously. From more than 5,000 applications with health questions that we have handled, as of 2026, we know that insurers can assess the same medical history in different ways (PKV-Welt experience value 2026).

For business founders in particular, the health check can be separated early from the financial decision. This way, you can find out which private options you actually have without having to make the switch straight away.

The line between self-employment as your main occupation and self-employment on the side is a key requirement for classifying your insurance status. § 5 (5) SGB V links the exception from compulsory insurance set out there to self-employment as a main occupation.

This applies, for example, to an employee who also registers a business or offers consulting services on the side. The side activity alone does not end an existing compulsory insurance from the employment.

For managing shareholders of a GmbH, the position as managing director alone does not decide access to private health insurance. First, it must be clarified whether, under social insurance law, the work is dependent employment or self-employment. Here the Deutsche Rentenversicherung looks mainly at the legal power under company law.

As a rule, there is no dependent employment if the managing shareholder holds at least half of the share capital or has a comprehensive blocking minority under the articles of association. With a smaller stake and no comprehensive blocking minority, on the other hand, the person can be bound by instructions. What matters is the legal ability to prevent instructions from the shareholders' meeting, not just the actual freedom in everyday work.

Employment status is assessed by the Deutsche Rentenversicherung Bund in the status determination procedure. If the employer's report shows that an employee is a managing shareholder of a GmbH, the collecting agency must start a status determination procedure under § 7a (1) SGB IV.

For private health insurance, the result is decisive. In the case of dependent employment, the rules for employees generally apply. If the work is classed as self-employment, the Jahresarbeitsentgeltgrenze (i) is not an entry hurdle. A detailed assessment for this group is available on our portal for the self-employed under private health insurance for GmbH managing directors.

Under the Artists' Social Insurance Act, self-employed artists and journalists can be subject to compulsory insurance in statutory health, long-term care and pension insurance if they carry out their artistic or journalistic work commercially and not just temporarily, § 1 KSVG. The Artists' Social Insurance Fund is not itself the statutory health insurance fund. It determines the insurance status and organizes the payment of contributions, as the Artists' Social Insurance Fund explains in 2026.

A switch to private health insurance is still possible, but not under the general logic for the self-employed. Career starters can apply to be exempted from compulsory statutory health insurance if they prove private health insurance cover. The application must be made no later than three months after compulsory insurance has been determined, § 6 KSVG.

Higher earners have a separate option for exemption after three consecutive calendar years with a correspondingly high income from work, § 7 KSVG. With private health and long-term care insurance, the Artists' Social Insurance Fund can pay a contribution subsidy on application, § 10 KSVG.

Even if your self-employment gives you the right to choose private health insurance, your previous statutory health insurance does not end automatically. If compulsory insurance or family insurance ends, the membership first continues as a voluntary membership under § 188 (4) SGB V, subject to the conditions set out there. To leave immediately, a period of two weeks applies after the notice from the statutory health insurance fund, and you must also prove other cover in case of illness.

For the requirements, this means the following. Before the planned start of your private cover, it must be clear which insurance status you currently have and from when your private cover can start.

The statutory requirements answer whether you can switch. How predictable your income is helps decide whether the timing for the switch is already right. Read how switching to private health insurance works for the self-employed.

A business founder can meet the formal requirements for a switch to private health insurance as soon as self-employment as a main occupation begins. In 2026, the Federal Ministry of Health confirms the choice between voluntary statutory and private health insurance for self-employed people who are no longer subject to compulsory statutory insurance.

We would not conclude from this that you should switch automatically. If your order book and income are still hardly predictable, it can make sense to wait and see how the business develops first. Your insurability on health grounds can be checked anonymously beforehand.

After the statutory right to choose, the most important requirement for us is self-employment with sufficiently predictable income. The private premium should not depend on whether a single month goes particularly well or badly.

• Federal Ministry of Health, people with statutory insurance and the right to choose, 2026.
• Federal Ministry of Health, contributions of voluntarily insured people, 2026.
• § 5 SGB V, compulsory insurance and self-employment as a main occupation.
• § 188 SGB V, mandatory follow-on insurance.
• § 19 VVG, pre-contractual duty of disclosure.
• Artists' Social Insurance Act, §§ 1, 6, 7 and 10 KSVG.
• Artists' Social Insurance Fund, exceptions and exemption from compulsory health insurance, 2026.
• Deutsche Rentenversicherung, managing directors of a GmbH, as of 2026.
• § 7a SGB IV, determination of employment status.
• PKV-Welt experience value 2026, more than 5,000 applications with health questions.
• PKV-Welt advice principle 2026, for a business start that is still uncertain, the change of system should not depend only on a small monthly premium difference.