Which health insurance is suitable for self-employed expats?

Self-employed people in Germany have more freedom but also more responsibility around health insurance. There's no employer doing the registration for you, and the choice you make can quietly shape your finances for decades.

Voluntary GKV (freiwillige Krankenversicherung) calculates contributions based on your declared income, with a defined monthly minimum and maximum. The minimum applies even in low-income years — which can pinch when business is slow — but in stronger years the contribution rises proportionally rather than jumping suddenly. Importantly, family members can often be co-insured for free under Familienversicherung, just like for employees.

PKV (private health insurance) calculates premiums on age at entry, health questions and the benefit package you choose. The premium can be lower than the GKV minimum in your early healthy years, which is part of why it sometimes looks attractive at first glance. Over time, however, it rises and continues into retirement. And every family member needs their own contract.

Switching from PKV back to GKV is restricted by law, especially after age 55, so the choice is essentially long-term in nature.

For most self-employed expats — with realistic chances of family changes, low-income stretches, or a possible move abroad — voluntary GKV is the safer choice. PKV makes more sense for established, high-income, single self-employed people with a clear long-term German plan and the willingness to actively manage the contract over decades. The right answer rarely jumps out from a single PKV quote.