Everyone assumes private health insurance only pays off for the wealthy. The numbers say otherwise — and the mistake is already baked into the question.
The short answer. Statutory health insurance (GKV) calculates your contribution based on your income, and as a self-employed person you carry it entirely on your own — with a good income, quickly more than 1.000 euros a month including long-term care insurance. Private health insurance (PKV) is priced by age, health and benefits. For young, healthy self-employed people with a stable income it's often attractive, while family and old age sometimes speak for the GKV. What decides it is your individual case, worked through in full.
The moment you become self-employed, your whole perspective on health insurance changes. In salaried employment, the employer pays half of the contribution. The self-employed carry it entirely alone. Anyone who doesn't factor that in is comparing apples to oranges.
What the statutory health fund asks of the self-employed
In the statutory system, your contribution is based on your income, up to an upper limit: the Beitragsbemessungsgrenze (contribution assessment ceiling, BBG). Anyone above it pays the maximum contribution. As a self-employed person without an employer subsidy, you cover both halves entirely on your own. The applicable contribution rates and reference figures are published by the GKV-Spitzenverband.
In practice, that means self-employed people with a stable income quickly pay more than 900 euros a month in the GKV, regardless of how often they see a doctor or how healthily they live. You pay into the system, not for your health.
A model case makes the difference clear. Max, 36, a self-employed IT consultant with an income above the contribution assessment ceiling: in the GKV his contribution is at the maximum rate, more than 1.000 euros a month including long-term care insurance. In the PKV he can pay considerably less, depending on his health and chosen benefits, at a different level of coverage. The question isn't whether he can afford the PKV. The question is whether he wants to afford the GKV.
How the PKV calculates its premiums
Private health insurance follows a different logic. Your premium doesn't depend on your income but on three factors:
- your state of health when you join
- your age when you switch
- the benefits you lock in
Anyone who joins the PKV young and healthy pays permanently lower premiums than someone who switches only at 50, even if both earn the same income. Timing matters more than salary.
GKV or PKV: the direct comparison
Here's how the two systems differ on the points that tip the scales for the self-employed:
| Statutory (GKV) | Private (PKV) | |
|---|---|---|
| Contribution | based on your income, up to the contribution assessment ceiling; as a self-employed person you carry the full contribution alone | based on your entry age, state of health and chosen level of benefits, not on your income |
| Family | children and a spouse without their own income can be covered free of charge | every person pays their own premium, children included |
| Benefits | a legally defined catalogue, the same for everyone; can be adjusted by political decision | agreed by contract; benefits once granted can't be taken away from you |
| In old age | the contribution keeps following your income, so in retirement usually your pension | premiums can rise; ageing reserves and relief components soften the increase |
| Returning | admission is generally open | a return to the GKV only in certain constellations, and from 55 practically hardly at all |
Who the PKV often pays off for
- self-employed people with a stable income who aren't aiming to return to salaried employment
- employees whose income is permanently above the compulsory insurance threshold
- people who join young and in good health
- anyone to whom a higher level of care from doctors and specialists matters
What the self-employed should also keep in mind
The system question is only half the decision. As a self-employed person, three more points belong on the table:
- Daily sickness allowance. As a self-employed person, you get no continued salary payment. If you're out for longer, your income stops from day one. A daily sickness allowance covers exactly this gap, whether you're insured statutorily or privately.
- Premiums in old age. If you're privately insured, relief components taken out while you're still young can keep your premium predictable in retirement.
- Timing. Premium and acceptance depend on your state of health and entry age. Every year you wait changes your terms, rarely for the better.
The honest flip side
The PKV isn't a sure thing. In old age, premiums can rise, and family members aren't automatically covered. If you have to insure your family or expect a tight budget in retirement, the statutory route is sometimes the better one. There's no universal answer, only the right answer for your case.
That cuts both ways. I won't advise you for or against the PKV before we've worked through your situation in concrete terms. It's not about the system, it's about what works for you in ten, twenty and thirty years.
Can I switch back from the PKV to the GKV?
This question belongs before the decision, not after. Returning to the statutory fund is tightly regulated by law. As a self-employed person, the path usually runs only through salaried employment subject to social insurance with an income below the compulsory insurance threshold, and that before your 55th birthday. From 55, a return is practically hardly possible at all. So anyone who chooses the PKV should treat it as a long-term decision and plan for the old-age premiums from the outset.
What makes sense now
The most common mistake is waiting. If you take the topic seriously for the first time at 35, you still have good options. If you start at 50, you still have some, just fewer of them.
A first conversation about the topic doesn't mean a decision. It means you'll know what a well-founded choice costs you before you make it. I find that more useful than relying on general rules of thumb that don't know your specific case.
I've put together an overview of both routes in the health insurance section. How a full private policy is structured in detail, you can read under private health insurance.
If you'd like to know what the comparison means for your situation: I'm Eduard Strekert, financial advisor for Deutsche Vermögensberatung AG (DVAG), tied agent, based in Lüdenscheid. In an initial consultation we work through both systems, for your specific case, free of charge and without obligation.
Frequently asked questions about the GKV and PKV for the self-employed
As a self-employed person, can I switch back from the PKV to the GKV?
Only in certain constellations. As a rule, the path runs through salaried employment subject to social insurance with an income below the compulsory insurance threshold, and that before your 55th birthday. From 55, a return is practically almost impossible. That's exactly why the decision deserves to be worked through carefully.
What does statutory health insurance cost for the self-employed?
The contribution is based on your income, and without an employer subsidy you carry it entirely alone. With a stable income above the contribution assessment ceiling, it quickly exceeds 1.000 euros a month including long-term care insurance. The exact amount depends on your income, your health fund and its supplementary contribution.
Who does the PKV pay off for in particular?
Often for self-employed people with a stable income who join young and healthy and aren't aiming to return to salaried employment. What matters is being able to bear the premiums in old age, too, and factoring in your family planning.
Are children covered in the PKV?
No. In the PKV, every person pays their own premium, children included. In the GKV, children and a spouse without their own income can be covered free of charge as family members. With larger family plans, that can change the calculation considerably.
Related reading:
- Retirement planning for the self-employed: how to build it without an employer
- Private health insurance in detail
- Financial advisory for the self-employed in the Märkischer Kreis region
Eduard Strekert is a financial advisor for Deutsche Vermögensberatung AG (DVAG), tied agent. This article is general information and does not replace personal advice. It does not constitute investment or tax advice.