Public vs. private health insurance: How to choose when you’re a freelancer in Germany

German health insurance can be tricky for foreigners. Here’s what you should know before you decide between public and private.

Nandini Jammi
May 18 · 5 min read

If you want to move to Germany on the German freelance visa, you have to show up to your visa appointment with proof of health insurance no matter what.

If you have a full-time job that pays less than €60,750, you get to enroll in your choice of public insurance by default through your employer. If you’re self-employed however, you have an even bigger choice to make: public or private health insurance?

For most German and EU citizens, the clear choice is still public health insurance — contributing to the public system today will ensure they’re 100% covered when they retire.

However, if your plan is to live in Germany as an expat or digital nomad for a fixed period of time, you might want to weigh your options.

What is the best health insurance for freelancers?

When I was making my decision, I got tons of conflicting advice from friends, colleagues and fellow expats. It seemed like everyone had really strong opinions in both directions — it was stressful.

The stakes are kinda high because once you enroll in private insurance, you can’t get back on the public system because you’ve decided not to pay into it.

So once you’re on private, there’s no going back to the cushy public system. You could be screwing yourself over, but also maybe not!

I ended up considering a lot of factors when I finally came to my decision: my age, income, overall health expectations and of course, whether I’d stay in Germany for the long-term.

I ended up going with private.

It really is a very personal decision, and I would recommend you really sit down and think about what is best for you. I hope the following overview makes it a little easier for you to break down your own decision as you navigate this shitshow.

Public vs. private health insurance: pros, cons and why it’s complicated

Public insurance

If there’s a reasonable chance you expect to live in and retire in Germany in your old age, you should definitely choose public insurance.

Public insurance in Germany is truly amazing. I am not kidding when I say you will never see a medical bill as long as you live. I’ve heard stories of people in the hospital for months — treated well and fed well — and leaving without paying a penny out of pocket.

A friend of mine gave birth in Germany (rather than her native Poland) said she was shocked at the amazing level of care she received “for free.”

PROS:

  • Covers you for everything, including expensive things like pregnancy, long-term disability and cancer
  • It’ll cover everything, even when you’re old
  • Seriously, everything. It will cover all fees if you’re (God forbid) hospitalized for the rest of your life

CONS:

  • Sometimes you have to wait to get a doctor’s appointment
  • There are some limitations for non-emergency health services (public only covers 20-minutes of physiotherapy, for example)
  • It can be expensive if you’re young and healthy (it can cost up to €800 a month)
  • Dental care is not included (beyond 1x a year checkups)

WHY IT’S COMPLICATED

The catch with public insurance is that you’re on the hook for both your “employer” and “individual” contribution — so you have to pay twice as much out of pocket. This can cost up to €800 a month, depending on how much you earn.

The cost of health insurance for freelancers making €4,000 a month. (Source: Techniker Krankenkasse’s cost calculator)

Your monthly contribution is tied to your projected income for the year, so if you end up making less than what you expected…you’re still going to have to pay up!

Sure, you’ll get a refund at the end of the tax year when you report your actual income. (Conversely, if you make more than what you expected, you’ll have a hefty bill on your hands at the end of the year.)

Either way, you have to constantly budget when you’re on public insurance and may find yourself short on cash when you need it the most.

Private insurance

Private insurance is considered “fancy” and most Germans don’t have it. As I mentioned above, private insurance is not even an option for employees making less than €60,750 per year.

It’s definitely weird to be in the same category as “rich” people, but it does also make sense because neither group is paying into the public system that will take care of you unconditionally.

When you’re on private, you get your first choice of doctor, skip the lines and it often covers random things that public insurance doesn’t. Besides that, doctors LOVE treating privately insured patients because they get to itemize invoices for every little thing they do, which is great €€€ for them!

The short-term perks are really great for you too. I was able to get 1-hour custom physiotherapy sessions and a year’s supply of contact lenses covered. Public doesn’t cover any of that.

PROS:

  • You get to see any doctor you want, anytime you want (fancy!)
  • It can be cheaper than public insurance if you’re earning over €42k a year
  • Dental care is generally included (2x a year cleanings and any medically necessary treatments)

CONS:

  • You will not receive unlimited care in the event of long-term disability or disease

WHY IT’S COMPLICATED

A lot of folks discouraged me from going for private insurance because they perceive it as a risky move — and they’re not wrong.

That’s the thing with private insurance! You get the bells and whistles when you’re relatively healthy but it will eventually tap out at a certain point and leave you with the bills.

In a worst case scenario where you are unable to go back to work for months or even years, the German public system will pay for you to live.

You can’t count on that from private.

Why I chose private insurance

I ended up going with Ottonova, an expat-friendly health insurance for expats that I projected would cost me less per month (€312) than public insurance (€450+). It made sense for me because I’m:

a.) young and healthy

b.) wasn’t sure what my income would be

c.) only spending a few years in Germany

I realized I would never really see an ROI from public insurance and that I would just be stressed out all the time figuring out how to budget for it each month.

Ottonova actually exceeded my expectations in several ways. It covers literally everything and even includes a concierge to help me find English-speaking doctors and book appointments.

I know some of my friends would have chosen differently, but I ended up being pretty happy with my decision.

But if you’re going through the same public vs. private dilemma now, my advice remains the same: sit down and figure out what’s right for you.

(Full disclosure: This article does contain an affiliate link, for which I may earn a small commission.)

Nandini Jammi

Written by

Product Messaging Strategist + Organizer @ Sleeping Giants | www.nandinijammi.com

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