Health insurance: As a self-employed insure legally or privately?

In Germany, about 90 percent are insured with a statutory health insurance. In contrast to employees, self-employed persons are not subject to compulsory insurance and have the choice: they can freely choose between a statutory or private health insurance . Employees have this option only from a monthly income of currently 4,950 euros gross ...

Legally or privately insured
The self-employed, for example, when starting their own business or starting a business before deciding how to insure themselves, should not make the decision easy. Because this has far-reaching implications for the future : Who decides today, for example, for a private insurance, can change later only in a few cases back to the legal insurance. Even if private insurance, which is initially more favorable to young people in the first instance, seems more attractive at first glance, a legal insurance can be the more suitable alternative for many, especially in the medium and long term.


Different calculation of costs
While with employees half the cost of public health insurance - without additional contributions - paid by employers to carry self-employed contribution alone: Basically, they have to pay for their contributions, for their income to gross income threshold from the current 4,425 euros incurred, complete wear yourself. Proof of income is the income tax assessment of the tax office . The income from business operations or self-employment specified therein forms the basis for calculating the premiums.

A private health insurance can be just for younger, especially well-earning, cheaper than the statutory health insurance. With age, however, the contributions for a private insurance increase, and a later change back to the legal insurance is usually not easy. Even if the order situation fluctuates and the income from self-employment is not so high, the contribution for the private insurance remains the same, while the costs for the statutory health insurance to the income level.

The contribution calculation for the self-employed has been carried out since 2018 with statutory health insurance funds, namely always with reservation and is corrected retrospectively with the income tax assessment for the calendar year in question.

This works in a similar way to an electricity bill: you first pay contributions based on the last income reported in the tax bill. If the income tax assessment is present, then it is compared what was paid in this calendar year and what would have been payable. This can lead to recalculations or contribution reimbursements.

Anyone who already knows that he will earn more in the current year than in the previous year, for example, at the Siemens company health insurance SBK voluntarily pay more contribution in order to later pay less.


With private insurance pre-existing illness and age play a role
Benefits are usually very different for private health insurances and are combined depending on needs and financial possibilities. The more one is willing to spend for a private rate, the more benefits are included. Statutory health insurance, on the other hand, is based on the principle of solidarity : everyone pays depending on their income, and everyone receives the same medically necessary and meaningful benefits, regardless of their personal financial situation.

Also, with the statutory health insurance no (pre) illness or the age in the calculation of the contribution is factored in, as is the case with private tariffs. In the case of the latter, all pre-existing conditions must be specified, which can then influence the costs. For example, people with a chronic illness and thus higher treatment costs pay a significantly higher amount than people without pre-existing conditions. In some cases, private health insurance companies do not accept people with serious illnesses as insured persons. If you ignore previous illnessesWhether consciously or accidentally, private insurance may exclude the cost of treating this disease and reclaim money for treatments that have already been reimbursed.

Family planning should be included in the decision
Family members (usually children and spouses) who earn less than 435 euros or have only a 450-euro job are covered by the statutory health insurance. Private insurance does not have this option. Those who are self-employed and have a family or want to start a business, therefore, have financial advantages in the case of a legal insurance , since no additional insurance premium is due for children and spouses with no or little income.

Statutory self-employed persons who are entitled to sickness benefit receive maternity benefits before and after childbirth. To earn this claim, self-employed have to pay 0.6 percent more contribution than for a statutory insurance without sick pay. This usually corresponds to only a slightly higher contribution of a few euros per month. Private insured self-employed, however, are not entitled to maternity benefits.

Even with parental allowance, there are points that speak for the statutory health insurance, especially if there are only a few other income during the reference: Self-employed pay during the receipt of parental allowance - as long as the self-employment is not exercised or only small additional income available - only a health insurance contribution of currently around 180 euros .

The cash contribution during parental leave is thus significantly lower than the normal minimum contribution, which is currently around 410 euros a month for self-employed persons without a start-up subsidy . Private insured self-employed must in principle continue to pay their contribution as agreed, even if their income is lower than before.


Direct reimbursement of costs versus later reimbursement
Anyone considering self-employment as a private insurance should also keep in mind that he often has to pay in advance at the doctor's and at the pharmacy - the costs will only be billed to the insurance afterwards. For smaller "aches and pains" such as colds that is usually no problem. However, particularly in the case of serious illnesses, treatments and medicines quickly cost several thousand euros - money that not everyone on the verge has to put up for reimbursement by private insurance. For legally insured persons it is easier, because here the doctor and pharmacist calculate the legal benefits directly with the health insurance . The bill goes directly to the insurance in most cases, so insured people do not have to worry about it.


The decision should be well considered
Since private insurance can only rarely be changed back into statutory insurance, self-employed persons must therefore include a few other factors besides the actual contribution or tariff when choosing between statutory and private health insurance :

Is it certain that my income will remain the same or increase, so that growing costs for a private health insurance remain affordable with increasing age (because a later change to the statutory health insurance is not always possible without problems)?
Do I have a chronic illness or pre-existing conditions that would raise a private insurance rate?
Do I have children or a partner whom I want to insure free of charge, which is only possible in the legal insurance?
Am I planning to start a family in the future? Women should ask themselves these questions, as private insured persons, unlike legally insured persons, are not entitled to maternity benefits.
Am I willing to spend time accounting for my medical or medical expenses with private health insurance?
Do I always have the financial buffer to go to the doctor and the pharmacy in financial advance until the amounts are reimbursed by the private insurance?
Individual advice is worthwhile
Anyone who wants to learn more about the costs and possibilities of statutory insurance as a self-employed person or founder can obtain quick and uncomplicated advice from the Siemens Health Insurance SBK .

The SBK is one of the 20 largest statutory health insurance companies with more than one million insured persons and is open to all interested parties. Among other things, she advises self-employed persons on their health insurance contribution and on whether there is the possibility for a reduction of the contribution - for example by applying for a contribution relief.

In addition, the SBK advises on the subject of supplementary insurance and which of these are individually sensible. More information and contacts find self-employed here .

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