Opting out of public health insurance in favor of private health insurance?
When establishing insurance coverage under the Artists' Social Insurance Act (KSK), many self-employed artists and journalists face the choice: statutory or private health insurance?
Though it is mandatory for KSK members to be insured with public health insurance, there is also an option to be privately insured. You can exempt yourself from public health insurance under certain conditions.
Exemption from public health insurance for private health insurance:
Eligibility:
New Professionals: Self-employed artists/journalists within the first three years of their career.
High Earners: Those exceeding the income threshold for statutory insurance over three years.
Exemption is permanent for high earners but temporary for new professionals (up to three years after the initial exemption period ends).
Returning to GKV is possible for new professionals during their exemption but not for high earners once exempt.
Both public health and private health are subsidised by the KSK.
Contributions are income-based, offering affordable coverage for those with low, uncertain, or fluctuating incomes.
Benefits include:
Coverage without waiting periods or consideration of pre-existing conditions.
Free coverage for non-working spouses and children.
Maternity allowance.
Continued income-based contributions after retirement (health insurance for pensioners).
The statutory contribution rate is 14.6%, split equally between the insured and the Artists' Social Insurance Fund (7.3% each). Additional contributions are shared equally.
Example: For an annual income of €36,000 (€3,000/month) gross, your monthly contribution would be €219 + half the additional rate of the chosen provider.
Contributions are based on your age and health condition when you join private health
Some pre-exsting conditions might be excluded
For young people and high-earners, premiums are usually lower than public health premiums
Priority access to specialists
Exempt individuals can apply for a private health insurance subsidy from KSK
Subsidy amount: 7.3% of income + half the average additional contribution rate (1.7% in 2024), capped at 50% of the premium.
Example:
Private health premium: €220/month; annual income: €30,000 (€2,500/month) gross; subsidy: €110/month.
If the annual income drops to €12,000, subsidy reduces to €81.50/month.
Private Long-Term Care Insurance:
Statutory long-term care insurance is bundled with public health insurance.
Private care insurance must accompany private health insurance, with contributions calculated similarly but at lower rates.
Summary
Self-employed artists and journalists under the KSK have the option to choose between public health insurance and private health insurance, each with its own perks.
Public health insurance is great for those with lower or fluctuating incomes since the contributions are based on how much you earn. It also includes benefits like free coverage for non-working family members and continued coverage in retirement.
Private health insurance, on the other hand, offers more personalized options and access to higher-quality healthcare, which can be a big draw for high earners or people who want more control over their coverage. While the premiums aren’t income-based, subsidies from the KSK can help with costs, although they might not cover everything.
Switching to private health insurance does mean meeting certain conditions, and once you make the move, it’s usually permanent. Both options have their strengths, so the right choice depends on your income, needs, and priorities.