What does it mean to be "voluntarily insured" in the public healthcare system?

In Germany, everyone is required to have health insurance whether they’re only here for a temporary stay for touristic reasons, to study, to visit family, or to work. Some people are freiwillig versichert (voluntarily insured) and some people are pflichtversichert (mandatorily insured).

The difference between being voluntarily and mandatorily insured is that the people who are voluntarily insured have the choice to be insured through the public health insurance system or one of the many private health insurance providers while anyone who is mandatorily insured must be insured through the public health insurance system.

A yearly income threshold of €64,350 has to be passed for someone to be able to get private health insurance, but unlike public health insurance where your monthly premium depends on your income, private health insurance premiums are determined by your age and health when signing up. Depending on your tax bracket, this means the highest someone will ever pay for public health insurance is €769.16 per month (which is pretty high).

That’s why many people look at switching to private health insurance which can be significantly cheaper and offer added coverage benefits like the ability to see a chiropractor, dental insurance, vision insurance, and no more recommendation from your general practitioner to see a specialist doctor. There are, however, a few downsides: you need to file a claim for reimbursement and pay out-of-pocket for most procedures, switching back to public can be difficult depending on your situation, certain pre-existing conditions may not be covered, your dependents each have their own monthly premiums, etc.

Self-employed and freelancers are always voluntarily insured

That means they almost always have the choice of which insurance they want to get.

Sometimes, however, public health insurance will deny someone’s application for coverage if they’re voluntarily insured. Private health insurance can also deny that person’s application (for things like pre-existing conditions or freelancers who earn less than €30k per year), which leaves them with only a select few options for insurance (which tend to be quite expensive unless they have been in Germany for less than 5 years).

For people who are not eligible for private, public, expat, or cannot afford other health insurance options, we recommend that you consider taking a full-time job at a German company to switch to public insurance before continuing your self-employment or freelancing.

The requirements of getting public health insurance while voluntarily insured

The rules to get this type of public insurance are pretty complicated and strict. These are the requirements to get into voluntary insurance.

  • You have to decide to join the public insurance within 3 months of coming to Germany.

  • You have to have previous public insurance history in Europe

    • Option 1) You are publicly insured in Europe at the moment for at least 12 months consecutively and decide to switch to a German public insurance provider

    • Option 2) You have been publicly insured in a European country for more than 24 months in the last 5 years. These 24 months don’t have to be consecutive or in one country exclusively.

If you're a freelancer from the EU click here.

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