Before you start

An employment contract, or evidence of self-employed income
Meldebescheinigung from your Anmeldung
Steuer-ID and, once issued, your social security number
A German bank account for contributions

Step-by-step

1
Establish which system is actually open to you
Employees below the compulsory insurance threshold — around EUR 77,400 gross for 2026 — must be in the statutory system. Above it, and for freelancers and the self-employed, private cover becomes available. This is eligibility rather than preference, and worth checking before a broker frames the choice.
OnlineWho: YouFirst month
2
Default to statutory unless you are certain
Statutory funds differ modestly in supplementary rate and extras, and switching between them is straightforward. Starting statutory keeps every option open. Starting private closes most of them, permanently after 55.
OnlineWho: You
3
If you are self-employed, budget for the whole contribution
A freelancer pays both halves of health and long-term care insurance, calculated on income with a minimum assessment base even in a thin year. That minimum is what catches people in their first freelance winter — the contribution does not fall to zero simply because the invoices did.
OnlineWho: You
4
Check whether the Künstlersozialkasse applies to your work
The KSK covers self-employed artists, writers, musicians, journalists, designers and photographers, paying the employer share of health, long-term care and pension contributions. Acceptance requires evidence that the creative work is your principal occupation and that it earns above a modest annual minimum. Applications take months and are worth starting early.
OnlineWho: You
5
Get the membership confirmation for your residence permit
The Ausländerbehörde requires proof of valid cover before issuing or activating a permit. Your insurer issues a Mitgliedsbescheinigung on request within days — have it before the appointment rather than discovering the requirement in the room.
OnlineWho: You
6
Register with a Hausarzt while you are well and learn 116117
Your GP is the gateway to specialists and to the sick note German employers require from the third day of an absence. Register early. For urgent problems outside surgery hours, 116117 routes you to whatever is open rather than to a hospital emergency department where a non-emergency waits at low priority.
In personWho: You

Documents you’ll need

Employment contract or evidence of freelance income
Meldebescheinigung
Steuer-ID and social security number
Passport and residence permit
Portfolio, contracts and income evidence, for a KSK application

Things most newcomers don’t know

The Künstlersozialkasse pays the employer half of your contributions, and most eligible newcomers never apply.

The KSK exists because freelance creative workers have no employer to split social contributions with, so the fund takes that role for health, long-term care and pension. Designers, writers, photographers, musicians and journalists all commonly qualify. The catch is that acceptance requires the creative work to be your principal occupation and to clear a modest annual income floor, and the application takes months — so start it long before you need it.

Source: Künstlersozialkasse

A freelancer's statutory contribution does not fall to zero in a bad month.

Contributions are assessed on income but with a minimum assessment base, so even in a quiet quarter there is a floor beneath what you owe. New freelancers budget from their good months, hit a thin winter, and find the contribution unchanged. Statutory funds will reassess downwards on evidence of reduced income, but you have to ask — they do not do it on their own.

Source: Bundesministerium für Gesundheit

Going private is close to a one-way door, and dependants are the hidden term.

Private premiums are lower for a young healthy high earner and rise with age rather than falling. Every family member is separately underwritten with their own premium, where the statutory system covers a non-earning spouse and children at no extra charge. Returning to statutory cover is possible only under narrow conditions and effectively impossible after 55. Model the thirty-year path, not the first year.

Source: Bundesministerium für Gesundheit

116117 is the number that keeps you out of an emergency department.

The national medical on-call service handles urgent but non-life-threatening problems outside surgery hours and directs you to whatever is actually open. Newcomers default to the hospital, where a non-emergency is triaged accordingly and can wait many hours. Save the number now — you will be looking for it at a point when looking anything up is difficult.

Source: Kassenärztliche Bundesvereinigung

Common mistakes to avoid

Freelancing in a creative field for years without ever checking KSK eligibility.
Budgeting a freelance health contribution from good months and forgetting the minimum assessment base.
Choosing private cover on a first-year premium comparison without modelling family and age.
Turning up at the Ausländerbehörde with no membership confirmation from your insurer.
Waiting until you are ill to look for a Hausarzt with an open list.

Some of this may be out of date. Spotted something inaccurate? Help us keep it right for the next newcomer.