Freedom, and the Loss of the Rails
Becoming self-employed changes your insurance status immediately: the income threshold no longer gates you, so private health insurance is open regardless of what you earn. That freedom is real — but so is the loss of the employed person’s safety rails. There is no employer paying half your premium, and in year one your income is often lumpy and hard to predict. Choosing PKV as a founder is less about eligibility and more about structuring cover you can carry through a bumpy start.
The founder’s pivot: as an employee, the employer subsidises roughly half your PKV premium. As a founder you pay it all yourself — so the premium you can comfortably sustain in a lean month, not the one you can afford in a good one, is the right planning figure.
PKV vs Voluntary GKV for Founders
Founders can also choose voluntary statutory insurance, and the trade-off is worth naming. Voluntary GKV charges a percentage of income (within limits), so it flexes down when you earn little — comforting in a slow year, but expensive once you are profitable, and it does not build ageing reserves. PKV charges a fixed premium based on age and health, independent of income — predictable and often cheaper for a healthy founder, but unforgiving in a month with no revenue. Neither is universally right; your health, age and income trajectory decide.
Structuring PKV to Survive Year One
- Choose a sustainable tier: pick benefits you need at a premium you can meet in a poor month, not a maximal tariff you can only afford when flush
- Use the deductible sensibly: a moderate Selbstbehalt lowers the premium; too high an excess just moves risk onto your leanest months
- Add Krankentagegeld: as a founder you have no sick pay — daily-sickness-benefit cover replaces income if illness stops you working
- Keep a premium buffer: hold a few months of premium aside so a slow quarter never threatens the policy
Don’t Over-Optimise Too Early
It is tempting to buy the leanest possible tariff to protect cash, then plan to “upgrade later”. Be careful: upgrading means fresh health questions, and a condition that appears in the meantime can make the upgrade costly or impossible. Better to start at the benefit level you actually want, at a premium you have stress-tested against a bad month, than to under-insure and find the door narrower when you try to move up.
The Bottom Line
For founders, PKV is a genuine and often attractive option — the income threshold is gone and a healthy entrant can get strong cover at a predictable price. The discipline is planning for a first year without an employer subsidy and with uneven income: choose a sustainable tier, add sickness benefit, keep a premium buffer, and don’t under-insure on the assumption you can freely upgrade later.
Frequently Asked Questions
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