Health insurance and pension as a creator in Germany
9 min read · Updated on 2026-10-27
Short answer
In German health insurance everything hangs on one distinction: whether self-employment is your main occupation or a side one. On the side, you stay in your existing cover; as your main occupation, you pay alone – in 2026, with the average additional contribution, about 20.5 percent of your profit for health and long-term care insurance, at least about 270 euros a month. If you work essentially for one agency only, compulsory pension insurance can apply as well.
Creators talk about taxes all the time. About health insurance and pensions, almost never — even though the health insurance contribution is the bigger item for many, and it arrives late, once you have grown used to the income. This article sorts out what is coming and when. It does not replace advice from your health insurer or a professional, and that sentence is meant seriously.
The one question everything hangs on
For health insurance there is really only one distinction that matters: are you self-employed as your main occupation, or on the side?
As long as OnlyFans runs alongside a job, studies or training, and the emphasis clearly sits there, you stay in your existing cover. As an employee you keep paying through your employer, as a student through student cover. Additional contributions may fall due on your profit, but your status stays the same.
Once the balance tips, everything changes: whoever is self-employed as their main occupation insures themselves — and pays alone what employer and employee otherwise split.
How insurers decide what counts as "main occupation"
There is no single number that flips the switch. Insurers follow the guidance of the National Association of Statutory Health Insurance Funds (GKV-Spitzenverband), which gives clear rules of thumb if you are also employed:
| Your job alongside | What the insurer assumes |
|---|---|
| full-time | side occupation – there is no room left for self-employment as your main occupation |
| more than 20 hours a week and more than 1,977.50 € gross a month | side occupation |
| at most 20 hours a week and at most 1,977.50 € gross a month | self-employment is your main occupation |
The 1,977.50 euros are half of the monthly reference figure (Bezugsgröße) for 2026. Without a job, time matters most: more than half-time – more than 20 hours a week, counting preparation, follow-up, admin and bookkeeping – points to main occupation; it can be so below that too if the income is your main source of living. Anyone employing someone beyond a mini-job is presumed by law to be self-employed as a main occupation unless they show otherwise. If no rule fits, the insurer compares time and income: if the self-employment clearly outweighs the rest on both – as a guide, by at least 20 percent – it counts as your main occupation.
The practical advice: ask your insurer before they ask you. A phone call describing your situation costs nothing. A reclassification applied retroactively across two years can hurt badly.
Thinking about working with an agency? Applying takes two minutes – free of obligation and confidential.
Go to the applicationThe three states and what they cost
| State | Who pays | What to watch |
|---|---|---|
| covered through a partner or parents | nobody | in 2026 at most 565 € total income a month — cross it and the cover ends entirely, not gradually |
| self-employed on the side, with a job | the employer keeps paying its share | the insurer weighs hours, income and employees together |
| self-employed as your main occupation | you alone, the full contribution | in 2026 at least about 270 € a month, even in weak months; the contribution is estimated and corrected later against your tax assessment |
What it costs once you pay yourself
As someone self-employed in their main occupation, you pay the full contribution for health and long-term care insurance alone. The figures for 2026:
| What | 2026 |
|---|---|
| Health insurance | 14.0% without sick pay entitlement, 14.6% with |
| Additional contribution | depends on the insurer, 2.9% on average |
| Long-term care insurance | 3.6%, childless from age 23: 4.2% |
| Minimum assessment base | 1,318.33 € a month |
| Contribution ceiling | 5,812.50 € a month |
Without sick pay and with the average additional contribution, that is 20.5 percent of your profit for health and long-term care insurance, 21.1 percent if you are childless – at least about 270 euros a month (about 278 euros childless), at most about 1,192 euros (about 1,226 euros childless). That is our calculation with the figures in the table; your insurer's additional contribution is on its website.
Two things regularly come as a surprise:
There is a minimum contribution. The insurer calculates on at least 1,318.33 euros a month – one ninetieth of the monthly reference figure per day – even if you earn less. So in a weak month you still pay. The reduced minimums for start-ups that used to exist have been abolished; the minimum applies to everyone self-employed as a main occupation.
The contribution starts as an estimate. Your insurer sets it based on what you declare and corrects it later against your tax assessment. Anyone who estimated too low in year one gets a back payment in year two — on top of the ongoing contributions. This is exactly where creators get squeezed who could not yet judge their income in the first year.
Family cover: the point most people miss
Anyone covered through a partner or parents pays nothing — as long as their own total income stays below a limit. In 2026 it is 565 euros a month, one seventh of the reference figure; only for a mini-job does 603 euros apply. For the self-employed, profit counts, not revenue. What this means while studying is covered in OnlyFans while studying in Germany.
Cross it and family cover ends. Not gradually, but entirely. And because insurers often only notice when the tax assessment arrives, the claim comes with a delay, for a period in which the money has long been spent.
If you are on family cover and your income is growing: keep an eye on that threshold and report it yourself as you approach it.
The pension trap for creators with one agency
The point almost nobody knows — and it hits precisely those creators who work with an agency.
In Germany, self-employed people are generally not subject to compulsory pension insurance. But there are exceptions, and one is called employee-like self-employment. Simplified, it applies when both are true:
- You employ nobody subject to social insurance, and
- you work permanently and essentially for a single client.
Anyone earning their entire income through one agency can fall under this. Compulsory pension insurance then applies — and where the obligation is established later, retroactively. The contribution rate in 2026 is 18.6 percent. Without proof of your income, the pension insurance charges the standard contribution, about 736 euros a month in 2026; if you prove a lower income, you pay correspondingly less, at least about 112 euros.
Two exceptions help: for the first three years after first starting out you can be exempted on application. And marginal self-employment – a profit of regularly no more than 603 euros a month in 2026 – is exempt anyway.
Whether it applies in your case depends on the specifics: how the collaboration works, who carries the business risk, whether there are other income streams. This is exactly the question worth having checked once by someone qualified to answer it. The German pension insurance offers a formal status determination procedure for this.
And the pension itself?
Whoever is not covered gets nothing — that is the uncomfortable flip side of the freedom. A creator income can be good for years and still produce not a single pension entitlement.
Three routes are open:
- Voluntary contributions into the statutory pension scheme. Flexible, and you can fill in past years.
- Private provision, from a simple ETF savings plan to subsidised contracts.
- Real assets, such as property — with every advantage and drawback that entails.
Which fits depends on your situation. What does not fit is the most common variant: doing nothing, because the topic is unpleasant and retirement seems far away.
If you move abroad
The moment a move abroad is on the table, both topics change fundamentally — different systems, different obligations, and the question of what happens to entitlements already earned. We covered this in more depth in the articles on relocating abroad as a creator and setting up a company abroad. Short version: plan first, move second — not the other way round.
The three things that actually matter
- Call your health insurer before your status changes. The call takes ten minutes and prevents the most expensive surprises.
- Set money aside for more than tax. Anyone who only builds a tax reserve gets caught cold by the first contribution back payment. Budget for both together.
- Have the pension question checked once if your income essentially comes from one agency. Settled once, it is settled for years.
We support our models with these questions and work with tax advisers who know creator income. What we do not do: tell you which insurance to buy — that is someone else's job, and rightly so.
Sources
- Section 5 SGB V — compulsory health insurance — subsection 5: self-employed as a main occupation, presumption for employers
- GKV-Spitzenverband: guidance on self-employment as a main occupation (German) — 20 hours a week, half the reference figure, clearly outweighing (version of 20 March 2019, copy hosted by VIACTIV Krankenkasse)
- Section 240 SGB V — how contributions are assessed for voluntarily insured members — subsection 4: at least one ninetieth of the monthly reference figure per day
- Section 241 SGB V — general contribution rate and Section 243 SGB V — reduced rate — 14.6 and 14.0 percent
- Federal Ministry of Health: average additional contribution 2026 (German) — 2.9 percent, Federal Gazette of 10 November 2025
- Care contribution rate regulation 2025 (German) — 3.6 percent, and Section 55 SGB XI — 0.6 points extra for the childless
- Social insurance reference figures 2026 (German) — reference figure 3,955 euros, contribution ceiling 5,812.50 euros a month
- Section 10 SGB V — family cover — one seventh of the reference figure
- Section 2(1)(9) SGB VI — pension insurance for the self-employed with a single client
- Pension contribution rates 2026 (German) — 18.6 percent
- Section 165 SGB VI — contribution base for the self-employed — standard contribution from the reference figure, floor from the mini-job limit
- Section 6 SGB VI — exemption — subsection 1a: three years after starting out
- Section 5 SGB VI — exemption from insurance and Section 8 SGB IV — marginal work — marginal self-employment, limit derived from the minimum wage
- Deutsche Rentenversicherung: status determination procedure — how to settle that question for good
- SVS: health insurance for the self-employed (Austria)
Questions about your own situation?
Send us a few details – we usually get back to you within 24 hours for a free, confidential first conversation.
Want to know what to expect first? How the start as a model works