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Bookkeeping for freelancers in healthcare: what you need to know
Written by Ilias5 min read
As a freelancer in healthcare, whether you're a nurse, carer or support worker, your bookkeeping differs from other sectors on a few points. The most important is the VAT exemption for care services. In addition, the kilometres you drive between clients, your employment relationship statement and the usual entrepreneur deductions play a role. This article explains what you should watch for as a healthcare professional.
VAT exemption for care providers
Many care providers are exempt from VAT. Nursing and caring activities that fall under the BIG Act are exempt, as are services aimed at the medical care of people. This means you don't charge VAT on your invoices, but also that you can't reclaim VAT on your purchases. You then usually don't file a VAT return either, although there are exceptions for coaching or non-medical support, for example.
Pay close attention to which part of your work is exempt and which isn't. If you also give training or advice that doesn't fall under the care exemption, that part may be subject to VAT. A mixed administration requires a clean split, so that you know per service whether VAT applies.
Tracking kilometres and travel costs
As a healthcare professional you often drive from client to client. Those business kilometres matter for your bookkeeping. If you drive a private car, you may record 0.23 euros per kilometre as costs. Keep a watertight mileage record with date, destination and number of kilometres, because the tax authorities may ask for it.
If you travel by public transport or bicycle, those costs are also deductible as business expenses as long as they relate to your work. Keep your receipts and tickets digitally and your bookkeeping stays tidy.
Entrepreneur deductions and the hours criterion
If you meet the hours criterion of 1,225 hours per year, you're entitled to the self-employed deduction and, in your early years, the starter's deduction. For care providers the hours criterion is sometimes tricky: only the hours you spend directly on your business count, including travel time and administration. So keep good track of your hours.
In addition, as an entrepreneur you get the SME profit exemption, which automatically exempts part of your profit. If you work through agencies, watch your entrepreneur status for income tax: the tax authorities check whether you're genuinely independent and not effectively employed.
This article provides general information based on the rules known for 2026 and does not replace personal tax advice. For your specific situation, we're happy to take a look with you.
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