Bookkeeping for freelancers in healthcare: what you need to know
Written by Ilias Aarrass7 min read · Published on · Last reviewed on 
In short
Providing care to the patient is exempt from VAT, but making yourself available to an institution counts as supplying staff and is taxed at 21 per cent.
- Exempt turnover means you cannot reclaim the VAT on your own costs.
- Kilometres between clients are fully business, at 0.25 euros per kilometre in 2026.
- The 1,225-hour criterion also counts travel time, administration and training.
- With mixed work you need an allocation key for your input VAT.
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. If you are paid from a personal budget, also read pgb care providers and tax.
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, in 2026 you may record 0.25 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.
The three things that make care bookkeeping different
Working in care brings three particularities: the VAT exemption and its limits, the kilometres between clients, and the independence question with agencies and institutions.
- Check per assignment whether you provide care (exempt) or effectively hire out staff (taxed at 21 per cent). The contract and actual direction decide this; see the care exemption.
- Log your kilometres between clients: in district care and outpatient support that is often the largest deduction, at 0.25 euros per kilometre.
- Working largely through one institution or agency, test your independence: own clients, own planning and substitutability weigh heavily now enforcement has resumed.
- Keep your professional registration, conduct certificate and diplomas with your records; clients and the tax authorities ask for them.
- Exempt turnover means no VAT deduction on your costs. Mixed work requires an allocation key for your input VAT.
Exempt or taxed: the four situations
The healthcare VAT exemption depends not on your profession but on what exactly you supply and to whom. That distinction also decides whether you may reclaim VAT on costs.
| What you do | VAT | Reclaim VAT on costs? |
|---|---|---|
| Providing care to the patient, BIG-registered | Exempt | No |
| Making yourself available to an institution | 21%, this counts as supplying staff | Yes, for that part |
| Training, advice or coaching | Usually 21% | Yes, for that part |
| Exempt and taxed turnover side by side | Split per revenue stream | Only in proportion to your taxed turnover |
Frequently asked questions
Must I charge VAT as a care freelancer?
Usually not: care to the patient, provided from your own expertise, is exempt. Effectively deployed as agency staff, under the institution's direction and roster, it is taxed at 21 per cent.
Can I reclaim VAT on my costs?
Not insofar as your turnover is exempt. Doing taxed work too, such as training, you deduct input VAT proportionally. Record that allocation key.
Do kilometres between clients count as business?
Yes, fully, at 0.25 euros per kilometre in your private car. In district care that adds up fast; a complete daily log is worth it. See mileage records.
I work through an agency. Am I genuinely independent?
That depends on the facts: who sets your roster, method and rate, and can you be substituted? Since enforcement resumed, institutions themselves scrutinise this too. See false self-employment.
Which costs are typically deductible in care?
Your professional registration and renewal, mandatory training, logoed workwear, medical supplies, your phone pro rata and your kilometres. The conduct certificate for an assignment belongs there too.
Does the hours criterion apply to care freelancers too?
Yes, 1,225 hours including travel, administration and training. With a full caseload you clear it easily; do record the hours for the self-employed deduction.
Sources
- VAT exemption in healthcareBelastingdienst · belastingdienst.nl
- Business use of a private vehicle in 2026Belastingdienst · belastingdienst.nl
Sources checked on
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.
