Despite compulsory insurance: Tens of thousands in Germany uninsured

Even if you have difficulty paying, you can go back to the statutory or private health insurance scheme. How you should proceed and where you can get support.

“Are you privately insured or have statutory insurance?” This question, which is often asked when first contacting a new doctor’s office, would probably have to be answered with “neither”. Despite the current obligation to have health insurance, there are many consumers who do not have health insurance. This is fatal – at the very latest when they fall ill. But if you are without insurance once, you do not have to remain uninsured forever. We clarify the answers to the most important questions.

The general health insurance requirement has been in force since 2009. Anyone who was kicked out of their insurance before the introduction of the health insurance – for example because they could no longer afford the premiums – and has not re-registered since then is still living without insurance today. These people are often self-employed.

According to Sabine Wolter from the NRW Consumer Advice Center, other people affected include homeless people, people who are staying in the country illegally, or those who return to Germany after a long stay abroad and have not re-registered with health insurance.

Only since the introduction of compulsory health insurance can no one be thrown out of health insurance – whether statutory or private. Even if you can no longer afford the contributions at some point, you are not thrown out. In statutory health insurance (GKV), however, benefits may then be suspended, and in private health insurance (PKV) you may be placed in a lower-benefit tariff. In both cases, the insurer only covers the treatment costs in the case of acute illness, pain or pregnancy.

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“It is important to contact your health insurance company immediately,” advises Barbara Weber from the advice portal Finanztip. In the event of temporary insolvency, a deferral of contributions may be requested. For those with private insurance, switching to the cheaper basic tariff with fewer benefits may also be an option.

According to Weber, anyone who has problems making a living can also try to apply for citizen’s allowance or basic security. If approved, the office will then pay a subsidy towards the health insurance contributions.

In principle, that can happen. Doctors would only have to treat people without valid health insurance in serious or life-threatening cases, says Barbara Weber.

However, uninsured people usually do not have to go without medical help. In many cities there are aid organizations that provide voluntary care to people without health insurance in various contact points or mobile practices. These include Doctors of the World, Malteser, Caritas and Johanniter. Those seeking help can find the nearest option online.

Anyone who was last insured under statutory health insurance should go back to their previous health insurance provider. Those who were previously privately insured also generally have no choice but to go back to private health insurance, provided that nothing has changed in their life circumstances and they have, for example, switched from self-employment to employment subject to social insurance contributions.

The problem: Returnees have to pay at least part of the arrears that accrued in the months and years in which no contributions were made – plus any late payment surcharges. Depending on the length of the uninsured period, this can add up to considerable sums.

However, claims for contributions made long ago are time-barred. According to Sabine Wolter, statutory health insurance companies can only demand payment of contributions made no more than four years ago. For private health insurers, the deadline ends after just three years. In any case, private health insurers are only allowed to demand the full premium for the first six months of non-payment. For subsequent months, they are not allowed to charge more than one sixth, says Wolter.

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Consumers are generally well advised to seek professional advice when rejoining private or statutory health insurance. Good places to go are, for example, the Independent Patient Advice Foundation Germany or the advice centers of consumer centers. There, experts can calculate whether the claim of the respective health insurance company was calculated correctly or whether the list contains contributions that have already expired. In this case, the appropriate adjustments would have to be made.

If the additional charges are correct but still so high that those affected cannot possibly pay them in one lump sum, they can try to agree on payment in installments with their statutory health insurance or private health insurance provider. However, there is no entitlement to this, explains Barbara Weber.