Life without health insurance: “I should pay more than 20,000 euros”

Andreas Fink is self-employed and, according to his own statements, works in the “editorial area”. He has everything he needs to live, an apartment, enough food, friends, a family.

What Andreas Fink doesn’t have: health insurance. “It started with self-employment, since the income is rather low at the beginning,” he says in an interview with FOCUS online. “So you sort out the things that cause the most costs.”

In his case, that was the premiums he paid for his health insurance. Fink, who doesn’t want to read his real name on the internet, has been living as an “uninsured” person for more than ten years. And is aware of what that means.

“I know the concerns. You ask yourself: what if you have an accident? Who is going to pay for that?” Fink knows that he will be asked to pay for it himself. At the moment it’s just a few dental bills, 30 or 40 euros. But will it stay that way?

“I assume that several hundred thousand people do not have health insurance”

Andreas Fink is not an isolated case. According to the Federal Statistical Office, around 60,000 people in Germany have no health insurance. Those are the official numbers.

Jürgen Wasem, Professor of Medical Management at the University of Duisburg-Essen, assumes that the number of unreported cases is high. “In particular, people from precarious living conditions, such as the homeless, are disproportionately often not recorded by the microcensus,” he says in an interview with FOCUS online.

There are also people who do not have a legal residence permit, such as refugees. Wasem assumes that between 700,000 and one million people living in Germany do not have health insurance.

This is explosive. Because health insurance is actually compulsory in this country. Every citizen residing in Germany – with a few exceptions – must be insured, either privately or legally.

The two “types of insurance” differ greatly from each other. In principle, statutory health insurance (GKV) is open to everyone. More than 90 percent of the benefits that the insured receive are prescribed by law and are therefore the same for all health insurance companies.

The contribution that a person has to pay depends on gross income. This means that whoever earns more also pays in more. With private health insurance (PKV), the sum that is due depends on age, state of health and the insurance cover that a person wants.

Private vs. statutory health insurance

The self-employed are free to choose whether they want statutory or private insurance. Employees can only enter private health insurance if they have exceeded the so-called “annual income limit” for a year. This is 66,600 euros in 2023.

A private health insurance often offers more extensive services than a statutory health insurance. But as you get older, so do the costs. Some private patients have turned to FOCUS online. They report on “absurd premium increases” and “gagging contracts”.

The insured often has no choice but to pay the high premiums or negotiate with the respective private health insurer. It is usually not possible to return to statutory health insurance. From the age of 55 it is virtually excluded.

It is no longer possible to return to statutory health insurance from the age of 55

This is particularly problematic when the contributions are so high that the insured person can no longer bear them. That’s how Alexander Horn felt. He wants to remain anonymous but tell his story.

Horn had private health insurance for many years. “Now, at retirement age of 67, I can no longer afford the whole thing,” he wrote in an e-mail to our editors. He cannot return to the GKV.

So Horn, who was self-employed, who worked as a teacher at music schools and in the trades, was classified under the so-called “emergency tariff”. It is intended to offer private patients minimum insurance protection if they can no longer pay their contributions.

Emergency tariff: benefits severely restricted

“The emergency tariff only provides for the reimbursement of expenses for services that are necessary for the treatment of acute illnesses and pain conditions as well as pregnancy and maternity,” says paragraph 153 of the Insurance Supervision Act.

Medical help so only shortly before collapsing. A solid health insurance is no longer that. Nevertheless, there are good reasons why private patients cannot simply switch back to statutory health insurance if the contributions are too high for them.

“The statutory health insurance works more than the private health insurance with interpersonal and intergenerational redistribution,” says Wasem. “Therefore, a constellation in which people – as long as they are young and healthy – opt for private health insurance and then return to statutory health insurance when they are old and ill should be avoided.”

If you want to re-enter, you have to pay extra

Another problem are patients who have not had health insurance for a while. Because they don’t come back to the GKV that easily. “Anyone who was not insured once must – if they want to re-enter statutory health insurance – usually pay additional contributions,” says Wasem. The health insurers demand additional contributions for up to four years remain, says the economist.

Jochen Mayer is such a person. He also wants to remain anonymous. From 2013 to 2018 he took care of his wife, who was suffering from cancer, as he told FOCUS online. “She was in bed most of the day, every few days she had to have chemo. We spent more time in the hospital than at home.”

Mayer has two daughters who were minors at the time. Due to his wife’s cancer, he had to give up his part-time self-employment and was unemployed.

The family was forced to move out of the rented terraced house near Berlin. Then, in 2018, Mayer and his wife separated. Mayer didn’t think for a second about his health insurance. He was convinced he would have family insurance until the divorce. Then he got a letter from his health insurance company.

“I should pay more than 20,000 euros”

“It said I was no longer insured. I was supposed to pay more than 20,000 euros in arrears,” he says. Mayer does not know whether his ex-wife deregistered him from family insurance and if so, when exactly. He doesn’t know what went wrong.

But one thing was clear to Mayer from the start: he couldn’t afford more than 20,000 euros. The health insurance company stuck to its claims, the 61-year-old did not pay. “Now I have a letter that says I can only get medical help free of charge for serious illnesses,” he says. Medical care only in emergencies.

But even if the procedure seems tough – it has its right to exist. Because insurance that you only take out when you need it doesn’t work. That would be unfair to all those who deposit consistently.

Wasem also says: “Those affected can usually negotiate that the rest contribution is subsequently requested, which is 65 euros per month.” In other words: apply for a reduction.

Thuringia with a showcase project

Anyone who needs medical help but is not insured can also approach individual clubs and institutions. In Thuringia, for example, those affected can contact the “Anonymous Health Insurance Scheme”.

“There will always be people who fall out of a system. And we believe that access to medical care is a state task,” said coordinator Carola Wlodarski-Simsek in 2021 on “Deutschlandfunk Kultur”.

The “anonymous health insurance certificate” is intended to help lead people back to health insurance. Or, if that is not possible, provide them with medical treatment options.

Malteser want to return people to health insurance

There are similar projects all over Germany. The Malteser Medizin München (MMM), for example, offers “basic medical care”, said Eberhard Köhl of the “Süddeutsche Zeitung”.

The doctor is one of around 50 volunteers at MMM, he runs a consultation for people without health insurance. The Malteser carried out a total of 1100 treatments last year.

In order to bring those affected back to health insurance, the facility works together with the Condrobs health clearing house. Sometimes, but not always, such a return succeeds.

Nevertheless, the number of uninsured Germans has increased in recent years, say the Malteser. Andreas Fink, who deliberately forgoes health insurance, finds that he simply “has to take care of himself”. “I call it personal risk,” he says, “and that’s why the Americans haven’t died out yet.”

Health insurance is not compulsory in the USA. Many working-age Americans are uninsured, with 28.9 million in 2020, according to the “Ärzte-Zeitung”.