Without Health Insurance in Germany: Who is Affected and Why?

In Germany, health insurance is mandatory, yet many people still live without coverage. This situation affects various social groups, each facing specific challenges. In this blog post, we explore why some people in Germany lack health insurance, which groups are particularly affected, and what measures can be taken to address this issue. If you’d like to book a training or a lecture on this topic, contact us at kv.fragen@gmail.com.

Who is Affected?

Self-Employed and Students

At the beginning of their self-employment or studies, self-employed individuals and students can choose between statutory health insurance (GKV) or private health insurance (PKV). Some opt for private insurance as it seems cheaper initially. However, PKV premiums increase with age and a health check at the start of the contract can lead to pre-existing conditions being excluded or priced higher.

The main issue for the self-employed is financial uncertainty. Regardless of whether they have statutory or private insurance, they must bear the cost of health insurance themselves. With low or irregular income, many find it difficult to pay the premiums. Students often have irregular and low income as well, leading them to prioritize rent and food over health insurance. This results in unpaid contributions and debt. In both private and statutory insurance, failing to pay contributions for two months leads to a different form of coverage. More on this can be found in my blog post about debt and suspended benefits in the GKV.

Occasionally, self-employed individuals who were uninsured before the introduction of the insurance mandate continue to be uninsured today.

Self-employed individuals and students with a temporary visa cannot enroll in statutory health insurance. They are dependent on so-called private incoming insurance, which excludes pre-existing conditions or is limited to emergency care.

EU Citizens without Free Movement Rights

Citizens of the European Union (EU) living in Germany are initially entitled to free movement, meaning they have lawful residence under certain conditions. They must have health insurance and sufficient financial means, accompany family members who meet these requirements, or work in Germany. If they no longer meet these requirements, they lose their free movement rights and cannot enroll in statutory health insurance.

While they could theoretically switch to private insurance, the premiums, especially in the basic tariff, are often very high. As a result, many EU citizens fall through the cracks and remain without insurance even if they continue to live in Germany.

Homeless People

Not all, but many homeless individuals are not insured. This often happens because they are no longer reachable by their health insurers. Statutory health insurers are allowed to deregister members if they do not pay contributions and are unreachable for more than six months. The insurer must do everything possible to contact the member. If treatments are billed by doctors, this counts as contact with the insurance.

Due to this regulation, homeless people often lose their insurance coverage unnoticed. Given their precarious living conditions, it is particularly challenging for them to regain access to the healthcare system.

Released Prisoners

After release from prison, many people are without health insurance. During imprisonment, they are covered by the free healthcare provided by the justice system, which does not involve a health insurance company. To avoid paying contributions during imprisonment, many cancel or suspend their health insurance. Some insurance forms also end automatically when another form of coverage begins. The problem is that after release, they need to reapply for insurance, which is often not straightforward. Without a fixed address, job, or sufficient income, many are denied access to health insurance, leading them to seek medical help only when it is too late.

Migrants without legal residence papers

Migrants without legal residence papers (Sans Papiers) have little access to health insurance in Germany. They theoretically have a right to emergency medical care, similar to asylum seekers. However, they face a significant barrier: the obligation to report under §87 of the Residence Act. This obligation means that official authorities, such a social benefits offices, must forward their data to the immigration authority. As a result, many avoid seeking medical care out of fear of deportation, even when they urgently need medical attention. Access to basic healthcare remains severely restricted.

Why Do These Groups Fall Through the Cracks?

There are various reasons why people live without health insurance in Germany. Legal conditions and bureaucracy play a significant role, as well as financial constraints. Self-employed individuals, students, homeless people, and released prisoners face similar challenges: they either do not have enough money to pay contributions or are difficult for insurers to reach due to their precarious living situations. The situation is particularly dramatic when untreated illnesses, which could be managed with simple medical measures, become severe. This affects not only the individuals but also burdens the healthcare system, as uninsured patients often seek help only in expensive emergency situations. Hospitals rarely receive reimbursement for the services provided.