No health insurance: why this can happen to everyone

Almost a year ago, the actor and ex-jungle camper Heinz Hoenig suffered suddenly and heavily. He fought for his life in hospitals for five months. The infected esophagus was removed, he was operated on at the main artery (Aorta), and further interventions are to follow this year.

He is in need of care, a stair lift had to be installed at home. All of these costs were mainly financed by donations from his many fans – because Heinz Hoenig has no health insurance.

Which sums have so far been accumulated can only be roughly estimated. Around 160,000 euros in donations were already consumed loudly last November when Hoenig’s wife Annika in her podcast “24 – (K) a summer in Berlin” said that another 90,000 euros would be necessary for an intervention in a Leipzig hospital. A payment post or installment payment plan was rejected, a doctor told her: “Ms. Hoenig, either you put the money on the table until the day after tomorrow, or we don’t take up your husband.”

Further interventions that still follow must be financed again by donations. Kärsten-Hoenig has supposedly tried to insure her husband back for months-so far without success.

You can get into such situations if you save yourself health insurance contributions in the healthy years of your life. And if you once said goodbye to the solidarity community, the return will be made more difficult. Basically, however, the social system in Germany is designed in such a way that you can hardly avoid the health insurance obligation.

How it comes to cases like Heinz Hoenig and which solutions there are – here are the most important questions and answers.

Since 2009, every person with residence in Germany has had to be insured. There is an income ceiling up to which there is an obligation to compulsory insurance in a statutory health insurance. It has risen significantly in recent years. In 2025 it is currently 5512.50 euros per month. Anyone who lies above this income limit can be insured privately on January of the following year, or they remain in the health insurance company as a volunteer. Neither statutory health insurance companies nor private health insurance can terminate their members.

Theoretically, the number of uninspired persons would have to go back to zero because of this legal obligation in Germany. But their compliance is hardly controlled. For example, it is not regularly captured by people from other EU countries who are legally in Germany, but are neither insured in their home country nor in this country. Immigrants from third countries without a valid residence status are often not insured.

There are also “long-term insurance”-that is, people who were not insured before the general health insurance obligation was introduced. Many self -employed people are likely to fall into this group who have never taken care of it or earned too little to pay the contributions.

We do not know from Heinz Hoenig since when he has not been insured. But his wife Annika says that after a private bankruptcy he could no longer afford the contributions.

Without health insurance, there are often homeless people or people who were terminated by their health insurance due to unpaid contributions before 2009. In addition to all of these cases, there is also a special right of termination for private health insurance: If the member of a “pre -contractual breach of notification” has been guilty, for example, knowingly does notify a cancer in the application for admission, the insurance may withdraw from the contract.

According to the Federal Statistical Office, only 61,000 people were not insured in Germany in 2019, significantly less than in 2015 than there were 79,000. However, experts assume a high number of unreported cases. The health economist Jürgen Wasem from the University of Duisburg-Essen assumed in an article in the aid organization “Doctors Without Borders” of a few hundred thousand people.

The health insurance of defaulting people, who have not paid their contributions despite double reminders for two months, rests automatically. This means that you are generally still insured, but can only use treatments acute diseases and pain. If you are privately insured, you will be classified in a legally prescribed “emergency tariff”, for which you will only pay around 100 to 150 euros per month.

For example, if a patient needed root canal treatment due to acute tooth root inflammation, he may then decide together with the dentist to try it with pain treatment. Unlike the basic tariff (SU), the emergency tariff cannot choose yourself, it is intended for exceptional financial situations.

Uninsured persons can report to the statutory health insurance company, in which you used to be a member. It must definitely accept it, regardless of the current state of health. However, for the time in which one was without sufficient insurance cover, contributions, for the four years ago, one percent of a default surcharge is calculated per month.

However, “intentionally reserved contributions” only become expired 30 years after the due date. People who are assigned to private insurance due to their insurance history also have a right to resume. You then pay the full premium retrospectively for the first six months without insurance, then a sixth of the contribution. You have to accept private health insurance and at least offer you the so -called basic tariff, which corresponds to that of statutory health insurance.

Basically yes. However, this also depends on where the person lives. In several municipalities and federal states, there have been so -called for several years, which have specialized in integrating people without health insurance into the regular health system or social assistance and giving them access to medical care. The state capital Munich, for example, has launched its own health fund with several hundred thousand euros, which in such cases pays the costs for necessary medical services.

Dominik Heck from the Association of Private Health Insurance PKV says: “In principle, the person concerned would have to submit an application for membership in private health insurance.” From the day of the application, i.e. before the examination and promise, services would then also be taken over. However, if the medical emergency occurred before the start of insurance, the individual case must be carefully checked. A reimbursement of costs is usually excluded.