It is a slow descent from private patient to uninsured. You don’t just get thrown out of health insurance, be it private or statutory. It’s all the more fatal once you’re outside.

Actor Heinz Hoenig needs several life-saving operations. The problem: The 72-year-old has no health insurance, like 61,000 other people in Germany. But how can it happen that someone in a country like Germany, where insurance is compulsory, no longer has insurance cover?

In principle, employees who have a job that requires insurance, i.e. earn more than 538 euros per month, as well as those who receive social assistance, are automatically covered by health insurance. Self-employed people, and therefore many artists or actors like Heinz Hoenig, have to take care of themselves. They often choose private health insurance because the contributions for young, healthy people are significantly lower than those for statutory health insurance companies.

However, as you get older, the contributions quickly become more expensive. In exceptional cases, health insurance costs several thousand euros per month, while employees and pensioners have to give up an average of 14.6 percent of their income or pension. Anyone who can no longer afford the amounts will be warned after two months. Once. Twice. After six months, the insured person then slips into the so-called emergency tariff. The only way out of this is who can pay the contribution debts that have arisen – and they continue to add up until you are back on the full tariff.

In this emergency plan, the insurance only pays for pain treatment and acute care. The example of a root canal treatment shows what this means. Instead of resolving the inflammation and placing a crown, the doctor can only treat the pain. The services are therefore significantly lower than what private patients are otherwise used to and are also significantly below the service catalog of the statutory health insurance companies. In the emergency tariff, further contributions are due. However, they are significantly lower: 100 to 125 euros per month.

However, once you are out of your health insurance, it is difficult to return – and health care is expensive. There is no control over compulsory insurance. If you don’t have insurance, you have to pay yourself – even if the bill is 140,000 euros, like for Heinz Hoenig’s operations. In exceptional cases, social assistance recipients can receive support from the social welfare office. In some municipalities, such as Munich, there are also special offers of help.

In the case of Heinz Hoenig, his wife Annika has been trying for years to find a way for him to get back into insurance. The problem: Anyone over the age of 55 has virtually no chance of returning to statutory health insurance if they were previously privately insured. A trap that many pensioners also fall into. Only the basic tariff of private health insurance remains. It would at least cover what the statutory health insurance companies pay. It currently costs 850 euros – the maximum rate of statutory health insurance. Operations would also be covered here – but without private patient privileges such as two-bed rooms and treatment by a senior physician.

But only those who pay their contributions – and debts – are eligible for the basic tariff. To do this, you have to submit an application and pay the contributions for the previous uninsured years. Theoretically, health insurers are only allowed to charge contributions for five years, but the following applies: you pay the full contribution of 850 euros for the first five months of the term and one sixth for the remaining four years and seven months. With the basic tariff you could buy your way back into private health insurance with just under 12,000 euros. However, anyone who still has debts from their insurance period must also pay them.

If you can’t afford this, you may be left with family insurance. Here, a spouse who earns less than 538 euros can slip into statutory health insurance under the umbrella of the other partner. However, that doesn’t seem to have worked for the Hoenigs either.

Returning to insurance coverage is easier for those with statutory health insurance. She has to reinstate her old cash register. However, additional payments must also be made for the insurance-free period, but for a maximum of four years. There are also big discounts. Anyone who cannot pay their debts also falls into the emergency tariff in the GKV.

Statutory insurance also includes mandatory follow-up insurance. Hoenig’s wife Annika Kärsten-Hoenig is currently trying to take this path. Also with moderate success. This insurance option is available to all those who previously had health insurance and then no longer have compulsory insurance, including employees who earn more than 69,300 euros a year, as well as self-employed people, pensioners and artists. Anyone who does not take out health insurance and provides proof of this to their health insurance company will remain protected by their health insurance company via the follow-up insurance. This is to prevent anyone from falling out of insurance coverage. However, the protection is not expressly intended for former privately insured people.