Are health insurance premiums overwhelming? Then you should contact your provider in good time. There is often a way to reduce the premium.

Although there is a general health insurance requirement in Germany, there are people who are neither legally nor privately insured. According to the Federal Statistical Office, this applied to around 61,000 people in 2019; the number of unreported cases could be much larger. This usually only becomes a serious problem for those affected when they need medical treatment. Then they have to bear the sometimes immense costs themselves. Impossible for many. Ideally, it doesn’t even get that far.

Particularly affected by the lack of insurance coverage are: self-employed people, freelancers and the unemployed who at some point can no longer afford the contributions due to fluctuating or lack of income. There is the possibility of reducing contributions for some people who are voluntarily insured with statutory health insurance (GKV) and for those who are privately insured. The Association of Insured Persons (BdV) recommends that consumers contact their insurer in good time if a difficult financial situation is foreseeable.

Unlike private health insurance, the contribution payments for statutory health insurance do not depend on benefits, age and health status. Here the amount of the contributions depends solely on the earned income. But this can vary greatly from year to year, especially for self-employed people and freelancers.

Anyone who has to pay high contributions to statutory health insurance due to a good financial year may be burdened disproportionately in times of lack of orders. In such cases, those with voluntary statutory health insurance can submit an application to their insurer for a premium reduction.

According to the NRW consumer advice center, the prerequisite for approval is that the actual income in the current year is likely to be more than 25 percent below the income determined in the last income tax assessment. An advance payment notice for income tax is sufficient as proof.

With private health insurance (PKV), lower premium payments are regularly associated with a loss of benefits. Older, long-term insured people who switched to private health insurance before January 1, 2009 can, under certain circumstances, switch to the so-called standard tariff of private health insurance. According to the PKV Association, its benefits are comparable to those of statutory health insurance. The contributions are capped at the maximum GKV contribution (2024: 755.56 euros per month).

Anyone who needs help within the meaning of social law and cannot support themselves from their income and assets can also switch to the basic private health insurance tariff. Here too, the benefits are comparable to those of the GKV, but the contribution rate may not exceed half of the GKV maximum contribution (2024: 377.78 euros per month).

Insured people who only switched to private health insurance from 2009 can switch to the basic tariff at any time. A need for help is not a prerequisite for them, says the BdV. However, if you actually need help, you may be able to count on subsidies or full coverage of the PKV contribution rates by the social welfare provider.

Furthermore, privately insured people who do not pay their premiums for months may be able to switch to the emergency tariff. According to the BdV, this only reimburses the treatment costs for acute illnesses and pain, pregnancy and maternity.

The services are somewhat more extensive for children and young people. According to the BdV, the premium for this is on average around 135 euros per month; deductibles and risk surcharges are suspended. However: Insured persons cannot force the switch to this tariff themselves. If they need help, they are generally denied access to the emergency tariff.

Anyone who has not had health insurance coverage for years but would like to return to statutory or private health insurance at some point must also pay back contributions – or at least parts of them – from the time without insurance. Even if he or she has never been to the doctor during this time. The NRW consumer advice center points this out. Depending on how long the insurance cover was interrupted, this can add up to considerable sums. Sometimes these can be paid in installments.

As a rule, uninsured people do not have to do without medical help. In many cities there are aid organizations that provide voluntary care to people without health insurance in various contact points or traveling practices. These include, for example:

Those seeking help can find the nearest option online.