2024-05-06 20:43:36
Heinz Hoenig was thrown out of private health insurance because of debts. He was not allowed to switch back to the legal system. Why?
Heinz Hoenig does not have health insurance. His family has been collecting donations for emergency surgery since last week. The background to Hoenig’s insurance coverage has now become known. As Hoenig’s wife Annika told the broadcaster n-tv, Hoenig was kicked out of private health insurance (PKV) a few years ago because he no longer paid contributions.
Because the actor was already over 55 years old at the time, he could not switch back to statutory health insurance (GKV). But why is that so? Under what conditions is it still possible to switch to statutory health insurance? And what can someone do if they can no longer afford the private health insurance contributions? The most important questions at a glance.
What is the difference between statutory and private health insurance?
In Germany, two models of health insurance exist in parallel, the statutory and the private. The majority of the population – over 70 million people – are legally insured, including the majority of employees. Private health insurance, on the other hand, often includes self-employed people and freelancers, high-earning employees and civil servants.
Private health insurance is often described as “better”. Treatment in special clinics and by specialists as well as more comprehensive denture services are often included. Insured people are usually entitled to a single room and a shorter waiting time to get to doctor’s appointments. The GKV, on the other hand, covers the most important health services.
There is a big difference when it comes to contributions: While in the GKV these are based on income, the contribution for private health insurance is calculated from the service package that insured people can choose individually. In some cases, those who are young pay less for private health insurance than for statutory health insurance, but contributions often rise significantly as they get older. Unlike the GKV, there is no upper contribution cap.
Why can’t you switch from private health insurance to statutory health insurance from the age of 55?
Statutory health insurance is organized based on solidarity. This means: those who earn a lot pay more. Those who barely earn anything earn less. All contributions go into one pot and benefit those who use medical services. Anyone who pays into the system is entitled to benefits from the system. Those with private insurance do not contribute to this solidarity system.
The legislature has therefore severely restricted the return of privately insured people to the GKV from a certain age – the limit is 55 years. The aim is to prevent citizens from exploiting the two systems for their own benefit. In other words: Anyone who takes out PKV insurance at low premiums as a young person should not be allowed to insure themselves “cheaply” again in old age – then in the GKV – at the expense of the solidarity community.
Conversely, anyone who has paid a lot into the GKV throughout their life should also benefit from it as a pensioner. Because the GKV contribution in old age continues to depend on income – i.e. pension -, retirees usually pay less. Even if they need more or more expensive treatments as they get older.
Under what conditions is it still possible to switch from PKV to GKV?
For people with private health insurance who have celebrated their 55th birthday, returning to the statutory health insurance is only possible under very strict conditions. Only those who were compulsorily insured for at least 2.5 years in the previous five years – for example, were employed and had earnings below a certain limit – can change. Five years ago this limit was a good 60,000 euros gross per year.
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It is also possible for older people to return to the GKV if only the spouse earns money and they were compulsorily insured in the GKV for at least 2.5 years in the five years preceding the change. A final exception applies to severely disabled people. These are requirements that are likely to apply in very few cases. And which do not apply in the case of Heinz Hoenig.
When can the PKV exclude an insured person?
The short answer: If they have consistently failed to pay the contributions. According to the consumer advice center (VZ), private health insurers are allowed to issue a reminder if the insured person has owed at least two monthly contributions. If he doesn’t pay and a second reminder is due, the insurance company can switch to the so-called emergency tariff.