Anyone living in Germany must have health insurance.

The compulsion is intended to prevent people from being crushed by unimagined treatment costs in an emergency.

A clear, irrefutable rule - and yet there are always individual fates that slip through this tightly woven network.

Monica Ganster

Editor in the Rhein-Main-Zeitung.

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In a city like Frankfurt, the health department estimates that there are probably several hundred people.

The Clearingstelle project was set up for them two years ago to show patients with no or unclear health insurance coverage how they can find their way back into the regular medical system.

The social worker Maria Wirth advises this group of people on Wednesdays between 2 p.m. and 5 p.m. in the health department.

The project, a collaboration between the Frankfurt University of Applied Sciences and the public health department, has just been extended by another year until the end of 2023.

The need is there, says Wirth.

In the first year, from February 2021, she advised 118 people, most of them women.

Her clients ranged in age from 19 to 82;

about a quarter were German,

The reasons why people need the help of Maria Wirth are very different.

There are people who were able to afford private health insurance while they were working, but in old age the contributions become overwhelming and they have slipped into social welfare.

As a rule, there is no return to the statutory coffers after the age of 55.

Then, in emergencies, at least the basic tariff in private health insurance must be paid, which was 769 euros a month in 2022, according to Wirth.

For comparison: This is the maximum tariff in statutory health insurance, which can be found on the website of the Federal Ministry of Health.

Anonymous check-ups

Or that is the woman from a third country who is expecting a child from her German boyfriend.

When the child is born, she will receive a residence permit and can then also take out health insurance.

Until then, she has no insurance.

Preventive medical check-ups are offered in the "Humanitarian Consultation Hours" of the Health Department, because people without insurance can generally be treated anonymously there on an outpatient basis.

However, should there be complications during pregnancy, for example, or a caesarean section should even be necessary, debts of several thousand euros quickly accumulate.

Wirth knows that losing a job is often the trigger for losing health insurance altogether.

Some would then have to take care of voluntary continued insurance and failed.

"Sometimes it's language problems, other times psychological problems that make this task a huge hurdle," lists the forty-three-year-old, adding: "The forms are anything but easy to use."

The social worker explains that the old health insurance first asks for the income to be disclosed.

Ignore, play dead, none of that helps.

The insurance then automatically classifies the unemployed in the highest tariff – provided that this is not contradicted.

Debts accumulated, often unnoticed.

If the health insurance company does not hear from their customers for half a year and no contributions are transferred, the health insurance company can terminate the contract.

The patients only noticed this when the health insurance card no longer worked at the next doctor's appointment.

That is usually the moment when help is needed for a stuck situation.

And Maria Wirth was asked.