Germany is known for its comprehensive healthcare system, and having health insurance is mandatory for anyone living in the country. Yet, new figures from the Federal Statistical Office (Destatis) show that around 72,000 people in 2023 had no health insurance at all, and no entitlement to any medical coverage.
Although the number represents less than 0.1% of the population, experts see the group as significant because those without coverage are often among the most vulnerable — and they typically seek care only in emergencies.
Who is most likely to be uninsured?
The data indicates clear demographic patterns:
- 61% are men — around 44,000 people
- 75% are classified as “not in employment” — roughly 54,000 people
This group includes retirees whose insurance lapsed, older students beyond family coverage, and people outside the regular job market. Loss of paperwork, financial difficulties, or complicated transitions between insurance providers can also lead to unintended gaps.
Not insured — yet still covered
An additional 198,000 people technically had no insurance contract, but retained access to healthcare services through government programs. Among them are:
- Asylum seekers
- Recipients of social assistance
- Voluntary armed service members
- They count as “uninsured” statistically — but are not left without medical care.
- Most residents remain in public healthcare
Germany’s statutory health insurance system remains the backbone of national care: 73.3 million people were legally insured (≈ 89% of the population)
including 16.8 million via family insurance
5.1 million are voluntarily insured in the public system — mostly self-employed people and employees earning above the annual income threshold
Meanwhile, about 9 million residents (≈ 11%) are covered by private health insurance, often benefiting from tailored tariffs but facing rising premiums with age.
Experts warn of hidden risks
Although the number of uninsured people is small, health policy researchers argue that those affected face serious financial dangers. Emergency treatments for uninsured patients can lead to high medical debts, delaying necessary care and worsening long-term health outcomes.
Healthcare associations are urging clearer information, especially for students, new residents, and retirees — groups often unaware that a missed contribution can lead to immediate loss of insurance status.
Universal coverage exists on paper — but not necessarily in reality.
