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I'm not German myself, but I'm pretty sure the public health care system is open to all legal residents, no matter what age they move there. But like most count

I'm not German myself, but I'm pretty sure the public health care system is open to all legal residents, no matter what age they move there. But like most countries, there are significant hurdles to immigration, and they would be even higher for somebody in retirement age.

weinzierl 3y ago
I am indeed German and to the best of my knowledge our health care system is not open to all legal residents. I worded it carefully above, because it is complicated and there might be loopholes, but in general a person older than 55 that has never been in the German health system will not get in.
- mongol 3y ago
  What if they are EU citizens?
  - weinzierl 3y ago
    Doesn't matter. Even if you are a German citizen and by 55 you've never been in the health system you're out of luck.
    - lfittl 3y ago
      In the above described scenario (US-based retiree moving to Germany), its likely the social security totalization treaty applies, giving them access to the health system: https://www.ssa.gov/international/Agreement_Pamphlets/germany.html https://www.ssa.gov/international/Agreement_Pamphlets/german...
      - weinzierl 3y ago
        This is about social security and has nothing to with health care. In fact it says: "Although the agreement between the United States and Germany allows the Social Security Administration to count your German credits to help you qualify for U.S. retirement, disability or survivor benefits, the agreement doesn’t cover Medicare benefits. As a result, we cannot count your credits in Germany to establish entitlement to free Medicare hospital insurance." There might be other loopholes though.
    - microtherion 3y ago
      It appears that if an immigrant was previously in a public health care system in their country of origin, they would qualify: https://www.tk.de/firmenkunden/versicherung/tk-service-ausland/beschaeftigung-auslaendischer-mitarbeiter/altersgrenze-eu-auslaender-2046102?tkcm=aaus https://www.tk.de/firmenkunden/versicherung/tk-service-ausla... https://www.krankenkassen.de/incoming/leben/nicht-erwerbstaetig/ https://www.krankenkassen.de/incoming/leben/nicht-erwerbstae... That would cover most EU countries, though probably not the US (assuming that "private, but mandatory" does not qualify as "public").
- microtherion 3y ago
  So correct me if I'm wrong, but: * Germany has an Obamacare-like system: Insurance is private, but mandatory. * You can choose and change your insurance provider freely, and they cannot reject you So if that is true, health insurance companies have the risk of older residents joining, whether or not the previously resided in Germany, and it's not like they benefited from their contributions before. So how exactly would this exclusion work? Is insurance not mandatory for immigrants after a certain age? Do insurance companies have a right to reject them? I was not able to find a direct discussion of the question, but this page discussing the health problems of older immigrants (including "access to the health care system") does not mention the possibility that they would be excluded from the health care system altogether: https://heimatkunde.boell.de/de/2013/11/18/ältere-migrantinnen-soziale-lage-und-gesundheit https://heimatkunde.boell.de/de/2013/11/18/ältere-migrantinn...
  - Agingcoder 3y ago
    I think it’s public, not private.
    - microtherion 3y ago
      Ah, I was mistaken. I was correct in that insurance is mandatory, but most people get the insurance from a state-run insurance company: https://www.informedhealth.org/the-german-health-care-system.html https://www.informedhealth.org/the-german-health-care-system... https://www.ssa.gov/policy/docs/progdesc/ssptw/2018-2019/europe/germany.pdf https://www.ssa.gov/policy/docs/progdesc/ssptw/2018-2019/eur... [Corrected to admit my error]
      - weinzierl 3y ago
        First of all, it is not mandatory for everyone. Anyone with an income above an entry level IT job is exempt, but there are other exceptions as well. Secondly it is not open to anyone. If you opted out of it at a young age you usually cannot come back (it's a bit more complicated). If you were not in the system for a couple of years and are over 55 you are out. So the US retiree will not get in, but the migrant with a low-incone that worked a couple of years in Germany has mandatory health care forever. Thirdly, it is not a single state-run insurance company. There are many companies that provide mandatory health care and you can choose freely but you have to choose one if health insurance is mandatory for you. The companies differ in premiums and benefits but usually not by much. They also cannot refuse you if (and usually only if) health care is mandatory for you. The biggest ones are AOK, Barmer and maybe Tk. Bigger companies like BMW run their own ones for their employees. Of course there are many companies that provide private health care. You can have private insurance in addition or, if you are exempt from mandatory health care, instead of the mandatory providers. Everything is more complicated, but that is the rough idea.

weinzierl 3y ago

I am indeed German and to the best of my knowledge our health care system is not open to all legal residents. I worded it carefully above, because it is complicated and there might be loopholes, but in general a person older than 55 that has never been in the German health system will not get in.

mongol 3y ago
What if they are EU citizens?
- weinzierl 3y ago
  Doesn't matter. Even if you are a German citizen and by 55 you've never been in the health system you're out of luck.
  - lfittl 3y ago
    In the above described scenario (US-based retiree moving to Germany), its likely the social security totalization treaty applies, giving them access to the health system: https://www.ssa.gov/international/Agreement_Pamphlets/germany.html https://www.ssa.gov/international/Agreement_Pamphlets/german...
    - weinzierl 3y ago
      This is about social security and has nothing to with health care. In fact it says: "Although the agreement between the United States and Germany allows the Social Security Administration to count your German credits to help you qualify for U.S. retirement, disability or survivor benefits, the agreement doesn’t cover Medicare benefits. As a result, we cannot count your credits in Germany to establish entitlement to free Medicare hospital insurance." There might be other loopholes though.
  - microtherion 3y ago
    It appears that if an immigrant was previously in a public health care system in their country of origin, they would qualify: https://www.tk.de/firmenkunden/versicherung/tk-service-ausland/beschaeftigung-auslaendischer-mitarbeiter/altersgrenze-eu-auslaender-2046102?tkcm=aaus https://www.tk.de/firmenkunden/versicherung/tk-service-ausla... https://www.krankenkassen.de/incoming/leben/nicht-erwerbstaetig/ https://www.krankenkassen.de/incoming/leben/nicht-erwerbstae... That would cover most EU countries, though probably not the US (assuming that "private, but mandatory" does not qualify as "public").
microtherion 3y ago
So correct me if I'm wrong, but: * Germany has an Obamacare-like system: Insurance is private, but mandatory. * You can choose and change your insurance provider freely, and they cannot reject you So if that is true, health insurance companies have the risk of older residents joining, whether or not the previously resided in Germany, and it's not like they benefited from their contributions before. So how exactly would this exclusion work? Is insurance not mandatory for immigrants after a certain age? Do insurance companies have a right to reject them? I was not able to find a direct discussion of the question, but this page discussing the health problems of older immigrants (including "access to the health care system") does not mention the possibility that they would be excluded from the health care system altogether: https://heimatkunde.boell.de/de/2013/11/18/ältere-migrantinnen-soziale-lage-und-gesundheit https://heimatkunde.boell.de/de/2013/11/18/ältere-migrantinn...
- Agingcoder 3y ago
  I think it’s public, not private.
  - microtherion 3y ago
    Ah, I was mistaken. I was correct in that insurance is mandatory, but most people get the insurance from a state-run insurance company: https://www.informedhealth.org/the-german-health-care-system.html https://www.informedhealth.org/the-german-health-care-system... https://www.ssa.gov/policy/docs/progdesc/ssptw/2018-2019/europe/germany.pdf https://www.ssa.gov/policy/docs/progdesc/ssptw/2018-2019/eur... [Corrected to admit my error]
    - weinzierl 3y ago
      First of all, it is not mandatory for everyone. Anyone with an income above an entry level IT job is exempt, but there are other exceptions as well. Secondly it is not open to anyone. If you opted out of it at a young age you usually cannot come back (it's a bit more complicated). If you were not in the system for a couple of years and are over 55 you are out. So the US retiree will not get in, but the migrant with a low-incone that worked a couple of years in Germany has mandatory health care forever. Thirdly, it is not a single state-run insurance company. There are many companies that provide mandatory health care and you can choose freely but you have to choose one if health insurance is mandatory for you. The companies differ in premiums and benefits but usually not by much. They also cannot refuse you if (and usually only if) health care is mandatory for you. The biggest ones are AOK, Barmer and maybe Tk. Bigger companies like BMW run their own ones for their employees. Of course there are many companies that provide private health care. You can have private insurance in addition or, if you are exempt from mandatory health care, instead of the mandatory providers. Everything is more complicated, but that is the rough idea.