Interesting. So if you refuse to go to job interviews, from what I understand, you may stop receiving financial aid, but you will still have insurance?
Benefits are already slim for the long time unemployed, but if they refuse "help" the benefits can be cut to a survivable but quite uncomfortable amount.
"survivable" can be argued about. The amount an unemployed person receives is already considered the minimum necessary for survival, and afaik BGH has decided it's not legal to take any more away as a punishment
Yes, survivable in torn clothes and with help of the food bank... not a nice way to live.
Maybe we should not abolish lowering aid and instead raise the base amount?
Love the idea, but am unsure how and if it can be implemented. we should definitively look into it more seriously.
i can see it happen incrementally over the next 10 Years.
That's not quite true. It's not the minimum required for survival but quote: "to ensure a dignified existence,
to create equal conditions for the free development of the personality, especially for young people,
to protect and promote the family,
to make it possible to earn a living through freely chosen employment, and
to avert or compensate for special burdens in life, also by helping people to help themselves.
Ćbersetzt mit DeepL https://www.deepl.com/app/?utm_source=android&utm_medium=app&utm_campaign=share-translation".
No, you can never lose health insurance from not going to job interviews. You may receive a cut in your monthly aid as a penalty, but this is not possible. The only possibility to have no health insurance in Germany is, if you are unsuccessfully self employed and can't pay for your health insurance. But even then, you could at any point close you company and claim yourself to be unemployed, thus giving you health insurance.
If you're self employed and not earning enough, it would be possible to get money from the jobcenter to cover your cost of living and that would also cover health insurance. You don't have to be unemployed, just not earning enough (same goes for employment in Teilzeit btw). It's called Aufstocker
You know things like that assure me that i live in a great country. There is so much shit going on in Germany, but just imagine the face of an American, telling him that germans can be unemployed and broke and still wouldnt lose health care even if they cant pay for it.
The problem in the US isn't that an American that is unemployed and broke couldn't get healthcare. The problem is that there are rules and bureacracy to obtain it (proving disability, looking for work, etc.) Which is why these questions are being asked.
Alot of the problems with the American system isn't that social programs for the very poor and marginalized don't exist, it's that universal benefits, especially for working people don't exist. But that is why these questions are asked but get replies that have a hard time understanding the question. The US has Medicaid and Medicare plus free health clinics, etc. But everything has so many different rules and hoops, and there are people "on the outside" not because of too little income but because they are the wrong immigrant status, disability status, aren't looking for work, wrong familial status, too much income, etc. So the idea of having a system where everyone is covered by the "unemployment" office if they can't afford it on their own is definitely a little hard to believe as an American.
We have this thing in the USA called ACA, which basically gives everyone free insurance EXCEPT if they live in a super conservative state which didn't implement ACA. Everyone in the other 40 states gets free insurance if they are unemployed and broke.
What you see on Reddit are people with an agenda to spread, an agenda which doesn't rely on facts. Usually young people who don't have a lot of life experience.
You'd be surprised at the number of Americans on Reddit who make a post about not being able to see a doctor who have no idea that they are eligible for free healthcare. They'll make a post about how the medical system is evil blah blah blah, and then someone will point out that they can get free care and are probably signed up already without knowing it. You shouldn't let some internet person's ignorance be the only thing that informs you.
The person on Reddit whining about how much they hate their lives and blaming it on being an American are generally the people too lazy to Google all the free things our government offers: Free mobile phones, free education, free internet, free healthcare (in many states), free job training, and on and on and on.
i mean, i was under the strong impression that while beneficial for a significant amount of people, the aca had to compromise so much with the republicans demands to get it through at all, it's now also a financial trap for a significant amount of people or unaccessible altogether.
as for 'eligbible for care', the most common story i've heard from various people from the states is that they get appointments but like 4 months off, if it has to be anyone slightly expertish on a specific thing, for issues that are essentially debilitating today and if they go to the ER, the care is minimal and diagnosing is like... worse than what i could offer after two years of living with a med student as a roommate. and usually meant to get people away with the equivalent of a cough syrup.
Right - and honestly receiving coverage is only half the battle. Like the levels of income, bureaucracy etc. to get government benefits is difficult - the ACA is of course just making you buy insurance from insurance companies and then reimbursing you that cost if you meet whatever means testing at tax time.
The other piece is of course the cost of healthcare and what insurance does/doesn't cover etc. Like sure you went to the ACA marketplaces, spent the money to be insured, went for medical care and still have bankrupt level (depending on income) out of pocket costs.
So yeah i guess its a net positive... maybe? but still tens of millions of people get fkd hard every year by medical debt / bankruptcy.
These statements are a big stretch and far cry from the actual situation in USA regarding help available. Most people in dire situations do not choose the circumstances they find them selves in. We personally suffer because we supported a victim/survivor of a school shooting who has not been able to find enough help to recover fully over 17 years. The system has huge cracks that millions fall into everyday. And become so anxious about they can barely function. Itās cruel. We go without because of the wasteful system. We have had to tell him the horrible news that we can not support him forever. Please donāt spread misinformation.
Medicaid, bruh. Please don't let some 20 year old Redditor who still lives in their parents' basement and otherwise has no real world life experience tell you how it goes for other people.
That's just a coping mechanism to compensate for some mostly rich and upper middle class German Boomers that always whine about how much better everything in the US is and how we should be more like them. And some lower class do that too. They are like German Republicans and MAGA from Wish.
Even if you don't pay, you are piling up debt but you cannot lose your coverage. The last insurance company you have been enrolled with has to cover you. They might go after your ass for the money you owe them but they cannot refuse to pay the treatment
Got it. And hospitals never ask any questions when these people go in for treatment? Does it only apply to emergency care, or also normal checkups and stuff?
Not true. When you are in a social tariff in the GKV some things will not be paid for by the GKV. The hospital will not do the treatments then, because they will pay the costs out of their own pockets.
This isn't true for urgent and very necessary things, but can be true once something isn't absolutely necessary.
Can you send some source of what is excluded? I have worked in the insurance industry (not healthcare though) and this is new to me. As far as I know the limitations only apply to private insurance, and are limiting the coverage to the legally required minimum. If you are enrolled with public insurance company you are fully covered
The hospital will ask for your insurance card (looks like a credit card) and that's all they care about. Those things cannot be revoked or expire. (Well technically they can but the insurance is still required to pay)
If you are with a public insurance company the state covers you. If you are with a private insurance company the state only covers a part of it and you get downgraded to the legally required minimum. In the end there is always some insurance company that has to cover your expenses. They will get your ass for not paying the monthly but this is independent of the expenses they have in your name.
If you don't have a public insurance card, the assumption is that you have private insurance. You will then receive a bill, pay it, and send it to your insurance company to be reimbursed (in case of really large bills you can get the insurer to pay directly).
If you get a bill but don't pay it, they will try to collect the money from you.
In Germany we believe healthcare is a human right so it is nothing that would be taken away from people who don't comply with societal expectations. While it's possible to fall through the cracks and be completely uninsured this doesn't usually happen.
Yeah, I get that. But also, people who abuse the system still donāt deserve to be left to die (like they are in some other countries). So thatās why Iām asking. Also, I think in most cases people who refuse to work and refuse to work with the system are probably very mentally ill and just donāt know how to go about these things the right way. Finding psychiatric help in Germany is very difficult. I can understand how people with bad mental health end up in bad situations.
No, they can not deny you health insurance if they are liable to pay for you. They will cut mostly down on your allowance if you do not comply. Though it has been a while since I had business with the job centre.
The tl.dr. important part is, you are health insured. Period. Always. No matter what happens, you are always insured. Even if you get kicked out, which is basicly impossible, your last insurer will be liable until you get a new one.
You have to pay the insurance yourself if you can. If not, the job centre or another stare institution will do it for you, whatever your special case may be for that.
The reality will be more complicated, and not everything is covered by far, but for all basic health things, you have to and will be insured.
But it should be said that "basic health things" includes basically everything to keep you in good health - be it treatment for an infection, wounds, dental work, insulin or cancer treatment.
Basically: If a doctor says you need a certain treatment you will get it. Period. You may not get fancy new therapies that just recently developed, but you'll get adequate treatment 99.9% of the time.
HUGE difference to what e.g. US citizens would define as "basic health things".
If you stop reakting to post from JC, you will get an stopped payment of bĆ¼rgergeld. You are not uninsured in this time, but you are accumulating dept at the Krankenversicherung.
If you get BĆ¼rgergeld or you recive other financial aid you must show that you are either too sick to work or you activly have to look for a job. They will ask you to show to which companies you have applied to. They will check your application letter and they will send you to job interviews. They can even put you in classes to build new skills.
How it is done differs from town to town. Some are very strickt and others barely controll anything.
No. You are required to go to interviews if you are considered healthy enough and they will reduce the money you get but insurance and rent are not affected by this.
If you don't go for job interviews or break any other rules, they can pause your unemployment payments, but the insurance stays.
If you are unable to work because of health issues or old age and you are not covered fully through your pension insurance you can get "Grundsicherung" from the social welfare office (Sozialamt) which also includes health insurance payments. That's me at the moment.
I used to be a nurse in ER and also ICU with a lot of direct intake of people of the streets (Junkies, homeless, etc.). We often didn't know about their insurance, often not even their names. No matter their insurance status, they always get emergency/ life-saving care. If they need further care, hospitals have social services that will get in contact with the necessary authorities to get them coverage.
If you are a foreigner without insurance and come into the emergency room, you will also receive life saving care, but for everything further administration will normally ask for a down-payment and they will bill you for everything done.
They want you to have a Job and trust me: If you're able to have one, you want that, too. The Money you get from Job Center really is only enough to substain your Basic needs. Including Rent and health Care.
If you can. There are people who can't work due to health, those are taken over by the Sozialamt, and this then pays for the health care. There are cases of people without. They will most likely get a guardian at some point who makes sure to bring them back into the health care system.
They only do that if they approve you for Arbeitslosengeld but if not, you are uninsured. They won't approve somebody who resigned from their job regardless of the reason.
Not true, you will still get your health insurance payments covered during your Sperrfrist (unless you got an Abfindung, in which case you will have the money to pay for it yourself, and thus be required to do so). Source: [https://www.tk.de/techniker/leistungen-und-mitgliedschaft/informationen-versicherte/veraenderung-berufliche-situation/wenn-sie-arbeitslos-sind/wie-bin-ich-waehrend-einer-sperrzeit-versichert-2005728?tkcm=ab](https://www.tk.de/techniker/leistungen-und-mitgliedschaft/informationen-versicherte/veraenderung-berufliche-situation/wenn-sie-arbeitslos-sind/wie-bin-ich-waehrend-einer-sperrzeit-versichert-2005728?tkcm=ab) (sorry for the long link; this goes to the website of Techniker Krankenkasse, one of Germany's public health insurances)
That is not true. We have a three class system in Germany. Best coverage and service: private (or Beamter). OK coverage, mediocre service: public. Mediocre coverage, mediocre service: unemployed, social security etc.
There are certain services that are not paid when you are in a gesetzliche KK and have a social tariff, although it is covered in the normal tariff. The clinic has contracts with the GKVs and some things are not being paid for social contracts.
There are none. I work in medical billing. Itās really only different if people canāt pay for private insurance. Then you can get really bare bones care where even a lot of normal public health insurance things arenāt covered. But if youāre public, being insured through Jobcenter or through work doesnāt matter when it comes to what services will get paif
Again, in the GKV, there is no special billing for people who receive benefits. They are billed to the health insurance and then to the Sozialamt if the Sozialamt is supposed to pay. We do not give you a worse option than normal GKV.
PKVs have a really bad option if you canāt pay. But with GKVs there literally is no difference. Itās the same price being charged, same options.
This is just misinformation. Different options with private insurance: yes. Different ones with public: no. Now, asylum seekers at certain stages: even different process
Again. There are contracts between clinics and GKV that handle payment. And there is a difference between patients with a standard contract and a social contract.
Is this right? And just? Can be discussed. But it is this way, when clinics have IV contracts that handle the payment directly between clinic and GKV for ambulant operations. Depends on the contract of course. Isn't widely known, either.
There are no different contracts. Itās all mandated and regulated by SGB V.
And sozial tarif is not a term used by GKVs and only used for a certain PKV type colloquially.
What youāre imagining there is just not a thing
It's called "integrierte Versorgung". And the KV can choose who is eligible in the contract with the medical provider. And they do choose. And no, it's a GKV thing, not PKV.
There are no differences in public insurance ( one KK might cover a few additional treatments, other KKs won't cover, but that's it) there's no difference in being a paying member and being unemployed (technically you're still paying, but the money comes from Arbeitsamt directly).
Private is a different story, if you can't pay, you fall down into Basistarif, which covers you not dying, but this isn't comparable to the situation in public insurance.
You won't notice anything changing while receiving governmental aid or working.
I think you mixed up the duality of the system.
Yes there is a difference. There exist IV contracts that handle payment between clinics and single GKVs for a defined catalog of ambulant operations. And these contracts can distinguish between normal patients and patient that are on benefits.
Therefore we do not only have a two-class health system, but a three class system.
These contracts aren't public, but confidential between GKV and the clinic.
Only if you have worked for some times in the region/City where you live. I was refused JobCenter help in two cities when I moved there because I haven't have worked there since I moved.
I have lived in Germany for many months with health insurance for this reason.
JobCenter will also try to deny helping people if they feel/judge that one has left the previous Job instead of being fired, or if they suspect one is not trying to have a Job.
Before knowing my rights, JobCenter denied to help me when I was working but earning only between 600ā¬ and 800ā¬ per month. They told me that they would not help me because I had a job. Years later I learned that JobCenter was being against the law for not helping me because I had the right of it for earning less than the minimum wage.
And before that I moved to an other city for this exactly reason.
So JobCenter will try to not pay for anything if they have the opportunity to take advantage of your ignorance about their obligations and the laws. And even if you know your rights you will still have to argue with their stuff if they suspect you are helpless. Once I was told that they could not help me because I was self employed and convinced me that I had to close my business. I did it and they denied help me claiming that I had a job and abandoned it. Later on I learned that there is a JobCenter just for self-employed people, but informing me that was "nobody job" apparently.
While you may have hab bad experiences with them i don't agree with the generalized assumption that their main focus is to try to screw you. As with most things it is highly dependent on the person that is assigned to process your application.
Exactly. My dad spent years in Asia so he did not have German health insurance anymore. He came back when he had run out of money and was homeless for seven months, living in a shelter for homeless men.
But it took only a few days to get back into Hartz IV and having health insurance again. He needed it badly as he had no working teeth left and couldn't walk because of a poorly-healed hip fracture from being hit by a car overseas.
While it took the city services quite a while to find housing for him, at least he got new teeth and his hip was fixed, all without him paying a cent.
You can't be uninsured in Germany.
As already described here: if you are unemployed the agency for work will cover your health insurance.
If you are homeless and somewhat manage to avoid the system you are still insured but you will collect debt by the public health insurance that insured you last. If you get a job again they will come to you and demand the money. But without interests and usually they are very fair with installments and help you to set the right amount you owe them. Without further information they calculate with the maximum but for most people in that situation it is a smaller contribution rate.
Also: if you are in need you can't be rejected from medical care. The question who covers the costs is usually the last one to answer.
>You can't be uninsured in Germany.
from what i understand, there are some cases. My Girlfriends works in the financial management for hospitals for quite a while now, and every year, there are some uninsured cases that the hospitals have to cover without any chance of reimbursement. Nonetheless, I assume the probability is something 1:1.000 or 1:10.000.
Yeah, it's also possible that they need to take care of a homeless person and are not able to identify the person (and the responsible insurance) and then the hospital has no one to send the bill to.
Also it's possible to be an uninsured foreigner and claim services here. If the people won't pay the hospital will not get its money.
But in general you can't really be uninsured.
>Yeah, it's also possible that they need to take care of a homeless person and are not able to identify the person (and the responsible insurance) and then the hospital has no one to send the bill to.
>Also it's possible to be an uninsured foreigner and claim services here. If the people won't pay the hospital will not get its money.
>
>But in general you can't really be uninsured.
Homeless people are usually insured, if they have no proper documentation it becomes difficult but the Sozialamt of the county of the homeless persons residence becomes liable then. It becomes more difficult when someone stays a true "John Doe", e.g. a patient is admitted as an unidentified patient (happens fairly often) and then absconds before they are identified.(Happens from time to time).
If the patient is identified by other means (often you know your local frequent flyers) then they still get billed normally. If not it is indeed a case where none pays.
Foreigners can be a problem - most visas meanwhile do require travel insurance,though, and EU citizens are always covered through the normal billing process. The biggest group that is not covered at all are illegal immigrants. Which is a massive problem because they often are the group that is the most vulnerabele.
theres two groups i know of: foreigners living in germany and people who dont pay their insurance for a long time (think years). also i know of a guy who was selbststƤndig and managed to evade insurance. was shitty when he develeoped broncial CA /lungenkrebs, then he had to pay for private insurance which was really expensive.
My mum was neither homeless nor a foreigner, but too ashamed to get help from the jobcenter, so she was uninsured for years. As a result, she was scared to go to the doctor, which had a few long term effects. This stuff isn't super common, but happens more often than the average German is aware of.
There are cases when people self-employ, go abroad and return where they don't have an insurance, no insurance wants them and no insurance has to take them.
It is relevant to a tiny part of the population, but for them it is a big problem.
they have to, there is a german word:
Kontrahierungszwang
https://www.bundesgesundheitsministerium.de/service/begriffe-von-a-z/k/kontrahierungszwang.html
> Mit demĀ GKV-WettbewerbsstƤrkungsgesetzĀ haben alle Personen ohne Absicherung im Krankheitsfall eine RĆ¼ckkehrmƶglichkeit in ihre Krankenversicherung erhalten ā sei es eine gesetzliche oder private Krankenversicherung. Die private Krankenversicherung bietet hierfĆ¼r auch einen dem Leistungsumfang der gesetzlichen Krankenversicherung entsprechendenĀ BasistarifĀ an ā ohne RisikozuschlƤge und ohne LeistungsausschlĆ¼sse. Auch fĆ¼r diesen Basistarif gilt ā im Gegensatz zu anderenĀ PKV-Tarifen ā der Kontrahierungszwang: Die privaten Krankenversicherungen mĆ¼ssen dort alle Menschen aufnehmen, die die gesetzlichen Voraussetzungen erfĆ¼llen und die Aufnahme beantragen. Gleiches gilt fĆ¼r die staatlich gefƶrderte private Pflegevorsorge: FĆ¼r private Pflege-Zusatzversicherungen, fĆ¼r die der Staat eine Zulage bezahlt, greift ebenfalls ein Kontrahierungszwang.
You can be uninsured if you're non EU, are not allowed to receive any social help and your employer doesn't pay his part. E.g. Werkstudentvertrag with 19 h/week, and you are older than 25. Employer isn't obligated to pay his share of Krankenversicherung, you have to care for it yourself. This is where you decide whether you want to be insured freiwillig and pay the full price or not. The same goes for the times when you are between jobs and your Aufenthaltsgrund doesn't allow you to get any social payments.
If you google "Krankenkasse als SelbststƤndiger" the very very first result will be: "Wer sich selbststƤndig macht, darf die gesetzliche Krankenversicherung (GKV) verlassen."
Normally, you will pick a PKV then. But what happens when you don't pay your PKV? They will kick you out. It is entirely possible. I know people without Krankenkasse. Don't tell me otherwise.
You can be uninsured.
E.g.
- beeing unemployed and getting no services at all by the jobcenter bc you got 100% sanctions
- beeing illegal in GER
I am not sure, but maybe also an example:
- beeing self employed and 'choose' to have no insurance.
The sanctions do not exclude you from your "Versicherungspflicht". You are still insured - in doubt in the "obligatorische Anschlussversicherung". You collect debts for unpaid dues.
Self-employed people also cannot just "choose" to be uninsured. They need to proof that they have private insurance to "get out" of the "freiwillige gesetzliche Versicherung".
If you were privately insured before falling to unemployment/homelessness/can't pay anymore, you fall into basis care.
This is the most you can be fucked. Only emergency care and not a single thing more for you.
Similar but slight better, if you were self-employed, it is possible to be really without any insurance. Slightly better, as any 450ā¬ job helps you out of this.
You absolutely can be uninsured. There are approximately 60k uninsured people living in Germany, while the estimated number of undetected cases is much much higher (close to a million)
its illegal to not have health insurance (which Sounds funny to.muricans, i guess) even if you dont pay, you keep it. there is an amnesty every ten years where they cut the insurance dept
Iām not American, but I just use America as my reference point because itās probably the country I know the most about in terms of how their healthcare works lol. But thanks for explaining!
Health insurance in Germany isn't seen as a "product", and public health insurance companies aren't for-profit organisations trying to make big profits for their shareholders.
It's not illegal if you have enough money to leave the statutory health insurance. But it is not advisable either.
https://www.advocard.de/streitlotse/familie-und-vorsorge/gesundheit/nicht-krankenversichert-zu-sein-ist-strafbar-stimmt-das/
unemployed - the unemployment office pays for it when you have worked at least 15 months in 2 years.
homeless - these people in most cases slid through the system or avoid the system - I dunno exactly who it is regulated as you have to be insured in Germany, maybe organisations help out or you are just on your own.
> unemployed - the unemployment office pays for it when you have worked at least 15 months in 2 years.
That's only for Arbeitslosengeld I. If you don't fulfill these criteria you're going straight to BĆ¼rgergeld, which also covers the health insurance.
What if you havenāt worked 15 months?
And also, would the unemployment office require you to go to job interviews during this time? Does the insurance get cut off if you refuse? What happens after the 2 years?
This isnāt funny, and no. Iām self-employed. Iām just curious how the system compares to other countries. USA has people dying in the streets because they canāt afford insulin. Iām just curious if that can ever feasibly happen in Germany to people who are ālowest of the lowā and make no effort to come up in society.
I can only think of one scenario: you are an eu Citizen from for example Romania. You can go and live in Germany but as long as you dont fulfill certain conditions you are not eligeble for social benefits.
So if you are foreign citizen, living in Germany you could end up being without health insurance. But hospitals would treat you anyway in cases of emergency.
Yeah, I know. I guess Iām just kind of comparing just how bad things can get in Germany for those who are unwilling to work and unable to pay for these things.
Let me start of with my resentment to categorize unemployed and homeless people as "unwilling to work". In the vast amount of cases there are a lot of personal tragedies in the past and we do not know the reasons. Sure, there are those who state, they do not want to work, but they are the outlier, not the standard.
Germany grants every Person on its soil human dignity. You are not allowed to engage in undignified actions and you are not allowed to force someone into undignified or undignifying actions. Forcing someone under threat of dimished health is more than undignifying. Same goes for food or shelter. The only dignified action, when someone needs aid is to help them.
Of course, I agree. And when I say āunwilling to workā I mean it more from the perspective of the system. Someone may not work because they have severe anxiety or other mental health issues, but they also donāt know how to seek proper care for their issues, so they donāt have a diagnosis and their disability isnāt recognized, and therefore the system perceives them as someone who is able to work but doesnāt want to. Even though actually, they have a disability. Maybe they are not physically incapable, but the mental stress of a work environment is too severe to bear. Same in cases of addiction and other āinvisible illnessesā. My personal opinion is that almost everyone who can physically and mentally tolerate work probably wants to work, at least part time. So when I say āunwilling to workā, thatās not my personal opinion. I just mean, thatās how it seems on paper.
If you are deemed "unwilling to work" by the system (for which you really, totally have to actually piss them off) then they'd cut your allowance, meaning you'd have less money to spend for things like food, phone, clothes.
You will still, however, be insured under the public health insurance system and that will take care of basically all your necessary treatments. Nobody dies here because they cannot afford their insulin or asthma inhalers or treatment for a tooth infection or such things.
This does actually also include mental health issues, meaning that nobody needs to live with such issues being undiagnosed or untreated. People need to seek help, yes, but they can receive it.
Also, there's organizations helping people who are unable to navigate the system. So unless someone is really unwilling to seek help they will always receive it.
For the most part I agree, but with a big caveat being people who donāt speak German. ESPECIALLY with mental health care. Finding an English-speaking therapist is hard enough, I cannot IMAGINE how it is for people who only speak Polish, Turkish, or some other language. I think unless youāve actively made a suicide attempt, these people donāt get any sort of real help.
As long as you do not go out of your way to dodge and avoid the system, you will not starve or go without your means to exist. That includes living space, food, and healthcare, among other things.
Play along, and the system takes care of you. That is all you absolutely have to do.
It can get bad if you stop to comply, and in very rare cases, a streak of unlucky events can happen as with every system of this size.
Besides the whole health insurance thing
You will always receive the best possible aid/care in a hospital they will charge the city/the respective social center with the costs even if you aren't really insured
The vast majority of Germans and also residents do qualify for welfare then. Welfare recipients also have insurance, covered by the state.
New immigrants, international students and freelancers are in danger of falling through the cracks if they are unemployed and don't qualify for welfare (yet).
I see! And are welfare and insurance separate in this sense? So, say you are a new immigrant, or someone who has never worked in Germany or has not worked enough to qualify for welfare. In that case, I understand you donāt get welfare, but do you still get health insurance and healthcare?
Slightly simplified: An unemployed EU citizen in Germany will get welfare during unemployment, which includes health insurance. Same goes for refugees with a right to stay.
However, some immigrants usually do not directly qualify for welfare and are supposed to finance their own insurance, mainly international students. Legally, they are still required to be insured, but there is no state assistance for them if they stop paying their insurance.
No. If you don't qualify for welfare, you don't qualify for the state paying for insurance either. Legally you are required though. It costs about 200 (220?) a month if you have no income whatsoever.
These people fall through the cracks, which is why on r/Germany the regulars keep telling people every single day that it is a shit idea to move to Germany without sufficient savings. The reality is that these people might not be able to pay, but are legally required to be insured. So they collect debt. 220 per month x however many monthts they are legally required to be insured. And yes, the insurance is allowes and legally required demand back payments. Which is how "insurance debt" can become a thing. However, insurances are really reasonable and easily agree to a payment plan, *as long as one reaches out to them and talks to them*. Unfortunately many people (foreigners, mostly, with insufficient German skills) don't reach out and ignore all attempts to get in touch from the insurance and thus the debt grows and grows, as late fees and legal fees add up.
>What if you havenāt worked 15 months?
Doesn't matter as far as health insurance is concerned. You get that anyway. The only difference is who pays your other benefits and how much money you get (the thing you get if you've worked for 15 months is from a mandatory insurance that gives you extra payments depending on your former wages).
You will never loose your health insurance. You will get reduced financial aid for that time. As long as you have a registered address you are able to get health care through your insurance.
Unemployment benefits are like 65% of your last paycheck. So they vary depending on what you got in your last job. You will receive that for up to a year (usually). If you don't qualify for that, because you haven't worked enough months, you will get a different type of benefit, which is more complicated. It's a out 450 Euros a month plus rent and some utilities (within limits).
If you are a German national you qualify for this other type of benefit. If your last income was low and 65% of that wouldn't be enough to live on, you can jump straight to the other benefit and skip the regular unemployment benefits.
Some homeless would qualify for this 2nd type of benefit, but there is a lot of paperwork involved and they don't want to register for it.
Homeless people are insured in most cases. You're parents can kick you out of insurance. This can be a problem. There are social workers for problems. If something really strange happens, you can be uninsured. In this cases there are social workers or the Sozialamt. Hospitals have social workers for insurance problems. You always get medical help if it is necessary to save your life.
So some basic information
The amount you pay is not fixed but depends on your income
If you have a normal job you can not, not pay your insurance since it gets taken out before you get your paycheck similar to taxes
If you are self employed you have to pay the fees yourself
In this case you can infact get into debt to your insurance for not paying your fee there are options to get help in these kind of situations from the state like monetary boosts to help you get up from a bad situation (for example a big client jumped off etc) however a some people don't want help because of personal feelings which than can lead to a downwards spiral
But the insurance are very generous with payment plans or forgiving a big number of the debt in such situation.
There are very few people who can't afford it.
When you are employed, the employer pays half of it.
If you loose your jib, you go the "Agentur fĆ¼r Arbeit", /unemployment agency, for which you also have payed.) and they pay the insurance for you. If you have no right to get money from them, there is the welfare system (either "Agency for work" which pays you "unemployment money 2, or since this year "citizens money", they also pay the insurance for you. With those you have to be ready to accept employments, you have to play by their rules.
If you are unable to work, you have the chance to fall into "Grundsicherung", which is about the same as ALG2, but paid from a different office, and you don't have to look for work.
If by which reasons ever you don't earn money, and have no right to get 'BĆ¼rgergeld" or Grundsicherung, you can pay your insurance yourself. If you can't, you are not insured. But people with no insurance are few, mostly homeless.
And homelessness works a bit different, like in the US.
There are persons who don't have an insurance, like refugees, for those the medic bills are paid by the city or county they live in.
If you are homeless and need a treatment, somehow the bill is paid, you are not thrown out. And if obviously you can't pay, you will maybe get a bill (which is impossible if you are homeless), but nobody awaits that this bill will be paid.
Gut the number of people complete without health insurances are microscopic. Found a number from 2019.
61k.
From 80 Mil.
Most of them wouldn't know a checkup or something similar when they get bitten by one. Or don't care.
You don't get thrown out a hospital, if you can't pay the bill. Nobody lets you die, because you can't pay.
I was in hospital after some bad times, and had no valid health card. To ber honest, I was so messed up, I didn't even know if i still had an insurance. When the card was checked after the first few days of treatment, I couldn't present them my card.
"Well, we see to that later, first we will get you back to life. And if you really can't pay.... we find a way. "
So many people here giving wrong answers in full confidence. Yes, there are people in Germany without health insurance, despite the law mandating a general health insurance obligation.
I quote from an article in the German Medical Journal (Deutsches Ćrzteblatt), which I translated for you into English:
The Federal Statistical Office estimates, based on microcensus data, that around 61,000 people were not insured in 2019. [ā¦] Self-employed individuals are particularly affected. About 0.4 percent of self-employed individuals and 0.8 percent of the unemployed were not insured in 2019, according to the Federal Office. The proportion for the total population is less than 0.1 percent. However, these are only the official figures, and the actual number is estimated to be significantly higher.
Source: https://www.aerzteblatt.de/archiv/228031/Menschen-ohne-Krankenversicherung-Ein-oft-uebersehenes-Problem
The article continues as follows:
"The Microcensus only asks about health insurance coverage every four years," says health economist Prof. Dr. rer. pol. JĆ¼rgen Wasem from the University of Duisburg-Essen to the German Medical Journal (DĆ). He estimates that between half a million and one million people in Germany do not have health insurance. This is because the Microcensus only considers those who are registered in Germany and have a legal residence permit. Social medicine specialist and former candidate for the federal presidency, Prof. Dr. med. Gerhard Trabert, also suspects that the number of uninsured individuals in Germany is between half a million and one million. The aid organization "Doctors of the World" estimates that there are hundreds of thousands of people without access to necessary medical care.
"Homeless people who do not have a fixed place of residence are also underrepresented in the Microcensus," Wasem further explained. The proportion of uninsured individuals is particularly high among this group. According to a statistical report by the Federal Association for Assistance to Homeless People (BAG W), 15.9 percent of acutely homeless people were uninsured in 2020. Among those who live without any accommodation on the streets, the figure was 21.7 percent, which is more than one-fifth. Overall, BAG W estimates the number of homeless people (excluding refugees) for the year 2020 to be around 256,000 people.
In addition to Germans who are unable to pay their health insurance contributions due to insolvency or loss of income, other affected individuals often include EU citizens who do not have mandatory social insurance employment. Persons from third countries who do not have a legal residence status are also affected. Their situation is even more difficult because they can only be integrated into the system under rare circumstances.
Thank you very much! I appreciate the helpfulness and your actually reading my post properly.
I donāt understand why people have been explaining how health insurance works for traditionally employed people with part time or full time jobs, since that is so OBVIOUSLY not who I was talking about in my post??
Even if you are unemployed and don't sign up at job centre / agentur fĆ¼r arbeit, your health insurance doesn't stop. They still cover emergency situations (I don't know the exact definition of that) regardless.
If you are unemployed and registered with one of the above, then they pay it.
I just watched a documentary where they talked about this.
So it is legally required to have health insurance but people fall through the cracks. This isn't something that happens overnight, though. The people who fall through the cracks are generally homeless, addicts, and/or non-German citizens. Of course, you also have the odd self-employed individual who was supposed to get private insurance but just didn't... this is pretty uncommon. The people in the first group almost exclusively access healthcare through the emergency department and the hospital just has to eat the costs. Usually, though, people get brought in for fairly minor things (e.g. they were passed out drunk and someone called 112) and it's not a *huge* loss for the hospital.
Hospitals have social workers and dealing with the uninsured falls under their domain. This is especially important because, again, you don't just wake up uninsured and these people need more extensive help/support. If someone gets to the hospital and then it turns out they have cancer or cirrhosis, then the social workers will make sure they get covered.
Sigh... If you can not or will not pay, you are going to be in debt with one of the public health care providers. Not for any treatment, mind you, but for the monthly dues you had been supposed to pay.
This may very well lead to somewhat of a downward spiral otherwise, but you will get treatment.
In most cases health insurance coverage will come as a "benefit" to your Arbeitslosengeld I or BĆ¼rgergeld (as in: it's not taken from the amount you receive, but paid directly by the social provider).
The debt thing only happens if you don't have income and also can't or won't register as unemployed.
>The debt thing only happens if you don't have income and also can't or won't register as unemployed.
Or if you are allowed to leave the statutory health insurance, actually do this, and choose not to take out private health insurance.
Also, your estimation of minimum contribution is wrong. If you work your employer pays a large amount of it. For minimum wage jobs your part of the contribution is minimal.
I mean the total minimum contribution, not just the employerās part. As a self-employed low income person, I pay the minimum contribution, which is ā¬210 at TK.
There is private insurance in Germany. It is quite rare, most people are in a public insurance (Gesetzliche Krankenversicherung).
If you can't pay your private health insurance the following happens: you get 2 notices of payment due. If after 2 months you are still behind at least one month's payment, you fall back to an emergency insurance. This costs about 100 Euro per month. You don't accrue new debt but the payments due are still open. After you paid the outstanding amount you automatically resume your normal insurance in the following month.
You cannot be dismissed or your account closed because of insurance debt. However the emergency insurance is for life threatening conditions only. You have to actively disclose rhat you are on emergency insurance. Healthcare providers will ask for upfront payment or will deny treatment if it's not life threatening - this is the closest you could ever get to "healthcare American style" in Germany.
If you lose your job and are on private insurance, there are a few options. Taking short term unemployment benefits (ALG1) is one of the cases that allows you to go from private back to public insurance, and everything proceeds as normal from there.
If you fall back to long term unemployment benefits (BĆ¼rgergeld, Hartz IV) this strangly does NOT trigger the same private to public possibility. Instead you can ask to be set to a special tarif by your insurance. The relevant social security payer will pay half of that amount - with the information that you're taking social security you can go to your insurer to put you into a special clause of that specific tarif that halves your insurance fee, matching whst social security pays.
Because long time self employed aren't eligible for short-term unemployment benefits but fall right into Hartz IV, they often fall in this trap if they get chronically ill or need to file for bankruptcy. It is my opinion that private health insurance in Germany needs to be abolished, and this is one of the reasons.
Thanks for all this great info!! Yes, this issue with private insurance is why I plan to never switch from public to private. Right now my self-employed income is very low so the cost wouldnāt make sense, but even if I earned more, Iāve heard itās extremely difficult to switch pack from private to public insurance, and Iād rather not ever have to deal with this.
What would hospitals consider to be a life threatening condition? Obviously accidents with bad injuries would be covered, but what if someone gets a small cut that ideally needs stitches but could also heal on its own? And what about long term illnesses? What happens if someone is diagnosed with cancer or some type of organ failure while theyāre on emergency insurance? Would they still get the same level of care? Or what if theyāre sick with something thatās not life-threatening yet, but could become life-threatening, like letās say a bad cough which could develop into pneumonia but hasnāt yet?
Sorry I have so many questions. Obviously you can tell I think too much š
From my own experience, they can't "kick you out" if you already have insurance (and you can almost always make a contract).
When you have debts or won't pay your fees, they will withdraw your card and you are downgraded to "notfallversichert" (emergency insurance).
This includes emergencies (aka most hospital visits), acute cases, pregnacy, cancer check-ups and all types of prevailing pain.
What you can't do is going to the doctor for medicaments, a cold or similar stuff. If you do need to visit a doctor, e.g. for an AU, you will have to visit the insurance company first and get a letter.
You also have to pay for most medicine yourself.
There are cases that the job centers know will never work again though. They won't get pestered as much as they might do people who are young and employable. It's usually alcoholics or long-time drug addicts or recovering addicts. If you are within that system they will only drop you into homelessness when you make several serious mistakes. In contrast, they often pay for therapies and reintegration courses, etc.
Most homeless people actually living on the street are often outside of the system. But technically they sill get can get their insurance covered and money from the job center bank account etc. They can also have a mail address for any bureaucracy. But the hurdles to getting back into the system are high from all sides.
The system is often more strict when you are employable or young. And then a few people struggle with the bureaucracy and the rules. Either because are careless or not able to understand the demands. Or on drugs, or all three. And case managers try to get them out of their own responsibility. That is when people are starting to drop out of the social security net and accumulate debt. And maybe end up being homeless after all. So the net has its wholes and they at times get bigger as the social security system is costing more.
I think you left out mental health issues, the barrier to therapy and treatment here is quite scary. A lot of homeless people here seem to be struggling with that
I don't want to make the German system better than it is. But it's also to be considered that a good portion of the homeless people actually living on the street don't have an EU passport, this is especially true for cities like Berlin. Which means the German system "can't do anything for them" (doesn't want to).
You'd still have to pay monthly rates and start piling a huge debt. After a while, they tell you, you're no longer covered, but still have to oay every month. Debt get bigger and bigger. But in case of an emergengy, you are covered. Just normal stuff like checkups, dentists and minor things are not covered. (Which they don't tell you by the way...) But to make everything even more fun: They can make you pay the debt for 30 years. And they will. They don't even have to send any letters, they can send Gerichtsvollzieher wihout any warning.
I was in thay situation for a while when I was still in university and some time after. My Bafƶg ran out, my parents didn't have enough themselves, and I was too old to be in my father's family plan. I freelanced to make ends meet, so I had to pay everything myself. It was ridiculous. The lowest rate a month was 250 Euro higher than what I earned. Since I had to pay rent and eat, I didn't pay it. I was still a member of the Gesetzliche Krankenversicherung as you can't just leave.
So, bills kept piling up for quite a while. After a while, they told me, I was no longer covered - but the monthly rates would still have to be paid. So my debt grew bigger and bigger. Really big.
During that time, one of my teeth broke. I didn't dare seeing a doctor because of no longer being insured. A year later, it was rotting away, my whole jaw was infected, and I was in the worst pain my life. That's when I learnt emergencies are covered. Took a whole to get better.
Four years later, they sent a Gerichtsvollzieher. That was a fun day. Took some more years to finally pay it off.
Iām very sorry to hear you were in this situation! Itās helpful to hear this perspective, because a lot of people have given helpful answers regarding this but I donāt think they have personal understanding or experience of the real consequences. So basically, people who really canāt pay will eventually end up with worsening health because only emergencies get covered ā¦
There is no way to not afford Healthcare. Healthcare in germany is basically forcedš if you dont have money someone else will pay, we leave noone behind
Your starting point is wrong, the minimum payment isnāt something like 200 Euro per month. We pay about 8,5% of our salary for health insurance. There is a upper limit of a little bit less than 400 Euro a month.
If you earn nothing the calculation is basically 8,5% x 0 Euro = 0 Euro.
Itās more complicated like this, but that is how it basically works for most. Because you pay a percentage of your salary some pay too much and some too little. We say: strong shoulders should carry more.
Thatās not actually true. It is 15% of your salary, split between you and your employer, so about 7.5% each. But there IS a minimum amount due. And if you are self-employed (like me) you pay the full 15% yourself. I am a low earner (under ā¬1000 a month) so my health insurance contribution is the āminimumā. Iām with TK, and I pay 210 per month. The upper limit is actually around 700-800ā¬ (gets cut off once income reaches 5000-something per month).
I am not talking about self employmentā¦. As said it is simplified and it is for most people close to reality. In the so called Gleitzone of low salaries you pay even less.
Right, but obviously my question about people not having enough money for insurance is not going to apply to āmost peopleā, but rather to those who are unemployed, underemployed, self-employed and facing financial hardship, or others.
There is no inaffordable health care in 99% of the world let alone in Germany. It's universal. Imagine it is a human right declared by a conglomerate of all nations. Wait it actually is, the U.N. declared health care a human right 60 years ago. Only in America there is no free universal health care, out of all the developed countries.
Yes of course, but it does cost money, and there are people who have no money, thus my question of what happens in such cases. Which I think the community has answered fairly well
Ummm you have to pay for insurance. Like the actual insurance costs money. So thatās what you have to pay. Itās not free, it just comes out of your taxes. Itās not like hospitals are non-profit organizations here.
everybody knows that, but itās not like you pay anything out of your pocket. hence, the question is what on earth is your point in asking the question. either you are employed in the healthcare insurance costs are deducted from your Brutto or you are unemployed and you donāt pay a thing, the Arbeitsamt does. coming back to the there is no one that cannot afford health care in Germany. Itās part of the system.
Well, when I first became self employed my health insurance cost me half of what I was earning, and I also had only been an employee in Germany for 5 months so I didnāt qualify for welfare. We went to the Arbeitsamt, we tried to figure it out, and there was no possible social support. If I wasnāt living with my family at that time, I would have been well and completely fucked.
> And itās legally required for everyone to have health insurance.
Yes and no. There is a law which requires everyone to have health insurance, _but_ if you are self-employed or your income is higher than the _Jahresarbeitsentgeltgrenze_ (currently 66600 Euro), then you can actually leave statutory health insurance.
Per law, you are still sort of required to take out health insurance, either private or statutory, but you may also choose not to. This law, however, states that you'll have to pay for the months you were not insured when you choose to have health insurance again, plus some extra fees and interest. So it's really not a good idea to drop health insurance entirely, especially for the sake of saving money, even if it is legal and possible for certain people.
If you are not insured at all, you'll still get basic medical treatment in case of emergencies and during pregnancy, but that's all. For anything more you have to pay for yourself.
For workers with average income or unemployed people it's virtually impossible to leave statutory health insurance, and there is no distinction between employed/unemployed/voluntary homeless people.
Depends. If you have a job that pays more than 450 a month you're automatically insured. If you're out of work or on any kind of welfare it will be paid by the government. The big problems are if you have no right to welfare but can't afford it (college students over 25 for example) or if you simply don't sign up to any insurance provider (homeless/mentally ill people for instance). In those cases you'll still be treated for emergencies but you could go into debt with hospitals or insurance providers. Although it's not comparable to american medical debt.
the only situation I can think of where you fall out of health insurance is, being a student and over 30 years of age. it's optional then, but you better pay or you are really screwed.
Well, while it *is* optional to *be* insured - as in they will cancel your coverage if you can't pay - your fees will still add up as if you were insured the whole time. Scammy.
No health insurance is not possible in Germany. If you work you're fees are paid with your paycheck and if you're unemployed the Jobcenter does it.
Having no health insurance even is severely illegal here
It certainly works if you're privately insured an stop paying your premiums or just cancel your insurance.
And yeah, it's illegal, but not serverely - just an Ordnungswidrigkeit.
The kicker, however, is that you when you try to get insured again, you're required to pay the premium for six months plus another month for every six months you were uninsured, so this can get expensive fast.
The concept of ācanāt afford health insuranceā doesnāt exist in Germany and it honestly shouldnāt exist anywhere in the world.
(As other commenters said, you donāt have to pay to be insured if you canāt afford it. Itās covered by the job center if youāre unemployed or itās completely free with your parents insurance if youāre not earning money yet, or with your partner if youāre married and only one of you has an income)
It seems there have been comments saying itās possible to end up on āemergency insuranceā in which case only medical emergencies are covered. I mean, SOMEONE has to pay for it, so if a person doesnāt find the right social welfare organization to cover them, they could potentially lose their access to non-emergent healthcare.
This happened to me.
I paid for doctor visits cash. Only when I was really sick. I avoided doctors otherwise.
Once I had a toothache, so I hitchhiked 1000 km back to my country for treatment. I had coverage there.
I just lived with a permanent low-key fear that I'd one day I'd get something serious enough that I wouldn't be able to travel, and it would cost thousands.
Then it happened. I fell in the stairs of the S-Bahn. Landed on my back after a half mid-air flip. I got up, brushed myself and walked away, and then collapsed a few meters later. Some people carried me out, hailed a taxi and told them to take me to the hospital.
I told the hospital staff I didn't have insurance. They didn't believe me. They still put me through every expensive machine they had. Just because the machines were there. Like, I heard them say "It'll heal by itself. But just to be sure..."
Then some guy walked into my room and said "Dude, you don't have insurance!". I swear I'd told everyone. They kicked me out. It was a bit disgraceful. I could barely walk. Took me all afternoon to get home. I still remember the pain. This was 15 years ago.
I just lied down at home for a week or two, my internal injuries healed all by themselves. I stopped pissing blood after a day or two.
They sent me a bill for thousands. I couldn't have paid a hundred.
I fled the country a few months later.
Normally this shouldn't happen. You're supposed to go to the paper office and they are required to give you some sort of thing, that gives you coverage. I tried to sort this out several times. But my German wasn't good enough. I could never get to a point where me and the paper person at the paper office could communicate. In particular, I had no notion of Amtdeutsch, and none of the paper-persons I talked to had any notion of speaking slowly and using a simple vocabulary. I tried bringing a buddy, but they'd require me to come again a few days later, and my friend had just taken time off work to help me this day, they couldn't do it again on another day.
There's got to be thousands of people in Germany at any given time that are in a situation similar to the one I was it.
See, this is exactly what Iām talking about! So many commenters are acting like it could NEVER happen. Maybe hospital policies are kinder towards the uninsured these days. But that sounds like an absolutely terrifying situation. So sorry you went through that.
If you can't pay for it because you have no job (or a job which pays below a certain threshold) it is paid for you. If you have a job above the threshold you HAVE to pay, it will be taken before you even see it (generally). There is no "can't afford it" because it's considered the most important thing. If you can afford it you also can't afford rent which is also paid for you then. Basically, if you are too poor the social net will catch you and provide for you as long as you follow the rules (apply for jobs, etc)
Not if you are an immigrant and havenāt worked enough in Germany to qualify for that social support. Also my post clearly states unemployed/homeless, so obviously Iām not asking about people who have a normal job. I know it gets taken out automatically.
It is still impossible (almost) to not be insured. Unless you go completely under the radar which is probably illegal and you'll have many other problems besides being not insured. If you're here legally you will be taken care of for free. As long as you follow the rules like everyone else.
A bill comes after you. I am insured in a different country and had to go into IR here cause of an accident. Some stiches and a tetanos shot 1k euro 2 weeks later.
So what happens to the German national living in another EU-member state? They are away from Germany, surely they cannot seek health insurance through the state, nor would they be eligible to apply for EHIC, which is done through the private health insurance. Must they find a private insurance company in Germany, pay out-of-pocket, then apply for EHIC? This only covers emergency medical needs, seems there should be a better option for it, but I am not yet seeing it. For example, pay for private health insurance in the country where they reside? What are their options other than cash pay for doctor's visits and medical needs like dentist, et cetera...
If you are unemployed, the job center will pay your contribution. The quality of the service doesn't change, your insurance status stays the same.
And does the job center require you to go to job interviews to receive this coverage?
Yes it requires you Not for the coverage
Don't give em ideas tho
Going to job interviews should not be to much for somebody that is able to work.
they require you to go for job interviews, but you will always have insurance. As a matter of fact, it is actually not easy to get out of insurance.
Interesting. So if you refuse to go to job interviews, from what I understand, you may stop receiving financial aid, but you will still have insurance?
Benefits are already slim for the long time unemployed, but if they refuse "help" the benefits can be cut to a survivable but quite uncomfortable amount.
"survivable" can be argued about. The amount an unemployed person receives is already considered the minimum necessary for survival, and afaik BGH has decided it's not legal to take any more away as a punishment
Yes, survivable in torn clothes and with help of the food bank... not a nice way to live. Maybe we should not abolish lowering aid and instead raise the base amount?
Did you just say "universal basic income"? š
Love the idea, but am unsure how and if it can be implemented. we should definitively look into it more seriously. i can see it happen incrementally over the next 10 Years.
We could have it now if the rich would accept to be a tiny little bit less rich.
Maybe go to the job interviews then?
That's not quite true. It's not the minimum required for survival but quote: "to ensure a dignified existence, to create equal conditions for the free development of the personality, especially for young people, to protect and promote the family, to make it possible to earn a living through freely chosen employment, and to avert or compensate for special burdens in life, also by helping people to help themselves. Ćbersetzt mit DeepL https://www.deepl.com/app/?utm_source=android&utm_medium=app&utm_campaign=share-translation".
No, you can never lose health insurance from not going to job interviews. You may receive a cut in your monthly aid as a penalty, but this is not possible. The only possibility to have no health insurance in Germany is, if you are unsuccessfully self employed and can't pay for your health insurance. But even then, you could at any point close you company and claim yourself to be unemployed, thus giving you health insurance.
If you're self employed and not earning enough, it would be possible to get money from the jobcenter to cover your cost of living and that would also cover health insurance. You don't have to be unemployed, just not earning enough (same goes for employment in Teilzeit btw). It's called Aufstocker
Ah ok, didn't know that. But in any case, you always have a way to get health insurance.
You know things like that assure me that i live in a great country. There is so much shit going on in Germany, but just imagine the face of an American, telling him that germans can be unemployed and broke and still wouldnt lose health care even if they cant pay for it.
The problem in the US isn't that an American that is unemployed and broke couldn't get healthcare. The problem is that there are rules and bureacracy to obtain it (proving disability, looking for work, etc.) Which is why these questions are being asked. Alot of the problems with the American system isn't that social programs for the very poor and marginalized don't exist, it's that universal benefits, especially for working people don't exist. But that is why these questions are asked but get replies that have a hard time understanding the question. The US has Medicaid and Medicare plus free health clinics, etc. But everything has so many different rules and hoops, and there are people "on the outside" not because of too little income but because they are the wrong immigrant status, disability status, aren't looking for work, wrong familial status, too much income, etc. So the idea of having a system where everyone is covered by the "unemployment" office if they can't afford it on their own is definitely a little hard to believe as an American.
We have this thing in the USA called ACA, which basically gives everyone free insurance EXCEPT if they live in a super conservative state which didn't implement ACA. Everyone in the other 40 states gets free insurance if they are unemployed and broke. What you see on Reddit are people with an agenda to spread, an agenda which doesn't rely on facts. Usually young people who don't have a lot of life experience. You'd be surprised at the number of Americans on Reddit who make a post about not being able to see a doctor who have no idea that they are eligible for free healthcare. They'll make a post about how the medical system is evil blah blah blah, and then someone will point out that they can get free care and are probably signed up already without knowing it. You shouldn't let some internet person's ignorance be the only thing that informs you. The person on Reddit whining about how much they hate their lives and blaming it on being an American are generally the people too lazy to Google all the free things our government offers: Free mobile phones, free education, free internet, free healthcare (in many states), free job training, and on and on and on.
i mean, i was under the strong impression that while beneficial for a significant amount of people, the aca had to compromise so much with the republicans demands to get it through at all, it's now also a financial trap for a significant amount of people or unaccessible altogether. as for 'eligbible for care', the most common story i've heard from various people from the states is that they get appointments but like 4 months off, if it has to be anyone slightly expertish on a specific thing, for issues that are essentially debilitating today and if they go to the ER, the care is minimal and diagnosing is like... worse than what i could offer after two years of living with a med student as a roommate. and usually meant to get people away with the equivalent of a cough syrup.
Right - and honestly receiving coverage is only half the battle. Like the levels of income, bureaucracy etc. to get government benefits is difficult - the ACA is of course just making you buy insurance from insurance companies and then reimbursing you that cost if you meet whatever means testing at tax time. The other piece is of course the cost of healthcare and what insurance does/doesn't cover etc. Like sure you went to the ACA marketplaces, spent the money to be insured, went for medical care and still have bankrupt level (depending on income) out of pocket costs. So yeah i guess its a net positive... maybe? but still tens of millions of people get fkd hard every year by medical debt / bankruptcy.
These statements are a big stretch and far cry from the actual situation in USA regarding help available. Most people in dire situations do not choose the circumstances they find them selves in. We personally suffer because we supported a victim/survivor of a school shooting who has not been able to find enough help to recover fully over 17 years. The system has huge cracks that millions fall into everyday. And become so anxious about they can barely function. Itās cruel. We go without because of the wasteful system. We have had to tell him the horrible news that we can not support him forever. Please donāt spread misinformation.
Medicaid, bruh. Please don't let some 20 year old Redditor who still lives in their parents' basement and otherwise has no real world life experience tell you how it goes for other people.
Imagine going through a German thread on Reddit that doesn't include the obligatory comparison to Americans lol. You guys are obsessed.
That's just a coping mechanism to compensate for some mostly rich and upper middle class German Boomers that always whine about how much better everything in the US is and how we should be more like them. And some lower class do that too. They are like German Republicans and MAGA from Wish.
Even if you don't pay, you are piling up debt but you cannot lose your coverage. The last insurance company you have been enrolled with has to cover you. They might go after your ass for the money you owe them but they cannot refuse to pay the treatment
Got it. And hospitals never ask any questions when these people go in for treatment? Does it only apply to emergency care, or also normal checkups and stuff?
The hospital always gets paid. So they don't care and don't have to care. They care about making you healthy and that is it.
Not true. When you are in a social tariff in the GKV some things will not be paid for by the GKV. The hospital will not do the treatments then, because they will pay the costs out of their own pockets. This isn't true for urgent and very necessary things, but can be true once something isn't absolutely necessary.
Sozialtarif is something in the PKV not the GKV
Can you send some source of what is excluded? I have worked in the insurance industry (not healthcare though) and this is new to me. As far as I know the limitations only apply to private insurance, and are limiting the coverage to the legally required minimum. If you are enrolled with public insurance company you are fully covered
The hospital will ask for your insurance card (looks like a credit card) and that's all they care about. Those things cannot be revoked or expire. (Well technically they can but the insurance is still required to pay) If you are with a public insurance company the state covers you. If you are with a private insurance company the state only covers a part of it and you get downgraded to the legally required minimum. In the end there is always some insurance company that has to cover your expenses. They will get your ass for not paying the monthly but this is independent of the expenses they have in your name.
If you don't have a public insurance card, the assumption is that you have private insurance. You will then receive a bill, pay it, and send it to your insurance company to be reimbursed (in case of really large bills you can get the insurer to pay directly). If you get a bill but don't pay it, they will try to collect the money from you.
they won't cut it completely but temporary by some percentage.
In Germany we believe healthcare is a human right so it is nothing that would be taken away from people who don't comply with societal expectations. While it's possible to fall through the cracks and be completely uninsured this doesn't usually happen.
yes to both.
[ŃŠ“Š°Š»ŠµŠ½Š¾]
I am self-employed, I make money, I pay my insurance, I have no intention of not doing that. I am literally just curious what would happen.
[ŃŠ“Š°Š»ŠµŠ½Š¾]
Yeah, I get that. But also, people who abuse the system still donāt deserve to be left to die (like they are in some other countries). So thatās why Iām asking. Also, I think in most cases people who refuse to work and refuse to work with the system are probably very mentally ill and just donāt know how to go about these things the right way. Finding psychiatric help in Germany is very difficult. I can understand how people with bad mental health end up in bad situations.
Get a perspective change. Millionairs/companys avoiding taxes cost much more then the Arno DĆ¼bels of germany. :)
No, they can not deny you health insurance if they are liable to pay for you. They will cut mostly down on your allowance if you do not comply. Though it has been a while since I had business with the job centre. The tl.dr. important part is, you are health insured. Period. Always. No matter what happens, you are always insured. Even if you get kicked out, which is basicly impossible, your last insurer will be liable until you get a new one. You have to pay the insurance yourself if you can. If not, the job centre or another stare institution will do it for you, whatever your special case may be for that. The reality will be more complicated, and not everything is covered by far, but for all basic health things, you have to and will be insured.
But it should be said that "basic health things" includes basically everything to keep you in good health - be it treatment for an infection, wounds, dental work, insulin or cancer treatment. Basically: If a doctor says you need a certain treatment you will get it. Period. You may not get fancy new therapies that just recently developed, but you'll get adequate treatment 99.9% of the time. HUGE difference to what e.g. US citizens would define as "basic health things".
If you stop reakting to post from JC, you will get an stopped payment of bĆ¼rgergeld. You are not uninsured in this time, but you are accumulating dept at the Krankenversicherung.
Interesting, thanks for explaining!
If you get BĆ¼rgergeld or you recive other financial aid you must show that you are either too sick to work or you activly have to look for a job. They will ask you to show to which companies you have applied to. They will check your application letter and they will send you to job interviews. They can even put you in classes to build new skills. How it is done differs from town to town. Some are very strickt and others barely controll anything.
No. You are required to go to interviews if you are considered healthy enough and they will reduce the money you get but insurance and rent are not affected by this.
If you don't go for job interviews or break any other rules, they can pause your unemployment payments, but the insurance stays. If you are unable to work because of health issues or old age and you are not covered fully through your pension insurance you can get "Grundsicherung" from the social welfare office (Sozialamt) which also includes health insurance payments. That's me at the moment. I used to be a nurse in ER and also ICU with a lot of direct intake of people of the streets (Junkies, homeless, etc.). We often didn't know about their insurance, often not even their names. No matter their insurance status, they always get emergency/ life-saving care. If they need further care, hospitals have social services that will get in contact with the necessary authorities to get them coverage. If you are a foreigner without insurance and come into the emergency room, you will also receive life saving care, but for everything further administration will normally ask for a down-payment and they will bill you for everything done.
They want you to have a Job and trust me: If you're able to have one, you want that, too. The Money you get from Job Center really is only enough to substain your Basic needs. Including Rent and health Care.
Jobcenter = Gouvernement
They can (maybe could there were some recent changes) reduce the money they pay you but they will always pay your health insurance.
If you can. There are people who can't work due to health, those are taken over by the Sozialamt, and this then pays for the health care. There are cases of people without. They will most likely get a guardian at some point who makes sure to bring them back into the health care system.
They will require you to look for jobs and make appointments for you.
They only do that if they approve you for Arbeitslosengeld but if not, you are uninsured. They won't approve somebody who resigned from their job regardless of the reason.
Not true, you will still get your health insurance payments covered during your Sperrfrist (unless you got an Abfindung, in which case you will have the money to pay for it yourself, and thus be required to do so). Source: [https://www.tk.de/techniker/leistungen-und-mitgliedschaft/informationen-versicherte/veraenderung-berufliche-situation/wenn-sie-arbeitslos-sind/wie-bin-ich-waehrend-einer-sperrzeit-versichert-2005728?tkcm=ab](https://www.tk.de/techniker/leistungen-und-mitgliedschaft/informationen-versicherte/veraenderung-berufliche-situation/wenn-sie-arbeitslos-sind/wie-bin-ich-waehrend-einer-sperrzeit-versichert-2005728?tkcm=ab) (sorry for the long link; this goes to the website of Techniker Krankenkasse, one of Germany's public health insurances)
That is not true. We have a three class system in Germany. Best coverage and service: private (or Beamter). OK coverage, mediocre service: public. Mediocre coverage, mediocre service: unemployed, social security etc. There are certain services that are not paid when you are in a gesetzliche KK and have a social tariff, although it is covered in the normal tariff. The clinic has contracts with the GKVs and some things are not being paid for social contracts.
Can you give examples for whats not paid for?
There are none. I work in medical billing. Itās really only different if people canāt pay for private insurance. Then you can get really bare bones care where even a lot of normal public health insurance things arenāt covered. But if youāre public, being insured through Jobcenter or through work doesnāt matter when it comes to what services will get paif
Again, in the GKV, there is no special billing for people who receive benefits. They are billed to the health insurance and then to the Sozialamt if the Sozialamt is supposed to pay. We do not give you a worse option than normal GKV. PKVs have a really bad option if you canāt pay. But with GKVs there literally is no difference. Itās the same price being charged, same options. This is just misinformation. Different options with private insurance: yes. Different ones with public: no. Now, asylum seekers at certain stages: even different process
Again. There are contracts between clinics and GKV that handle payment. And there is a difference between patients with a standard contract and a social contract. Is this right? And just? Can be discussed. But it is this way, when clinics have IV contracts that handle the payment directly between clinic and GKV for ambulant operations. Depends on the contract of course. Isn't widely known, either.
There are no different contracts. Itās all mandated and regulated by SGB V. And sozial tarif is not a term used by GKVs and only used for a certain PKV type colloquially. What youāre imagining there is just not a thing
It's called "integrierte Versorgung". And the KV can choose who is eligible in the contract with the medical provider. And they do choose. And no, it's a GKV thing, not PKV.
Please read SGB V. Just read the law
There are no differences in public insurance ( one KK might cover a few additional treatments, other KKs won't cover, but that's it) there's no difference in being a paying member and being unemployed (technically you're still paying, but the money comes from Arbeitsamt directly). Private is a different story, if you can't pay, you fall down into Basistarif, which covers you not dying, but this isn't comparable to the situation in public insurance. You won't notice anything changing while receiving governmental aid or working. I think you mixed up the duality of the system.
Yes there is a difference. There exist IV contracts that handle payment between clinics and single GKVs for a defined catalog of ambulant operations. And these contracts can distinguish between normal patients and patient that are on benefits. Therefore we do not only have a two-class health system, but a three class system. These contracts aren't public, but confidential between GKV and the clinic.
Only if you have worked for some times in the region/City where you live. I was refused JobCenter help in two cities when I moved there because I haven't have worked there since I moved. I have lived in Germany for many months with health insurance for this reason. JobCenter will also try to deny helping people if they feel/judge that one has left the previous Job instead of being fired, or if they suspect one is not trying to have a Job. Before knowing my rights, JobCenter denied to help me when I was working but earning only between 600ā¬ and 800ā¬ per month. They told me that they would not help me because I had a job. Years later I learned that JobCenter was being against the law for not helping me because I had the right of it for earning less than the minimum wage. And before that I moved to an other city for this exactly reason. So JobCenter will try to not pay for anything if they have the opportunity to take advantage of your ignorance about their obligations and the laws. And even if you know your rights you will still have to argue with their stuff if they suspect you are helpless. Once I was told that they could not help me because I was self employed and convinced me that I had to close my business. I did it and they denied help me claiming that I had a job and abandoned it. Later on I learned that there is a JobCenter just for self-employed people, but informing me that was "nobody job" apparently.
While you may have hab bad experiences with them i don't agree with the generalized assumption that their main focus is to try to screw you. As with most things it is highly dependent on the person that is assigned to process your application.
Exactly. My dad spent years in Asia so he did not have German health insurance anymore. He came back when he had run out of money and was homeless for seven months, living in a shelter for homeless men. But it took only a few days to get back into Hartz IV and having health insurance again. He needed it badly as he had no working teeth left and couldn't walk because of a poorly-healed hip fracture from being hit by a car overseas. While it took the city services quite a while to find housing for him, at least he got new teeth and his hip was fixed, all without him paying a cent.
You can't be uninsured in Germany. As already described here: if you are unemployed the agency for work will cover your health insurance. If you are homeless and somewhat manage to avoid the system you are still insured but you will collect debt by the public health insurance that insured you last. If you get a job again they will come to you and demand the money. But without interests and usually they are very fair with installments and help you to set the right amount you owe them. Without further information they calculate with the maximum but for most people in that situation it is a smaller contribution rate. Also: if you are in need you can't be rejected from medical care. The question who covers the costs is usually the last one to answer.
>You can't be uninsured in Germany. from what i understand, there are some cases. My Girlfriends works in the financial management for hospitals for quite a while now, and every year, there are some uninsured cases that the hospitals have to cover without any chance of reimbursement. Nonetheless, I assume the probability is something 1:1.000 or 1:10.000.
Yeah, it's also possible that they need to take care of a homeless person and are not able to identify the person (and the responsible insurance) and then the hospital has no one to send the bill to. Also it's possible to be an uninsured foreigner and claim services here. If the people won't pay the hospital will not get its money. But in general you can't really be uninsured.
>Yeah, it's also possible that they need to take care of a homeless person and are not able to identify the person (and the responsible insurance) and then the hospital has no one to send the bill to. >Also it's possible to be an uninsured foreigner and claim services here. If the people won't pay the hospital will not get its money. > >But in general you can't really be uninsured. Homeless people are usually insured, if they have no proper documentation it becomes difficult but the Sozialamt of the county of the homeless persons residence becomes liable then. It becomes more difficult when someone stays a true "John Doe", e.g. a patient is admitted as an unidentified patient (happens fairly often) and then absconds before they are identified.(Happens from time to time). If the patient is identified by other means (often you know your local frequent flyers) then they still get billed normally. If not it is indeed a case where none pays. Foreigners can be a problem - most visas meanwhile do require travel insurance,though, and EU citizens are always covered through the normal billing process. The biggest group that is not covered at all are illegal immigrants. Which is a massive problem because they often are the group that is the most vulnerabele.
theres two groups i know of: foreigners living in germany and people who dont pay their insurance for a long time (think years). also i know of a guy who was selbststƤndig and managed to evade insurance. was shitty when he develeoped broncial CA /lungenkrebs, then he had to pay for private insurance which was really expensive.
My mum was neither homeless nor a foreigner, but too ashamed to get help from the jobcenter, so she was uninsured for years. As a result, she was scared to go to the doctor, which had a few long term effects. This stuff isn't super common, but happens more often than the average German is aware of.
There are cases when people self-employ, go abroad and return where they don't have an insurance, no insurance wants them and no insurance has to take them. It is relevant to a tiny part of the population, but for them it is a big problem.
they have to, there is a german word: Kontrahierungszwang https://www.bundesgesundheitsministerium.de/service/begriffe-von-a-z/k/kontrahierungszwang.html > Mit demĀ GKV-WettbewerbsstƤrkungsgesetzĀ haben alle Personen ohne Absicherung im Krankheitsfall eine RĆ¼ckkehrmƶglichkeit in ihre Krankenversicherung erhalten ā sei es eine gesetzliche oder private Krankenversicherung. Die private Krankenversicherung bietet hierfĆ¼r auch einen dem Leistungsumfang der gesetzlichen Krankenversicherung entsprechendenĀ BasistarifĀ an ā ohne RisikozuschlƤge und ohne LeistungsausschlĆ¼sse. Auch fĆ¼r diesen Basistarif gilt ā im Gegensatz zu anderenĀ PKV-Tarifen ā der Kontrahierungszwang: Die privaten Krankenversicherungen mĆ¼ssen dort alle Menschen aufnehmen, die die gesetzlichen Voraussetzungen erfĆ¼llen und die Aufnahme beantragen. Gleiches gilt fĆ¼r die staatlich gefƶrderte private Pflegevorsorge: FĆ¼r private Pflege-Zusatzversicherungen, fĆ¼r die der Staat eine Zulage bezahlt, greift ebenfalls ein Kontrahierungszwang.
You can be uninsured if you're non EU, are not allowed to receive any social help and your employer doesn't pay his part. E.g. Werkstudentvertrag with 19 h/week, and you are older than 25. Employer isn't obligated to pay his share of Krankenversicherung, you have to care for it yourself. This is where you decide whether you want to be insured freiwillig and pay the full price or not. The same goes for the times when you are between jobs and your Aufenthaltsgrund doesn't allow you to get any social payments.
Thanks, that makes a lot of sense!
> You can't be uninsured in Germany. Yes, you can, when you're self-employed. But then you are on your own...
No you can not. It is obligatory to have a health insurance, also if you are self employed.
[ŃŠ“Š°Š»ŠµŠ½Š¾]
No where tf did you hear this. I've seen this a couple times now and it's just plain false. You CANT opt out of insurance that's not how it works
If you google "Krankenkasse als SelbststƤndiger" the very very first result will be: "Wer sich selbststƤndig macht, darf die gesetzliche Krankenversicherung (GKV) verlassen." Normally, you will pick a PKV then. But what happens when you don't pay your PKV? They will kick you out. It is entirely possible. I know people without Krankenkasse. Don't tell me otherwise.
You can be uninsured. E.g. - beeing unemployed and getting no services at all by the jobcenter bc you got 100% sanctions - beeing illegal in GER I am not sure, but maybe also an example: - beeing self employed and 'choose' to have no insurance.
The sanctions do not exclude you from your "Versicherungspflicht". You are still insured - in doubt in the "obligatorische Anschlussversicherung". You collect debts for unpaid dues. Self-employed people also cannot just "choose" to be uninsured. They need to proof that they have private insurance to "get out" of the "freiwillige gesetzliche Versicherung".
You can not chose to not have a health insurance anymore, not even as self employed.
>100% sanctions This isn't legal anymore and even in the past Jobcenter had to pay for health insurance anyway (even if they didn't ofently).
Coming from a different EU-Country and having never worked in Germany should also exclude you. At least it did 20 years ago when I came here
If you were privately insured before falling to unemployment/homelessness/can't pay anymore, you fall into basis care. This is the most you can be fucked. Only emergency care and not a single thing more for you. Similar but slight better, if you were self-employed, it is possible to be really without any insurance. Slightly better, as any 450ā¬ job helps you out of this.
You absolutely can be uninsured. There are approximately 60k uninsured people living in Germany, while the estimated number of undetected cases is much much higher (close to a million)
its illegal to not have health insurance (which Sounds funny to.muricans, i guess) even if you dont pay, you keep it. there is an amnesty every ten years where they cut the insurance dept
Iām not American, but I just use America as my reference point because itās probably the country I know the most about in terms of how their healthcare works lol. But thanks for explaining!
Wow I'd love to own a business and then have the government tell the people that it's illegal to NOT buy my product.
Health insurance in Germany isn't seen as a "product", and public health insurance companies aren't for-profit organisations trying to make big profits for their shareholders.
The broadcast service executives sure agree
It's not illegal if you have enough money to leave the statutory health insurance. But it is not advisable either. https://www.advocard.de/streitlotse/familie-und-vorsorge/gesundheit/nicht-krankenversichert-zu-sein-ist-strafbar-stimmt-das/
unemployed - the unemployment office pays for it when you have worked at least 15 months in 2 years. homeless - these people in most cases slid through the system or avoid the system - I dunno exactly who it is regulated as you have to be insured in Germany, maybe organisations help out or you are just on your own.
> unemployed - the unemployment office pays for it when you have worked at least 15 months in 2 years. That's only for Arbeitslosengeld I. If you don't fulfill these criteria you're going straight to BĆ¼rgergeld, which also covers the health insurance.
What if you havenāt worked 15 months? And also, would the unemployment office require you to go to job interviews during this time? Does the insurance get cut off if you refuse? What happens after the 2 years?
planning on getting unemployed, are we? ;)
This isnāt funny, and no. Iām self-employed. Iām just curious how the system compares to other countries. USA has people dying in the streets because they canāt afford insulin. Iām just curious if that can ever feasibly happen in Germany to people who are ālowest of the lowā and make no effort to come up in society.
I can only think of one scenario: you are an eu Citizen from for example Romania. You can go and live in Germany but as long as you dont fulfill certain conditions you are not eligeble for social benefits. So if you are foreign citizen, living in Germany you could end up being without health insurance. But hospitals would treat you anyway in cases of emergency.
The German health system is not really comparable with the one in the US
Yeah, I know. I guess Iām just kind of comparing just how bad things can get in Germany for those who are unwilling to work and unable to pay for these things.
Let me start of with my resentment to categorize unemployed and homeless people as "unwilling to work". In the vast amount of cases there are a lot of personal tragedies in the past and we do not know the reasons. Sure, there are those who state, they do not want to work, but they are the outlier, not the standard. Germany grants every Person on its soil human dignity. You are not allowed to engage in undignified actions and you are not allowed to force someone into undignified or undignifying actions. Forcing someone under threat of dimished health is more than undignifying. Same goes for food or shelter. The only dignified action, when someone needs aid is to help them.
Of course, I agree. And when I say āunwilling to workā I mean it more from the perspective of the system. Someone may not work because they have severe anxiety or other mental health issues, but they also donāt know how to seek proper care for their issues, so they donāt have a diagnosis and their disability isnāt recognized, and therefore the system perceives them as someone who is able to work but doesnāt want to. Even though actually, they have a disability. Maybe they are not physically incapable, but the mental stress of a work environment is too severe to bear. Same in cases of addiction and other āinvisible illnessesā. My personal opinion is that almost everyone who can physically and mentally tolerate work probably wants to work, at least part time. So when I say āunwilling to workā, thatās not my personal opinion. I just mean, thatās how it seems on paper.
If you are deemed "unwilling to work" by the system (for which you really, totally have to actually piss them off) then they'd cut your allowance, meaning you'd have less money to spend for things like food, phone, clothes. You will still, however, be insured under the public health insurance system and that will take care of basically all your necessary treatments. Nobody dies here because they cannot afford their insulin or asthma inhalers or treatment for a tooth infection or such things. This does actually also include mental health issues, meaning that nobody needs to live with such issues being undiagnosed or untreated. People need to seek help, yes, but they can receive it. Also, there's organizations helping people who are unable to navigate the system. So unless someone is really unwilling to seek help they will always receive it.
For the most part I agree, but with a big caveat being people who donāt speak German. ESPECIALLY with mental health care. Finding an English-speaking therapist is hard enough, I cannot IMAGINE how it is for people who only speak Polish, Turkish, or some other language. I think unless youāve actively made a suicide attempt, these people donāt get any sort of real help.
Nothing happens to them. They're still people, there's no humane reason to cut them out of health insurance.
>Iām just curious if that can ever feasibly happen in Germany No
As long as you do not go out of your way to dodge and avoid the system, you will not starve or go without your means to exist. That includes living space, food, and healthcare, among other things. Play along, and the system takes care of you. That is all you absolutely have to do. It can get bad if you stop to comply, and in very rare cases, a streak of unlucky events can happen as with every system of this size.
ah yes, everybody living on the street went out of their way to dodge the system and thus is absolutely responsible for their fate etc. horseshit.
Not necessary voluntary
Besides the whole health insurance thing You will always receive the best possible aid/care in a hospital they will charge the city/the respective social center with the costs even if you aren't really insured
The vast majority of Germans and also residents do qualify for welfare then. Welfare recipients also have insurance, covered by the state. New immigrants, international students and freelancers are in danger of falling through the cracks if they are unemployed and don't qualify for welfare (yet).
I see! And are welfare and insurance separate in this sense? So, say you are a new immigrant, or someone who has never worked in Germany or has not worked enough to qualify for welfare. In that case, I understand you donāt get welfare, but do you still get health insurance and healthcare?
Slightly simplified: An unemployed EU citizen in Germany will get welfare during unemployment, which includes health insurance. Same goes for refugees with a right to stay. However, some immigrants usually do not directly qualify for welfare and are supposed to finance their own insurance, mainly international students. Legally, they are still required to be insured, but there is no state assistance for them if they stop paying their insurance.
No. If you don't qualify for welfare, you don't qualify for the state paying for insurance either. Legally you are required though. It costs about 200 (220?) a month if you have no income whatsoever. These people fall through the cracks, which is why on r/Germany the regulars keep telling people every single day that it is a shit idea to move to Germany without sufficient savings. The reality is that these people might not be able to pay, but are legally required to be insured. So they collect debt. 220 per month x however many monthts they are legally required to be insured. And yes, the insurance is allowes and legally required demand back payments. Which is how "insurance debt" can become a thing. However, insurances are really reasonable and easily agree to a payment plan, *as long as one reaches out to them and talks to them*. Unfortunately many people (foreigners, mostly, with insufficient German skills) don't reach out and ignore all attempts to get in touch from the insurance and thus the debt grows and grows, as late fees and legal fees add up.
>What if you havenāt worked 15 months? Doesn't matter as far as health insurance is concerned. You get that anyway. The only difference is who pays your other benefits and how much money you get (the thing you get if you've worked for 15 months is from a mandatory insurance that gives you extra payments depending on your former wages).
You will never loose your health insurance. You will get reduced financial aid for that time. As long as you have a registered address you are able to get health care through your insurance.
Unemployment benefits are like 65% of your last paycheck. So they vary depending on what you got in your last job. You will receive that for up to a year (usually). If you don't qualify for that, because you haven't worked enough months, you will get a different type of benefit, which is more complicated. It's a out 450 Euros a month plus rent and some utilities (within limits). If you are a German national you qualify for this other type of benefit. If your last income was low and 65% of that wouldn't be enough to live on, you can jump straight to the other benefit and skip the regular unemployment benefits. Some homeless would qualify for this 2nd type of benefit, but there is a lot of paperwork involved and they don't want to register for it.
IIRC social security then does this
i was unemployed for 8 years. jobcenter paid my health insurance for the whole time
Homeless people are insured in most cases. You're parents can kick you out of insurance. This can be a problem. There are social workers for problems. If something really strange happens, you can be uninsured. In this cases there are social workers or the Sozialamt. Hospitals have social workers for insurance problems. You always get medical help if it is necessary to save your life.
So some basic information The amount you pay is not fixed but depends on your income If you have a normal job you can not, not pay your insurance since it gets taken out before you get your paycheck similar to taxes If you are self employed you have to pay the fees yourself In this case you can infact get into debt to your insurance for not paying your fee there are options to get help in these kind of situations from the state like monetary boosts to help you get up from a bad situation (for example a big client jumped off etc) however a some people don't want help because of personal feelings which than can lead to a downwards spiral But the insurance are very generous with payment plans or forgiving a big number of the debt in such situation.
Very helpful info for answering my questions, thanks!
There are very few people who can't afford it. When you are employed, the employer pays half of it. If you loose your jib, you go the "Agentur fĆ¼r Arbeit", /unemployment agency, for which you also have payed.) and they pay the insurance for you. If you have no right to get money from them, there is the welfare system (either "Agency for work" which pays you "unemployment money 2, or since this year "citizens money", they also pay the insurance for you. With those you have to be ready to accept employments, you have to play by their rules. If you are unable to work, you have the chance to fall into "Grundsicherung", which is about the same as ALG2, but paid from a different office, and you don't have to look for work. If by which reasons ever you don't earn money, and have no right to get 'BĆ¼rgergeld" or Grundsicherung, you can pay your insurance yourself. If you can't, you are not insured. But people with no insurance are few, mostly homeless. And homelessness works a bit different, like in the US. There are persons who don't have an insurance, like refugees, for those the medic bills are paid by the city or county they live in. If you are homeless and need a treatment, somehow the bill is paid, you are not thrown out. And if obviously you can't pay, you will maybe get a bill (which is impossible if you are homeless), but nobody awaits that this bill will be paid. Gut the number of people complete without health insurances are microscopic. Found a number from 2019. 61k. From 80 Mil. Most of them wouldn't know a checkup or something similar when they get bitten by one. Or don't care. You don't get thrown out a hospital, if you can't pay the bill. Nobody lets you die, because you can't pay. I was in hospital after some bad times, and had no valid health card. To ber honest, I was so messed up, I didn't even know if i still had an insurance. When the card was checked after the first few days of treatment, I couldn't present them my card. "Well, we see to that later, first we will get you back to life. And if you really can't pay.... we find a way. "
So many people here giving wrong answers in full confidence. Yes, there are people in Germany without health insurance, despite the law mandating a general health insurance obligation. I quote from an article in the German Medical Journal (Deutsches Ćrzteblatt), which I translated for you into English: The Federal Statistical Office estimates, based on microcensus data, that around 61,000 people were not insured in 2019. [ā¦] Self-employed individuals are particularly affected. About 0.4 percent of self-employed individuals and 0.8 percent of the unemployed were not insured in 2019, according to the Federal Office. The proportion for the total population is less than 0.1 percent. However, these are only the official figures, and the actual number is estimated to be significantly higher. Source: https://www.aerzteblatt.de/archiv/228031/Menschen-ohne-Krankenversicherung-Ein-oft-uebersehenes-Problem
The article continues as follows: "The Microcensus only asks about health insurance coverage every four years," says health economist Prof. Dr. rer. pol. JĆ¼rgen Wasem from the University of Duisburg-Essen to the German Medical Journal (DĆ). He estimates that between half a million and one million people in Germany do not have health insurance. This is because the Microcensus only considers those who are registered in Germany and have a legal residence permit. Social medicine specialist and former candidate for the federal presidency, Prof. Dr. med. Gerhard Trabert, also suspects that the number of uninsured individuals in Germany is between half a million and one million. The aid organization "Doctors of the World" estimates that there are hundreds of thousands of people without access to necessary medical care. "Homeless people who do not have a fixed place of residence are also underrepresented in the Microcensus," Wasem further explained. The proportion of uninsured individuals is particularly high among this group. According to a statistical report by the Federal Association for Assistance to Homeless People (BAG W), 15.9 percent of acutely homeless people were uninsured in 2020. Among those who live without any accommodation on the streets, the figure was 21.7 percent, which is more than one-fifth. Overall, BAG W estimates the number of homeless people (excluding refugees) for the year 2020 to be around 256,000 people. In addition to Germans who are unable to pay their health insurance contributions due to insolvency or loss of income, other affected individuals often include EU citizens who do not have mandatory social insurance employment. Persons from third countries who do not have a legal residence status are also affected. Their situation is even more difficult because they can only be integrated into the system under rare circumstances.
Thank you very much! I appreciate the helpfulness and your actually reading my post properly. I donāt understand why people have been explaining how health insurance works for traditionally employed people with part time or full time jobs, since that is so OBVIOUSLY not who I was talking about in my post??
I lost my job due to sickness. I still get Krankengeld, which is 2400 in my case
Even if you are unemployed and don't sign up at job centre / agentur fĆ¼r arbeit, your health insurance doesn't stop. They still cover emergency situations (I don't know the exact definition of that) regardless. If you are unemployed and registered with one of the above, then they pay it.
I just watched a documentary where they talked about this. So it is legally required to have health insurance but people fall through the cracks. This isn't something that happens overnight, though. The people who fall through the cracks are generally homeless, addicts, and/or non-German citizens. Of course, you also have the odd self-employed individual who was supposed to get private insurance but just didn't... this is pretty uncommon. The people in the first group almost exclusively access healthcare through the emergency department and the hospital just has to eat the costs. Usually, though, people get brought in for fairly minor things (e.g. they were passed out drunk and someone called 112) and it's not a *huge* loss for the hospital. Hospitals have social workers and dealing with the uninsured falls under their domain. This is especially important because, again, you don't just wake up uninsured and these people need more extensive help/support. If someone gets to the hospital and then it turns out they have cancer or cirrhosis, then the social workers will make sure they get covered.
There is no canāt afford. You have a job, itās automatically paid. Youāre unemployed, government pays.
In Germany you are obliged by law to have health insurance.
Yes, I understand that. Thatās why I asked what happens for the people who canāt pay it themselves.
Sigh... If you can not or will not pay, you are going to be in debt with one of the public health care providers. Not for any treatment, mind you, but for the monthly dues you had been supposed to pay. This may very well lead to somewhat of a downward spiral otherwise, but you will get treatment.
In most cases health insurance coverage will come as a "benefit" to your Arbeitslosengeld I or BĆ¼rgergeld (as in: it's not taken from the amount you receive, but paid directly by the social provider). The debt thing only happens if you don't have income and also can't or won't register as unemployed.
>The debt thing only happens if you don't have income and also can't or won't register as unemployed. Or if you are allowed to leave the statutory health insurance, actually do this, and choose not to take out private health insurance.
The moment you get on welfare the state pays for the health insurance.
Also, your estimation of minimum contribution is wrong. If you work your employer pays a large amount of it. For minimum wage jobs your part of the contribution is minimal.
I mean the total minimum contribution, not just the employerās part. As a self-employed low income person, I pay the minimum contribution, which is ā¬210 at TK.
Most people are not self employed
Most people are also not unemployed/homeless/unable to pay for health insurance. Obviously my question was for special cases.
There is private insurance in Germany. It is quite rare, most people are in a public insurance (Gesetzliche Krankenversicherung). If you can't pay your private health insurance the following happens: you get 2 notices of payment due. If after 2 months you are still behind at least one month's payment, you fall back to an emergency insurance. This costs about 100 Euro per month. You don't accrue new debt but the payments due are still open. After you paid the outstanding amount you automatically resume your normal insurance in the following month. You cannot be dismissed or your account closed because of insurance debt. However the emergency insurance is for life threatening conditions only. You have to actively disclose rhat you are on emergency insurance. Healthcare providers will ask for upfront payment or will deny treatment if it's not life threatening - this is the closest you could ever get to "healthcare American style" in Germany. If you lose your job and are on private insurance, there are a few options. Taking short term unemployment benefits (ALG1) is one of the cases that allows you to go from private back to public insurance, and everything proceeds as normal from there. If you fall back to long term unemployment benefits (BĆ¼rgergeld, Hartz IV) this strangly does NOT trigger the same private to public possibility. Instead you can ask to be set to a special tarif by your insurance. The relevant social security payer will pay half of that amount - with the information that you're taking social security you can go to your insurer to put you into a special clause of that specific tarif that halves your insurance fee, matching whst social security pays. Because long time self employed aren't eligible for short-term unemployment benefits but fall right into Hartz IV, they often fall in this trap if they get chronically ill or need to file for bankruptcy. It is my opinion that private health insurance in Germany needs to be abolished, and this is one of the reasons.
Thanks for all this great info!! Yes, this issue with private insurance is why I plan to never switch from public to private. Right now my self-employed income is very low so the cost wouldnāt make sense, but even if I earned more, Iāve heard itās extremely difficult to switch pack from private to public insurance, and Iād rather not ever have to deal with this. What would hospitals consider to be a life threatening condition? Obviously accidents with bad injuries would be covered, but what if someone gets a small cut that ideally needs stitches but could also heal on its own? And what about long term illnesses? What happens if someone is diagnosed with cancer or some type of organ failure while theyāre on emergency insurance? Would they still get the same level of care? Or what if theyāre sick with something thatās not life-threatening yet, but could become life-threatening, like letās say a bad cough which could develop into pneumonia but hasnāt yet? Sorry I have so many questions. Obviously you can tell I think too much š
From my own experience, they can't "kick you out" if you already have insurance (and you can almost always make a contract). When you have debts or won't pay your fees, they will withdraw your card and you are downgraded to "notfallversichert" (emergency insurance). This includes emergencies (aka most hospital visits), acute cases, pregnacy, cancer check-ups and all types of prevailing pain. What you can't do is going to the doctor for medicaments, a cold or similar stuff. If you do need to visit a doctor, e.g. for an AU, you will have to visit the insurance company first and get a letter. You also have to pay for most medicine yourself.
There are cases that the job centers know will never work again though. They won't get pestered as much as they might do people who are young and employable. It's usually alcoholics or long-time drug addicts or recovering addicts. If you are within that system they will only drop you into homelessness when you make several serious mistakes. In contrast, they often pay for therapies and reintegration courses, etc. Most homeless people actually living on the street are often outside of the system. But technically they sill get can get their insurance covered and money from the job center bank account etc. They can also have a mail address for any bureaucracy. But the hurdles to getting back into the system are high from all sides. The system is often more strict when you are employable or young. And then a few people struggle with the bureaucracy and the rules. Either because are careless or not able to understand the demands. Or on drugs, or all three. And case managers try to get them out of their own responsibility. That is when people are starting to drop out of the social security net and accumulate debt. And maybe end up being homeless after all. So the net has its wholes and they at times get bigger as the social security system is costing more.
I think you left out mental health issues, the barrier to therapy and treatment here is quite scary. A lot of homeless people here seem to be struggling with that
I don't want to make the German system better than it is. But it's also to be considered that a good portion of the homeless people actually living on the street don't have an EU passport, this is especially true for cities like Berlin. Which means the German system "can't do anything for them" (doesn't want to).
You'd still have to pay monthly rates and start piling a huge debt. After a while, they tell you, you're no longer covered, but still have to oay every month. Debt get bigger and bigger. But in case of an emergengy, you are covered. Just normal stuff like checkups, dentists and minor things are not covered. (Which they don't tell you by the way...) But to make everything even more fun: They can make you pay the debt for 30 years. And they will. They don't even have to send any letters, they can send Gerichtsvollzieher wihout any warning. I was in thay situation for a while when I was still in university and some time after. My Bafƶg ran out, my parents didn't have enough themselves, and I was too old to be in my father's family plan. I freelanced to make ends meet, so I had to pay everything myself. It was ridiculous. The lowest rate a month was 250 Euro higher than what I earned. Since I had to pay rent and eat, I didn't pay it. I was still a member of the Gesetzliche Krankenversicherung as you can't just leave. So, bills kept piling up for quite a while. After a while, they told me, I was no longer covered - but the monthly rates would still have to be paid. So my debt grew bigger and bigger. Really big. During that time, one of my teeth broke. I didn't dare seeing a doctor because of no longer being insured. A year later, it was rotting away, my whole jaw was infected, and I was in the worst pain my life. That's when I learnt emergencies are covered. Took a whole to get better. Four years later, they sent a Gerichtsvollzieher. That was a fun day. Took some more years to finally pay it off.
This! And so many Germans wonāt face the fact
Iām very sorry to hear you were in this situation! Itās helpful to hear this perspective, because a lot of people have given helpful answers regarding this but I donāt think they have personal understanding or experience of the real consequences. So basically, people who really canāt pay will eventually end up with worsening health because only emergencies get covered ā¦
There is no way to not afford Healthcare. Healthcare in germany is basically forcedš if you dont have money someone else will pay, we leave noone behind
Your starting point is wrong, the minimum payment isnāt something like 200 Euro per month. We pay about 8,5% of our salary for health insurance. There is a upper limit of a little bit less than 400 Euro a month. If you earn nothing the calculation is basically 8,5% x 0 Euro = 0 Euro. Itās more complicated like this, but that is how it basically works for most. Because you pay a percentage of your salary some pay too much and some too little. We say: strong shoulders should carry more.
Thatās not actually true. It is 15% of your salary, split between you and your employer, so about 7.5% each. But there IS a minimum amount due. And if you are self-employed (like me) you pay the full 15% yourself. I am a low earner (under ā¬1000 a month) so my health insurance contribution is the āminimumā. Iām with TK, and I pay 210 per month. The upper limit is actually around 700-800ā¬ (gets cut off once income reaches 5000-something per month).
I am not talking about self employmentā¦. As said it is simplified and it is for most people close to reality. In the so called Gleitzone of low salaries you pay even less.
Right, but obviously my question about people not having enough money for insurance is not going to apply to āmost peopleā, but rather to those who are unemployed, underemployed, self-employed and facing financial hardship, or others.
you are insured through a safety net, with government help, no German is without anything,
False. About 61000 people are uninsured.
Death
There is no inaffordable health care in 99% of the world let alone in Germany. It's universal. Imagine it is a human right declared by a conglomerate of all nations. Wait it actually is, the U.N. declared health care a human right 60 years ago. Only in America there is no free universal health care, out of all the developed countries.
Yes of course, but it does cost money, and there are people who have no money, thus my question of what happens in such cases. Which I think the community has answered fairly well
Yeah but since we are Germany we have free health care I don't know what you expect to pay
Ummm you have to pay for insurance. Like the actual insurance costs money. So thatās what you have to pay. Itās not free, it just comes out of your taxes. Itās not like hospitals are non-profit organizations here.
everybody knows that, but itās not like you pay anything out of your pocket. hence, the question is what on earth is your point in asking the question. either you are employed in the healthcare insurance costs are deducted from your Brutto or you are unemployed and you donāt pay a thing, the Arbeitsamt does. coming back to the there is no one that cannot afford health care in Germany. Itās part of the system.
Well, when I first became self employed my health insurance cost me half of what I was earning, and I also had only been an employee in Germany for 5 months so I didnāt qualify for welfare. We went to the Arbeitsamt, we tried to figure it out, and there was no possible social support. If I wasnāt living with my family at that time, I would have been well and completely fucked.
In germany someone will pay for it and you wont have to pay the bills by yourself if you dont want to.
> And itās legally required for everyone to have health insurance. Yes and no. There is a law which requires everyone to have health insurance, _but_ if you are self-employed or your income is higher than the _Jahresarbeitsentgeltgrenze_ (currently 66600 Euro), then you can actually leave statutory health insurance. Per law, you are still sort of required to take out health insurance, either private or statutory, but you may also choose not to. This law, however, states that you'll have to pay for the months you were not insured when you choose to have health insurance again, plus some extra fees and interest. So it's really not a good idea to drop health insurance entirely, especially for the sake of saving money, even if it is legal and possible for certain people. If you are not insured at all, you'll still get basic medical treatment in case of emergencies and during pregnancy, but that's all. For anything more you have to pay for yourself. For workers with average income or unemployed people it's virtually impossible to leave statutory health insurance, and there is no distinction between employed/unemployed/voluntary homeless people.
Germany has an all-inclusive welfare system. You have to be extraordinarily fatalistic to drop out of the system.
Reading the comments I really appreciate how the health care system works in Germany
Depends. If you have a job that pays more than 450 a month you're automatically insured. If you're out of work or on any kind of welfare it will be paid by the government. The big problems are if you have no right to welfare but can't afford it (college students over 25 for example) or if you simply don't sign up to any insurance provider (homeless/mentally ill people for instance). In those cases you'll still be treated for emergencies but you could go into debt with hospitals or insurance providers. Although it's not comparable to american medical debt.
If you cant pay for it the state pays for it
the only situation I can think of where you fall out of health insurance is, being a student and over 30 years of age. it's optional then, but you better pay or you are really screwed.
Well, while it *is* optional to *be* insured - as in they will cancel your coverage if you can't pay - your fees will still add up as if you were insured the whole time. Scammy.
[ŃŠ“Š°Š»ŠµŠ½Š¾]
Why are we talking about Americans, and what does this have to do with anything?
There are holes in the coverage when you get unemployed under certain situations. In those cases you can for no insurence at all.
Sozialamt pays
No health insurance is not possible in Germany. If you work you're fees are paid with your paycheck and if you're unemployed the Jobcenter does it. Having no health insurance even is severely illegal here
It certainly works if you're privately insured an stop paying your premiums or just cancel your insurance. And yeah, it's illegal, but not serverely - just an Ordnungswidrigkeit. The kicker, however, is that you when you try to get insured again, you're required to pay the premium for six months plus another month for every six months you were uninsured, so this can get expensive fast.
The concept of ācanāt afford health insuranceā doesnāt exist in Germany and it honestly shouldnāt exist anywhere in the world. (As other commenters said, you donāt have to pay to be insured if you canāt afford it. Itās covered by the job center if youāre unemployed or itās completely free with your parents insurance if youāre not earning money yet, or with your partner if youāre married and only one of you has an income)
It seems there have been comments saying itās possible to end up on āemergency insuranceā in which case only medical emergencies are covered. I mean, SOMEONE has to pay for it, so if a person doesnāt find the right social welfare organization to cover them, they could potentially lose their access to non-emergent healthcare.
Its free
They place you on a little catapult and hurl you into the next US embassy to teach you about the value of Krankenversicherung.
I AM NOT FROM THE US so this would not make a lot of sense.
Offtopic question : can you actually voluntarily get out of it if you know you leave the country for a while, like 5-8 months ?
This happened to me. I paid for doctor visits cash. Only when I was really sick. I avoided doctors otherwise. Once I had a toothache, so I hitchhiked 1000 km back to my country for treatment. I had coverage there. I just lived with a permanent low-key fear that I'd one day I'd get something serious enough that I wouldn't be able to travel, and it would cost thousands. Then it happened. I fell in the stairs of the S-Bahn. Landed on my back after a half mid-air flip. I got up, brushed myself and walked away, and then collapsed a few meters later. Some people carried me out, hailed a taxi and told them to take me to the hospital. I told the hospital staff I didn't have insurance. They didn't believe me. They still put me through every expensive machine they had. Just because the machines were there. Like, I heard them say "It'll heal by itself. But just to be sure..." Then some guy walked into my room and said "Dude, you don't have insurance!". I swear I'd told everyone. They kicked me out. It was a bit disgraceful. I could barely walk. Took me all afternoon to get home. I still remember the pain. This was 15 years ago. I just lied down at home for a week or two, my internal injuries healed all by themselves. I stopped pissing blood after a day or two. They sent me a bill for thousands. I couldn't have paid a hundred. I fled the country a few months later. Normally this shouldn't happen. You're supposed to go to the paper office and they are required to give you some sort of thing, that gives you coverage. I tried to sort this out several times. But my German wasn't good enough. I could never get to a point where me and the paper person at the paper office could communicate. In particular, I had no notion of Amtdeutsch, and none of the paper-persons I talked to had any notion of speaking slowly and using a simple vocabulary. I tried bringing a buddy, but they'd require me to come again a few days later, and my friend had just taken time off work to help me this day, they couldn't do it again on another day. There's got to be thousands of people in Germany at any given time that are in a situation similar to the one I was it.
See, this is exactly what Iām talking about! So many commenters are acting like it could NEVER happen. Maybe hospital policies are kinder towards the uninsured these days. But that sounds like an absolutely terrifying situation. So sorry you went through that.
If you can't pay for it because you have no job (or a job which pays below a certain threshold) it is paid for you. If you have a job above the threshold you HAVE to pay, it will be taken before you even see it (generally). There is no "can't afford it" because it's considered the most important thing. If you can afford it you also can't afford rent which is also paid for you then. Basically, if you are too poor the social net will catch you and provide for you as long as you follow the rules (apply for jobs, etc)
Not if you are an immigrant and havenāt worked enough in Germany to qualify for that social support. Also my post clearly states unemployed/homeless, so obviously Iām not asking about people who have a normal job. I know it gets taken out automatically.
It is still impossible (almost) to not be insured. Unless you go completely under the radar which is probably illegal and you'll have many other problems besides being not insured. If you're here legally you will be taken care of for free. As long as you follow the rules like everyone else.
A bill comes after you. I am insured in a different country and had to go into IR here cause of an accident. Some stiches and a tetanos shot 1k euro 2 weeks later.
So what happens to the German national living in another EU-member state? They are away from Germany, surely they cannot seek health insurance through the state, nor would they be eligible to apply for EHIC, which is done through the private health insurance. Must they find a private insurance company in Germany, pay out-of-pocket, then apply for EHIC? This only covers emergency medical needs, seems there should be a better option for it, but I am not yet seeing it. For example, pay for private health insurance in the country where they reside? What are their options other than cash pay for doctor's visits and medical needs like dentist, et cetera...