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I'm moving to Germany this summer and may not have a job solidified beforehand. In that case I'd need to take out a private insurance policy to hold me over until I'm working and on a statutory plan. I've read that it's difficult to switch from private to public and would like to know if I might face any difficulties.

I also have some old injuries. Would anyone be able to confirm that the state system accepts non-citizens with pre-existing conditions?

Thank you, Aaron W

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    Which country you are from? Which kind of medical insurance do you have at the moment? If you are on public insurance currently, you may qualify for German public insurance. – Janka Jun 6 '18 at 22:47
  • Depends on a lot of things. Are you older than 55? Will you be self-employed? Will your salary be larger than 50K a year or smaller than 400€ a month? Will you be eligible for any benefits while unemployed here? – nvoigt Jun 9 '18 at 6:36
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    You don't have to go private. Public health insurance companies do have plans to cover "freiwillig versicherte" (people who chose public health insurance although not required by law) and most of the time, being on such a plan makes you eligible for the normal plan with no questions asked when you get a job. – nvoigt Jun 9 '18 at 6:40
  • @nvoigt. He HAS TO go to private. If he arrives from abroad, he does not have the right to be "freiwillig versicherte", because he was not insured by public German insurace before. See tk.de/techniker/service/leistungen-und-mitgliedschaft/… – Andrey Sapegin Sep 1 '18 at 22:31
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    @AndreySapegin If he is from an EEA country, he can use EHIC for up to 3 months for basic/emergency treatment. – gerrit Nov 7 '18 at 18:59
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It's indeed difficult to switch from private to public health insurance, but if your salary is below 60750€ a year (in 2019), public health insurance is your only option, and public health insurers can't refuse to cover you.

Source: https://allaboutberlin.com/guides/german-health-insurance

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    This answer is correct. By default, one should always choose a public insurance. If eligible, one can always switch to a private insurance - afterwhich returning to a public is not possible. – Mark Johnson Nov 3 at 13:54
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Seems to me that on arrival, your only options for health insurance coverage are travel health insurance, private German health insurance or (if you are from a EU country and until 3 months in Germany) the EHIC health insurance card. Travel health insurance seems the simplest and cheapest for a few months or even a year, but they often exclude people with pre-existing conditions.

I've read that it's difficult to switch from private to public and would like to know if I might face any difficulties.

It is not difficult if (and only if!) your eventual job in Germany is as an employee. Because for employees, there are only two ways of being health insured, and both cases allow you to become part of the public German health insurance system without issues:

  1. You earn ≤4950 EUR/month. (This value is the so-called "Versicherungspflichtgrenze" for 2018, and changes slightly year after year.) If this is your case, you are obliged to be in the public German health insurance, means you are not allowed to choose private health insurance even if you wanted. So in this case, the public insurance has to take you.

  2. You earn >4950 EUR/month. In that case, you have the right to voluntarily join the public German health insurance even without having been insured there before (source).

I also have some old injuries. Would anyone be able to confirm that the state system accepts non-citizens with pre-existing conditions?

If you're obliged to be in the public system as an employee, they have to accept you (and I've yet to hear of a case where they did not). If you can only voluntarily join the system (second case from above), I am not sure.

  • This claim is false, once in a private insurance it is almost impossible to switch to a public one. – Mark Johnson Nov 3 at 13:51
  • @MarkJohnson The (only?) way out is becoming an employee, b/c employees are obliged to be in the public system. A friend made that switch last year, after 15+ years in the private system. – tanius Nov 3 at 23:16
  • @tanius Not all employees are obliged to be in the public system. My son's girlfriend had a choice of public or private, and she is very much an employee (albeit highly paid). – Martin Bonner supports Monica Nov 4 at 8:12
  • @MartinBonner You're right. I mentioned that case in list item 2 of my answer. – tanius Nov 4 at 14:48
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By default, one should always choose a public insurance.

If eligible, one can always switch to a private insurance

  • afterwhich returning to a public is rarely possible.

A travel insurance, covering the time into you start working, should be taken.


Difference in concept of public and private insurance

public (Gesetzliche):

  • solidarity between healthy and chronic health conditions

younger (often, but not always healthier) share the burden of those who are more elderly and thus more often have chronic health conditions

private:

based on needs of insured persons

  • heather pay less, chronic pay more

to cover the costs, which will change depending on envolving health conditions.

extras:
(not offered in the basic public services)

  • public: must be paid directly and will not be refunded
  • private: may be partially refunded or incorporated into the monthly contribution

This system is based on the Gesetz, betreffend die Krankenversicherung der Arbeiter of the 15th of June 1883 and assumed that most peaple would be living in the country their whole life long. Thus, for most, everything balances out.

For expatriates, the question is valid for someone only remaining 5 years, whether such a solidarity contribution (which they may not later benefit from) is worthwhile.

My personal experience was, when the time came in my professional life that I could switch to a private insurance, I was strongly advised by elder colleagues not to do so. The status symbol was not worth the later cost.

For expatriates, with a family, this aspect should be taken more into consideration, than for a single person remaining for 5 years.

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