[weinzierl]

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

[microtherion]

So correct me if I'm wrong, but:

* Germany has an Obamacare-like system: Insurance is private, but mandatory.

* You can choose and change your insurance provider freely, and they cannot reject you

So if that is true, health insurance companies have the risk of older residents joining, whether or not the previously resided in Germany, and it's not like they benefited from their contributions before.

So how exactly would this exclusion work? Is insurance not mandatory for immigrants after a certain age? Do insurance companies have a right to reject them?

I was not able to find a direct discussion of the question, but this page discussing the health problems of older immigrants (including "access to the health care system") does not mention the possibility that they would be excluded from the health care system altogether: https://heimatkunde.boell.de/de/2013/11/18/ältere-migrantinn...

[Agingcoder]

I think it’s public, not private.

[microtherion]

Ah, I was mistaken. I was correct in that insurance is mandatory, but most people get the insurance from a state-run insurance company:

https://www.informedhealth.org/the-german-health-care-system...

https://www.ssa.gov/policy/docs/progdesc/ssptw/2018-2019/eur...

[Corrected to admit my error]

[weinzierl]

First of all, it is not mandatory for everyone. Anyone with an income above an entry level IT job is exempt, but there are other exceptions as well.

Secondly it is not open to anyone. If you opted out of it at a young age you usually cannot come back (it's a bit more complicated). If you were not in the system for a couple of years and are over 55 you are out. So the US retiree will not get in, but the migrant with a low-incone that worked a couple of years in Germany has mandatory health care forever.

Thirdly, it is not a single state-run insurance company. There are many companies that provide mandatory health care and you can choose freely but you have to choose one if health insurance is mandatory for you. The companies differ in premiums and benefits but usually not by much. They also cannot refuse you if (and usually only if) health care is mandatory for you. The biggest ones are AOK, Barmer and maybe Tk. Bigger companies like BMW run their own ones for their employees.

Of course there are many companies that provide private health care. You can have private insurance in addition or, if you are exempt from mandatory health care, instead of the mandatory providers.

Everything is more complicated, but that is the rough idea.

[weinzierl]

The insurance companies are private but of course mostly financed by public money.

I think health insurance for civil servants (who are in a completely separate system) is state-run, but regular health insurance is private.

[mongol]

What if they are EU citizens?

[weinzierl]

Doesn't matter. Even if you are a German citizen and by 55 you've never been in the health system you're out of luck.

[lfittl]

In the above described scenario (US-based retiree moving to Germany), its likely the social security totalization treaty applies, giving them access to the health system: https://www.ssa.gov/international/Agreement_Pamphlets/german...

[weinzierl]

This is about social security and has nothing to with health care.

In fact it says:

"Although the agreement between the United States and Germany allows the Social Security Administration to count your German credits to help you qualify for U.S. retirement, disability or survivor benefits, the agreement doesn’t cover Medicare benefits. As a result, we cannot count your credits in Germany to establish entitlement to free Medicare hospital insurance."

There might be other loopholes though.

[microtherion]

It appears that if an immigrant was previously in a public health care system in their country of origin, they would qualify:

https://www.tk.de/firmenkunden/versicherung/tk-service-ausla...

https://www.krankenkassen.de/incoming/leben/nicht-erwerbstae...

That would cover most EU countries, though probably not the US (assuming that "private, but mandatory" does not qualify as "public").