Health insurance, why bother?

Flippant topic description i know, but it's something that's been bothering me - tried search function as well and couldn't find a dedicated thread on the topic -

I am 29 and don't have much money. I work freelance so salary goes up and down. 300 or so euros a month is a lot of money for me. Money I don't really have. I have no girlfriend or dependents. Touch a lot of wood obviously, but i have never ever been sick in my life. Honestly haven't seen a doctor since i was 8. No one in my family has any form of illness. I see a dentist once a year who always just cleans my teeth and sends me on my way. I have seen alot in the press that if you need any operations, you can go to Hungary and get them done at a very high quality for a very low price, so would it not just be far far cheaper to simply pay for operations and dentistry in Hungary as and when you need them?

anyone got any sensible thoughts on this?

If you live in Germany you MUST have health insurance. It's the law, so if you don't, you're breaking it!

You must not assume that you have the ability to choose on this. This is a country made of laws. Rules and laws make Ordnung. Ordnung muss sein!

don't really care about breaking the law, care more about not spending loads of money i don't have on something i may hardly ever use

What if you get hit by a car for example? You'd be fucked without insurance

What exactly would happen? Would they just refuse to treat you, or would they just send you the bill for the whole shebang like in the US?

Yes. The law aside, it's crazy not to have health insurance.

ER, they will treat and bill you for emergencies but then Worm will be back on the site wondering how he can get a loan to pay the massive costs.

I commend you for your attitudes towards the illiberal do-gooders centered in Berlin. But a quick reality-check reveals a truth in that: if you harm yourself, like getting hit by a car (or whatever) society will pay the costs of your parsimony. I will pay for your decision which may not have been your original intent.

To hijack the issue: I think that we pay way too much tax in Germany for what we get back in services (as if a German understands service). The do-gooders attempts to create heaven on Earth requires them to enforce their rules on everyone. In so doing, a moral hazard ensues.

Resistance is futile.

they could if he cannot prove he can pay for treatment.

You can have perfect 100% healt but still do yourself in. I tore a ligament skiing which cost my insurance company way more than I have been putting in. So yes, it is worth it just on the off-chance that something happens.

And you can't say "I wont get hurt, nothing happens to me". You never know when something is going to come at you from behind or fall out of the sky at you.

I can't agree more on the fact that health insurance here is one the biggest in the open scams i have ever seen.

EDIT: Insurance full stop is one of the biggest in the open scams.

Why shouldn't he? His choice, his consequences...

If you are a freelancer with no dependents and relatively young, get a quote for private health insurance, maybe you can get it cheaper than EUR 300 / month.

If you were to have a requirement for a non-emergency operation, let’s say varicose veins for example you could search for a hospital in the eastern part of Europe, possibly even within Germany and have it done privately for less money than you would have paid for health insurance over the years.

You claim to come from a healthy family but what if that changes as you get older?
What if you have an accident?

It’s the emergency situations that cost the money.
In an emergency situation, no hospital is going to leave you to bleed to death on the street but they WILL come for the money afterwards.

You get a bill. Thats what happened to me years ago when I was admitted for something. I had to claim it back with Bupa later.

Heh? Who said anything about should or shouldn't? I was merely asking what the procedure here is.

Actually, it's not the law. The law states that if you are employed and earn less than a certain amount you have to be state insured. Certain income groups can opt out of insurance altogether.

On the separate issue is health insurance a rip off in Germany generally?

The total health systems swallows a LOT of money and the proportion of outputs for the money is low.

There is every incentive to over treat people.
There is little disincentive for people to consume as many health "goods" as possible.
The profit motive, administrative complexity and the opt outs allowed to the upper middle to upper classes only add to the costs.

The only way to get costs down is introduce ONE Kasse, that EVERYONE pays into.

Is there some way of getting health insurance that only covers you for really nasty accidents, and leaving off dental plans and body MOTs and all that? i would do that if they offered it -

Yes. Talk to a broker and tell him that you only want basic coverage with a large "Selbstbehalt". You should be able to get something below 200 €/month.

Hospitals will try and recover their costs like any other debt.
Sooner or later they MIGHT write it off.

There exist in Munich a couple of charities that try and help people out if the can't access health care legally. ie they are illegal immigrants.
I've also heard that the City of Munich is thinking of setting up a fund to cover health costs for people without insurance.

If a charity or me, us, as taxpayers help someone out in that situation who NEEDS it, fine.
Less happy about doing it for someone who didn't want to pay contributions to the system like the rest of us do.

You don't want to get landed with a bill. I was working here and my insurance had lapsed at end of June. I had informed my employer at home about it but they forgot to renew it for me. First week in July I cracked my head off a staircase. I popped into the dr. who had her studio beneath me and she called an ambulance and I was shipped to the hospital where the doc looked at me for 2 seconds and dismissed me!! Nice bill for €1200 landed on my door a few weeks later which my company had to pay for! Now imagine if I had to actually get some treatment what the bill would be!

Worm, if you are a Brit, look in to Bupa International. They are WAY cheaper than the German companies (Mine used to be under 100 a month all in but now is more like ~170 as I am getting old)

They don't do dental on my plan but they do let me go to one of the best private knee doctors around for my ACL replacement etc. They have covered everything so far. it's just a pain cos you have to pay up and then claim back for normal things (I managed to get pre-approval for the surgery so that was not paid up fromt by me).

AS mentioned somewhere above: you are legally required to have health insurance in Germany. If you are a a EU-citizen, chances are you will not be detected as long as you are not needing to get treatment in case of severe injuries or disease. If however you get with an emergency in a hospital and you can not show some insurance card, two things are going to happen: a) you will get only the most perfunctory treatment, i.e. they won't let you die but thats about it. the public insurance will charge you for back-payment of the dues for public insurance from the day on you would have been required to be insured in Germany. And if you are an ExPat from outside of the EU, you will not get a renewal of your residence permit if you don't show health insurance coverage.

In addition, while understanding your monetarry dilemma, your free-rider attitude is exactly the reason why German insurance lobbies have succeeded in making insurance compulsory for everyone because if you end up with cancer, other major illnesses or after an accident in a hospital, the public has to take up your bills while you will be becoming a Hartz IV case. This is not the right way to do things, at least get yourself a travel-insurance which covers you in Germany for emergencies or the most basic international health insurance with high deductibles in order to get down the premium costs.

As for the risks: I myself as a very health person have suffered an appendix perforation when I was 30y old which required emergency surgery and then 3 weeks hospitalization, total costs (I saw the bills being privately insured): 25.000+ EUR. Last year some funny little bacteria got in my bloodstream over some open cut in my gum (probably from flossing) and attacked my joints so that I could barely move and had great pains. Result: 10 days hospital with costs in excess of 11.000.- EUR... those are cases that can hit everyone, you too, Worm, regardless of how careful you are and how healthy.

It's not the law yet, but will be at some point in 2009, AFAIK.

@ Tom17
I thought there was a long thread sometime that international health insurance companies are not allowed and you needed a domestic insurer?

yes, this sounds good!

and as for the person who says about cancer, well if i had something like that i suppose I would go back to the uk and do it on the good old NHS
it just annoys me how i get good cover from bupa in the uk for £40 a month, but it's more like €300 here

I missed this.. Haven't had any trouble with using Bupa yet.

If the NHS would treat you...

But anyway, your argument there is that if anything seriously happenend you would just expect everyone else to pick up the bill
but declne to pay your part in spreading the risk over the whole of society. Nice attitude.

er... not strictly my argument...actually was saying that I can't really afford the insurance in the first place - doesn't mean i don't actually WANT insurance of some sort

Your topic title is "Health insurance, why bother?", not "Health insurance, I can't really afford it".

Parnell and Tom17: basically the health reform law effective since April this year has the goal to get anyone living in Germany covered by health insurance. The issue if International Health insurances will be still possible for the future will be decided after Jan. 1st. 2009. From reading the law and comments from the relevant authorities I derived in the meantime that at least for EU-citizen the chance to use international health insurance remains in form of a little loophole in the law. The loophole being that you will be only forced into either public or private German health insurance with claims for back-payment over all the years you would have been forced to be insured if you (or your international health insurance) will not be able to cover the costs for treatment. Since internationa insurances usually have good coverage for inpatient, anyone with a good international health insurance should be safe here. Only problem coming up for EU-citizen can be that in addition long-term care insurance is required too and that is not covered by most internationa insurances I know. So far it seems that only ALC together with German ALLIANZ has develloped something here that will fulfill all legal requirements.
For all ExPats from outside the EU I fear that German "Ausländerbehörden" will require German health insurance starting at the latest in 2009 and will not accept international health insurances anymore.

Worm: the higher coverage costs in Germany are due to two different reasons: a) more coverage than from what I have learned is usual and available in the U.K and other places. You may not need it, but it is there just the same. German insurances have to build up a capital stock for old age in order to keep costs bearable when you become a senior citizen and are in need of more often and more expensive treatments. This is not the case with BUPA or any other international insurance where premium rise steeply when getting over 60+ years. If you know that your time in Germany is only limited, than of course it makes no sense in paying in capital for old-age when you never will be able to enjoy the benefits. And at the end of all this there is of course the terrible inefficiency of the German health system which makes it so expensive too, I grant you that.

If you can't afford health insurance, you need to start charging more, working more hours or changing jobs Mr. Freelance. I know it's expensive as a freelancer as I did it too, but the costs of not having it are potentially even higher.

Have a look around, you might get it cheaper.

Health costs ARE expensive. EUR 300 total is a lot less than what some people pay in the public system!

The other thing to consider with “basics only“ insurance.
Say your appendix burst or you broke your leg, they would pay.

But the stuff like check of your prostate or breast scan or smear tests
Or regular check ups for those over 40 etc they don’t.

Germany has been pretty bad on preventative care in the past imvho but it catching up.
I just think a regular smear test for women is better than suddenly being diagnosed with advanced cervical cancer for example.

Well as a UK citizen I'm insured through BUPA International, it may not cover as much as the German insurance but its a hell of a lot cheaper, I pay 173€ including evacuation costs if I have a problem anywhere in the world except the US, my old German insurance Techniker KK wanted 509€ per month which as a freelancer I could not in any way imaginable afford, the money I save more than compensating for any extra costs I have eg non-emergency dental work. I've had 1 accident since being with BUPA which meant me being treated in casualty and the payment from BUPA was quick and uncomplicated.

theoritically couldn't I just get a check-up once a year on the NHS whilst on holiday back in england?

Dental work is very expensive, replacing all my old British NHS lead-uranium fillings (put in 20 years ago!) cost 2500 euro, which DKV paid in full. This bill was justified, more or less, but it seems that many doctors deliberately rack the bill up when they see a private patient (One HNO doctor on Candidplatz nearly brought me to complain to the DKV she was so blatantly at it). But then those on the public system seem to have to fight to get even basic care. The system as it is seems broken.

A while back I thought the option of self insuring would be the solution to the problem because even considering this & other minor stuff I've had done I reckon I'd be much better off this far if I'd been able to self insure for the seven years I've been here. Instead of paying DKV for all their inefficiency and bureaucracy if I'd put 300e a month into a savings plan and invested it as I see fit then chances are I'd have a nice fund available should anything go tits up. I'd look for the most appropriate remedy, and I'd also be motivated to look for good value for my money, which is missing in the current private system.

However there are two faults with this:
1) As pointed out anybody's health can go really badly wrong and cost tens, if not hundreds, of thousands to put right and be way beyond any normal person's ability to pay. You never know what is waiting for you tomorrow, a year, ten years. Predicting the past is a lot easier than predicting the future... The burden then falls to the state, which simply can't afford it.
2) Although I may be responsible enough to put the money aside regularly there's a strong chance that many would not, and then end up with no funds and no ability to pay anything, then essentially having no access to healthcare. The worst possible outcome is to end up with a situation like in the US where millions have no cover whatsoever - which is what would then happen here. This is one area of US legislation where there are calls for more regulation, creating a system more like here.

Although the current system is awash with inefficiency and abuse it's hard to see how it can be improved much in reality.

No for using the NHS for routine checks.
Because your EHIC won't cover check-ups.


The EHIC (old E111 - so the EEA/EC coverage for health insurance) will cover you for emergencies, not for check-ups, otherwise there would be no waiting lists as people would vote with their feet.
It also shows that NHS healthcare tourists aren't always non-Brits...

katrina -

but what about getting check ups in the uk? or does what you posted mean that? also - does what you've posted mean that i am actually covered for 3-5 years here in germany on my e111?

E111 no longer valid, it is now a EHIC.
EHIC will cover those already insured under one member state for short trips for emergency cover or certain continuing conditions only.
The document has a longer validity period than the old E111 but it is for short-term visitors to another member country, not residents.
EHIC is not a replacement for insurance - especially for a UK citizen ordinarily resident in Germany who isn't paying for German insurance or isn't covered by the NHS either as they are not a UK resident.
Under the circumstances you have listed (UK citizen, German resident, freelancer, not insured) you have no entitlement as you do not pay.
That clearer?

EHIC is for EMERGENCY care for short term visitors (holiday, biztrip) and it works both ways.

The fact that the NHS is the UK has (or has had in the past) weaker gatekeeper controls than the health care system in Germany does NOT
mean you can get an annual check up in the UK "for free", ie at someone elses cost.

The UK (tries to) do joined up health care. Your annual check up (lets say for breast cancer) is arranged through your GP
who will get you an appointment arranged X weeks in advance. If you pose as a UK resident and try and get an appointment it might well get found out:

So who was your last doctor? Would you like to register with this practice? then I need your National Insurance Number please and your address, Your appoinment is on X (just before you enter or after you leave the UK). OK, you need to come to a session on breast self examination before the scan anyway. You need to come back to the surgery 2 weeks later for the results. Etc Etc Etc.

There are drop in centres but it isn't like in Germany where you can just walk into a specialists practice and get an (almost) instant appointment
ie Germany has an over provision of health care.

He's probably still down at his parent's address in the UK, no?! If he's still registered with his GP etc. here then he would not have any problems (not to say I think this is right or wrong).

He's not entitled to care, because he doesn't pay.
And people wonder why the NHS is skint?
Now, he could get treatment, but hey, I could burgle someone's house because they left their window open as well.
Possible? Yes. Right? No.

Yes I have worked for the NHS and for the DWP, that makes me a wee bit strict on fraud.

One just has to face up to it - life is expensive.

what a fucking monster pain in the arse.

Doctors have targets = they get extra money for certain (usually preventitive) meassures.

Becasue they get the money they are likely to try and get you into a health care routine that would VERY quickly expose the fact that
someone is illegally accessing NHS treatment...Then the evil dragon on the desk realises she make a quick 50 quid by ring the grass-line...
...and the UK, rightly or worngly, takes welfare fraud VERY seriously.

It is a pain in the ass to pay as much as you do here. I may be talking out of my ass but is there no cut off where you can make less than a certain amount and the state subsidzes your public insurance? It would if you are unemployed. If you truly can't afford it (not in the sense that you can't afford it because you must have the newest stereo), there should be some government subsidy.

Would you consider a mini-job somewhere to potentially get you into a public scheme? Something like a Saturday job or similar? Just an idea, I haven't really thought out how it could work, but it is a start.

I was unemployed and not entitled to unemployment benefits of any sort just over a year ago, and I was in exactly the situation you were in. I had never been really ill, and certainly hadn't seen a docotr for anything more than the necessary checkup to get my prescription for the Pill for years. I decided to go self-employed and do promotion work to tide me over, and because it meant I was entitled to private health insurance and not the over 300 euros a month the public would have taken off me to be "freiwillig versichert" (to do with husbands income etc). I opted for a package that cost me 120€ a month, but had a "Selbstbeteiligung" of 1250€ (ie. I had to accumulate bills for over 1250€ for the insurance to pay anything). This was, I figured at the time, the best way of doing things - I would go to the doctors once in that time, pay 250€ for it, and other than that, the 120€ a month meant that I was insured.

Brilliant plan - until I got appendicitis out of the blue and ended up paying over 1000€ out of my own pocket for the op and the hospital stay. Seriously, don't ever assume because you've never been ill before and don't have so much as a filling, you can skimp on health insurance.

Of course there are cuts offs, that's partly the reason the system is fucked in Germany.

If you are an employee and in the public health system you pay X% of your salary and it covers your dependents.
The fact that the middle to upper middle classes can desert the public system and have a financial incentive to do so is one of the reasons it is broke.

If you freelance, surely one should consider the costs before one embarks on the status?

sorry, not actually freelance - self employed.

just think, if i had contributed €300 a month for the length of my normal employment (11 years) i would so far have paid €40,000 euros for abolutely NOTHING