# Health Insurance for freelancers: pre-existing conditions, etc



## cerulean

My wife and I are considering a move to Berlin (or elsewhere in Germany) this fall and need to provide proof of health insurance coverage. We are also old enough - over 45 —*we'd need policies that would cover, without a lot of hassle, pre-existing conditions. Not that there's any ongoing expense, just things that have, well, pre-existed and need to be kept an eye on.

I thought that it would be simple but I've scoured the forums and it seems pretty complicated. We'd be coming on tourist visas and trying to get freelancer's visas. From what I gather, ALC is pretty good choice, but it doesn't seem to cover pre-existing conditions. Similarly I've read that private insurers are free to reject you or exclude pre-existing conditions, unless you get the BASIS option which is almost 700 euros per person, and thus prohibitively expensive.

We have ACA ('Obamacare') coverage here in NY state, and it's OK —*but I'd assumed we'd let that go. 

What would be my best course of action in Germany? It seems daunting.

Would one option be to get very cheap insurance in Germany without pre-existing, through ALC or something like that, and keep my Obamacare in the US and pay for that as well? That seems terribly expensive and kind of silly —

Any advice much appreciated!


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## beppi

If you live in Germany, you are required to join a German health insurer - international ones will not work, even if they cover treatment in Germany. ALC and ACA are thus out of the discussion!
In Germany, you have a choice of the public system, which costs a percentage of your income (subject to a minimum and maximum contribution) and includes pre-existing conditions at no extra charge, and the private system, which costs according to the risk you represent to the insurer - pre-existing conditions can thus cost more, be excluded from coverage or you could be rejected outright. There are many insureres in each system for you to choose from.
Another major difference is that dependents without own income are covered at no additional charge in the public scheme, but not in the private.
You probably want to join the public system.
The rules about who can join which are extremely complicated (some people have to be in one, others in the other, and some can choose), so you should contact an experienced health insurance consultant to analyse your situation. Or you just contact one or more public insurers and apply for membership (this can only be done within the first three months of taking residence in Germany and applies retroactively from the day you arrived).
For normal employees, the employer pays approx. half of the health insurance premium. As a freelancer, you'd have to bear both halves from your own pocket. In the public scheme, the premium is approx. 15% of your income (for employees this is employment income only, for others world income from all sources), subject to a minimum of approx. €150/month (if you earn €900/month or less) and a maximum of approx. €650/month (if you earn above €4000/month). At your age and with pre-existing conditions, a private insurance will almost certainly cost more - but you may consult a health insurance consultant about this.


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## Bevdeforges

Take a look at your contract for the ACA coverage. Each insurer has their own coverage and constraints. A few providers actually do allow for coverage when outside the US. (Some - but not all - Blue Cross affiliates have excellent coverage outside the US.) It really just depends on your policy terms and conditions.

If and when you succeed in getting a freelance visa, I suspect you'll wind up registering in the German social insurance system, so if all goes well, your insurance coverage may only need to be for a year or so until you get established. You might want to look at the AARO coverage - AARO is an association for Americans living overseas, and their insurance plan is meant to meet the visa requirements of most countries (particularly within Europe). 

More information here: https://aaro.org/medical-insurance 
Cheers,
Bev


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## Nononymous

Depending on what you're freelancing as, you might be able to join the Kunstlersozialkasse and obtain a better deal on public insurance that way. I know nothing further about this, but it might give you a starting point for research.


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