Retirement visa and family reunification: Recurring problems with health insurance for elderly people

Imagine you've cleared all the bureaucratic hurdles to reuniting with your family in Germany. Financing is in place, housing is secured, and the longing for your parents or the desire to spend your retirement in Germany is finally within reach. But suddenly, the entire plan falters – not because of missing documents or insufficient income, but because of a simple health insurance card . For many older people, especially those seeking to reunite with their parents as foreign skilled workers under Section 36 Paragraph 3 of the German Residence Act (AufenthG) , the legally required health insurance becomes an almost insurmountable barrier . As a law firm specializing in visa law, we repeatedly see even wealthy seniors despairing over the insurers' acceptance criteria, even though insurance coverage is a mandatory requirement for any residence permit.

The dilemma of the private insurance industry

In Germany, the health insurance system is divided into two tiers, but statutory health insurance (GKV) is often inaccessible to older immigrants , as they have frequently never been insured within an EU system. This leaves them with only the option of private health insurance (PKV). However, this presents a paradoxical reality: while the law mandates insurance coverage , private insurers operate as profit-driven businesses. Older applicants are considered "high-risk" due to their statistically higher prevalence of illness. This leads to a gradual reluctance to enter the system. In our daily practice, we see that applications for standard plans are often rejected due to pre-existing conditions, or the premiums are set so astronomically high that they defy all economic reason. This can result in visa denials, as insufficient coverage cannot be demonstrated.

The basic tariff as a legal lifeline

To close precisely these gaps in coverage, the so-called basic tariff was introduced on January 1, 2009. We consider this tariff to be the social corrective to private health insurance. The benefits under the basic tariff are comparable in type, scope, and amount to those of statutory health insurance (so-called substitute health insurance ; see also Section 2 of the German Residence Act ). The decisive advantage for our clients lies in the mandatory acceptance requirement. This means that private health insurers may not reject eligible individuals based on their age or medical history. Risk surcharges or the exclusion of certain benefits are also strictly prohibited. For seniors relocating to Germany and eligible for private health insurance, this tariff is often the only legally secure way to obtain the insurance coverage necessary for a visa.

Theory versus practice regarding the basic tariff for elderly people

Although the legal situation seems clear, in our consulting work we encounter a significant gap between the letter of the law and the reality on the ground . Many insurance companies are vehemently opposed to including individuals in the basic tariff. The reasons for this are varied, but often financial in nature: premiums are capped, and the companies cannot charge profitable surcharges. Furthermore, insurance brokers do not earn a commission on brokering this tariff, which is why it is rarely actively offered on the market. We frequently observe that applications are delayed by extremely complex forms or rejected based on legally dubious justifications. In many cases, our firm must intervene and forcefully enforce our clients' claims – sometimes even resorting to litigation – to clear the way for their residency permit .

Conclusion of our law firm

Health insurance for seniors and parents joining their families is currently one of the most complex bottlenecks in German immigration law. While the basic tariff is the intended instrument to grant these individuals residency, its practical implementation often resembles an obstacle course . We strongly advise addressing the insurance issue strategically not only after arrival, but also during the visa application process. Only those who know their rights vis-à-vis insurance companies and are prepared to enforce them legally if necessary can ensure that the dream of a life together in Germany doesn't fail due to a lack of insurance coverage.