Health Insurance

It is compulsory to have a German health insurance when residing in Germany.
I don't think your mother's US insurance is accepted, so she also must join a German one.
First, you need to find out if you must join the public or private scheme. The rules for this are quite complicated, but most likely you must join a private insurer. To find out, apply for membership at any insurer of your choice. There are many.
Public insurance costs a percentage of your income (approx. 15%, of which your employer pays roughly half if you work).  If you are self-employed or not working (without drawing German social security or similar), you'll have to pay a minimum of about EUR300/month. It is impossible to join the public scheme if above 55 years old.
Private insurers charge according to your age, health and coverage. They can be cheaper than public (for people below 30), but usually cost more - sometimes a lot more (EUR2000/month is possible!).

Hi Kierstin,
I assume you & your mother are US citizens.
It is not clear what the citizenship of your brother is, but that is not relevant, up to the point on who will pay all medical costs, when you end up in a German hospital during your stay. (ie until such time where you have become a German Citizen).

Only some pensioners in Germany are entitled to pay the minimum health insurance
Like with the pension thread in this forum, in Germany, once you have reached a pensionable age, everyone do not stand in the same (cost) line with Health Insurance as pensioners :

1) The Health Insurance for Pensioners (Krankenversicherung der Rentner-KVdR) are de facto not an insurance but an eligibility status.

2) You reach this KVdR status when you have have contributed 90% of the second half (ca. 20 years) of your employment years to the German State's public health insurance (Gezetzliche Krankenkasse). These people have the status "Compulsory Insurance = Pflichtversicherung"

In short - if your mother have not worked 20 years in Germany nor contributed to a German State pension fund - she is not eligible for compulsory health insurance as pensioner.


Hence special rules will apply for her - and this becomes usually more expensive since she has to pay-up additionally on top of what a eligible pensioner will pay for the same treatment (whether it is a box of aspirin or a hip replacement).

a) Those people that want to naturalize at an late age (after the legal pensionable age), will have to show that they have enough savings, assets (property/rent) to support them comfortably until they die. There are of course many millionaires that can show this. Based on these assets, also, a percentage becomes due for the calculation of pensioner health insurance (why a millionaire would voluntary chose to be dependent on such pensioner health insurance with basic health services- is in itself is a dichotomy)

This is therefore a catch 22 if you understate your foreign assets:

i) If you have no assets to support you, naturalization becomes more difficult
ii) which leads to the result that your brother living in Bitburg have to legally commit to carry all health costs for both of you - even if it means selling his home, or paying off a large debt for the rest of his life, for one 4 week hospitalization in the ICU.
iii) Else, a private insurer will assess that risk and simply make a monthly installment so high as to cover for all such eventualities.

Different Costs :

b) Even people in Germany (like those who have private health insurance) are not entitled to KVdR, but can apply for a subsidy to their PKV (Private insurance), once they receive pension. These rates are almost double (14,6%) that of KVdR (7,3%) of which private health insurances for non eligble pensioners are 15,7% (AOK), 16,1% (DAK) etc. In short = expensive, because of statistic probabilities of health costs and old-aged people.

Since you are middle-aged, you cannot claim to be a minor.  Unlike the US, Greece and a few other countries, this means that the pension /health insurance of your mother will not sufficiently carry you both, unless you are mentally disabled or have a special proven physical disability that disqualifies you from all types of work for the rest of your life.

Someone person have to cough up - What's the risks for you or your brother?

a)  Unless you're selling an oil company in Texas for millions,
b) the only way to get someone to carry that legal compulsory insurance, would be to get your brother to legaly proclaim his willingness to privately take all subsequential medical costs for you both (its not covered by his own insurance), and for you (alone) try to get a job as quickly as possible and hope that you both don't get sick in that time (for your brother's sake).

Probably it would be wise to meet up with a financial advisor in Germany who specializes in pensioners before you pack up your stuff for good in the US.

Some small pension fund and health insurance in the US might be better than the bad family relationships with your brother in Bitburg if he declines to engage in such a risky pledge.

*** minor disclaimer - this is of course an over simplication of the major points - there is sufficient small print and exceptions to keep this thread going for years.***

Although I don't fully understand JohannesM's explanations above (despite being German and well versed in health insurance matters), it does show how complicated things are. You should consult an expert specialized in these things to figure out which of the many constellations applies in your case.
But one thing is sure: You MUST get German health insurance when living here - and it won't be cheap!