This month, I’ve been trying to figure out how to obtain health insurance in Germany. There are two options here: public (the Krankenkasse) and private.

In America, I wasn’t eligible for private insurance due to pre-existing conditions (starting with being a Munchausen by Proxy survivor). Underwriters needed a record of every medical treatment I ever had, including those booked by my abuser for things I didn’t have.

I’ve been able to get coverage through healthcare.gov for many years, but this relies on the Affordable Care Act, which doesn’t cover international insurance. In 2016, when Alon and I were living in Paris together, I tried applying for a visa on my own but couldn’t get expat health insurance. I ended up moving to Florida instead. I expected to be in Florida for a few months; I ended up staying there for six years.

This time it’s different. Alon and I got married in February, which streamlined the immigration process. I do need health insurance to live here permanently, though.

I’m unlikely to be eligible for the Kasse because America doesn’t have statutory insurance. People who can’t afford health insurance don’t have health insurance. I had insurance through my father’s company as a kid; then through work; then through the Marketplace when I started freelancing. There’s the Künstersozialkasse for artists, which includes freelance game design and web design, but not programming.

America’s cruelty towards people who are sick or injured is a bit of a meme. People here in Germany are horrified when I talk about what I went through with my car accident, or what my friend Steve is going through with his kidney transplants and dialysis. Even last year I was still running into medical bills from ten years ago– my health insurance will do a sweep of benefits and rescind payment because it was related to the accident, and I have to spend my workday calling up insurance companies and trying to sort things out. If I got in accident here without insurance I’d still be paying less than I would in the US with insurance. When I talk to people in the US about DoctoLib and how much time and stress it saves you if you’re sick and need a doctor, they don’t believe me.

I’m looking into private insurance this week, and will see what my options are.