Health insurance for elderly Ukrainians in Europe: what refugees should pay attention to

After the start of a full-scale war in Ukraine, hundreds of thousands of elderly people were forced to leave their homes and move to European countries. Many of them are accompanied by children and grandchildren, but a large number are alone. For this vulnerable category of citizens, health care has become no less important than providing housing or processing documents. The state of health in older age requires constant supervision, treatment of chronic diseases, medication control and access to doctors. That is why the issue of health insurance for elderly Ukrainians in Europe is particularly acute.

The right to health insurance for elderly Ukrainian refugees

Most of the countries of the European Union provide basic state health insurance to Ukrainians who have one of the following statuses:

• registered as persons under temporary protection (TPI);
• received a residence permit for humanitarian reasons;
• are family members of a person who already has insurance in the state health care system;
• officially employed or registered as unemployed in local employment agencies.

Specific conditions vary by country. For example, in Poland, citizens with UKR status have the right to free medical care at the expense of the state, including treatment of chronic diseases. In Germany, elderly Ukrainians fall under the Krankenkasse system, where contributions can be paid by either the state or the municipality. In France, there is a Carte Vitale system, which also provides access to health services after registration.

Important: if a person does not have the appropriate status, but only entered without a visa, it is almost impossible to get state insurance. Then access to medicine may be limited or paid.

What public health insurance covers in Europe

In most countries, basic public insurance for elderly refugees covers:

• visits to a general practitioner (family doctor) and narrow specialists;
• carrying out laboratory tests, X-ray studies, ultrasound, MRI;
• emergency care and hospitalization for medical reasons;
• partial or full coverage of the cost of prescription drugs;
• participation in vaccination programs and screening examinations;
• limited physiotherapy and rehabilitation measures.

However, treatment is not always completely free. In many countries, the patient is required to pay a co-payment. For example:

• In France, the reimbursement of the cost of drugs ranges from 30 to 65%, depending on the drug.
• In Germany, a fixed fee of 5–10 euros is established for each prescription drug.
• In the Czech Republic, you often have to partially pay for expensive examinations or specialized therapy.

The co-payment applies only when all medical procedures are performed within the state system and on a doctor’s referral.

How to act for an elderly person in the presence of chronic diseases

In the case of chronic diseases, such as diabetes, hypertension, heart failure, oncology or rheumatoid arthritis, it is especially important to register in time with the health care system of the host country.

To receive regular treatment:

• you need to register with a general practitioner;
• provide him with translated data on already established diagnoses (disease histories, previous prescriptions, examination results);
• get into the local register of patients with chronic diseases, which allows you to receive certain groups of drugs for free or with a minimal co-payment;
• regularly update appointments, undergo examinations and agree on a treatment plan with a new doctor.

Without registration and established medical supervision in the new country, Ukrainians risk being left without access to the necessary medicines and examinations.

Electronic prescriptions and patient cards are only valid within one country. For example, a prescription issued in Poland will not be valid in Germany or Spain.

How to get insurance for an elderly person

To get access to medical care through the state system, an elderly person must go through several stages:

1. Registration with a municipality — for example, with the Bürgeramt in Germany or with a local administration in other countries.
2. Issuing a residence permit or obtaining the status of temporary protection.
3. Submitting an application to the insurance fund — depending on the country, it can be a state fund or selected from a list of recommended institutions.
4. Signing an insurance contract is often done automatically after status confirmation, but sometimes a personal presence is required.
5. Obtaining an insurance card, which is presented when contacting a doctor or pharmacy.
6. Choosing a family doctor and registering in his practice.

It is important to carefully save all documents that confirm the right to medical services, as well as agree with the doctor on the regimen of further treatment.

What services are not covered by basic health insurance

Despite the wide availability of medical services, some costs in Europe fall on the shoulders of the patient:

• visits to private doctors without a contract with the state system;
• aesthetic procedures (plastic surgery, cosmetic surgery);
• treatment of non-critical dental diseases (only emergency care – covered by insurance);
• home care for people with disabilities (requires a separate program or separate social insurance);
• prosthetics, orthopedic services, implants are usually only partially compensated.

Supplemental insurance or social assistance programs may cover some of these services, but the availability of such support varies by country.

Comparison of conditions in popular countries of residence

What elderly people and their relatives must pay attention to

Before choosing a country for long-term residence of an elderly person, one should take into account not only the level of health insurance, but also the following factors:

• are there Ukrainian-speaking staff in hospitals;
• are there translation programs in healthcare institutions;
• how accessible hospitals and rehabilitation centers are;
• whether there are social support programs for the elderly;
• is it easy to get to clinics and hospitals by public transport?

Even with insurance, lack of language skills or difficult logistics can make getting help very difficult.