The coverage for abortions in Bremen has, so far, apparently been more complicated than in many other federal states. Those who earn little and want the state to pay for an abortion must apply to the health insurance and prove with documents that they fall below the income thresholds and actually live in Bremen. Registration confirmation, bank statements, income confirmation: What precisely is required varies from insurer to insurer.
The governing coalition factions want to change this now — a proposal initiated by the Left party will be submitted to the Bremen state parliament this Thursday. In the future, the application should operate on a trust basis, as is the case elsewhere.
Abortions are time-sensitive: under normal circumstances they are legally permissible without penalties for only up to 14 weeks. To do so, there must be confirmation of pregnancy-conflict counseling, doctors who agree to perform the abortion, and a cost between roughly 200 and 500 euros: an abortion that is not medically indicated is not covered by health insurance.
In practice, in many cases the federal states cover the costs: The Pregnant Conflict Act, a federal law, states that a woman has a claim to cost coverage if “the burden of obtaining the funds for the abortion is not to be expected of her and she has her residence or habitual residence within the territory of this law.” Specifically, currently all pregnant women who receive social benefits or earn less than €1,500 net; every child increases the threshold by €356, rent over €440 is also creditable.
Onerous Administrative Agreement
The Pregnant Conflict Act is drafted in a fairly low-threshold way: “The procedure is conducted in writing at the request of the woman,” says Paragraph 20. “Facts must be credibly demonstrated.” In many places this is interpreted to mean that an oral application suffices: those in need who report the need are believed. In most federal states a simple self-declaration that the information provided is correct suffices, according to Bremen’s Left.
In Bremen, however, there is a 2002 administrative agreement between the state government and the health insurance funds. It states that the health insurance funds, when reviewing an application, must generally demand evidence of receiving social benefits or of income and assets. Only in North Rhine-Westphalia, the Saarland and Saxony-Anhalt is it regulated similarly, the coalition factions write in their proposal.
This is not trivial: especially for people in precarious living situations, written proofs are not always accessible. Those who survive on cash-in-hand do not receive pay slips; those who live with partners on their income also have no papers. And those who, for example, suffer from depression may never have documents filed — obtaining new documents costs valuable time.
Also for refugees, for Union citizens or for homeless people it becomes complicated: they often have “their ordinary place of residence in Bremen, but not always the required written proofs for this,” writes the Left in their proposal. Bremen’s administrative agreement from 2002 explicitly excludes some people from the circle of those entitled: “Foreign women who stay in Bremen without a residence permit, authorization or permission (illegal),” would have no entitlement to the cost coverage of an abortion, it states.
“This runs counter to the law and must be changed,” the proposal states. After all, the “ordinary residence” does not arise from a particular residence status, but is, according to the legal definition, simply the place where someone “does not merely stay temporarily.”
Approximately 1,580 abortions by Bremen residents occurred in Bremen in 2024. How many of them filed applications and how many applications were ultimately covered cannot be answered by the responsible social authority by press deadline on Wednesday. The requested health insurance funds do not distinguish the numbers by state of the applicants. Only AOK Bremen/Bremerhaven speaks of 950 to 1,050 applications per year.
Marina Mohr from the pregnancy-conflict counseling center Cara estimates that only about 20 percent of the pregnant women counseled by her clearly fall below the income thresholds and do not apply for cost coverage from the outset. The vast majority are eligible — the income of partners or parents is not checked in the applications. She welcomes a change in the law: “Always, it is hardest for those who are already living at the edge of the subsistence minimum.”
Also for the health insurance fund, the administrative agreement can mean additional effort. “Compared with other federal states, the cost coverage for abortions under the state’s remit in Bremen is too complicated,” says Sabrina Jacob, head of the state representation of Techniker Krankenkasse. Bremen should establish a leaner administrative procedure, she continues — “in the interest of our insured.”
