Long-term care insurance (Pflegeversicherung) was added to Germany’s social security system in 1995 to ensure that everyone is prepared for the eventuality of needing long-term nursing care, whether due to accident, illness or old age.
Statutory long-term care insurance (Pflegepflichtversicherung) vs supplemental long-term care insurance (Pflegezusatzversicherung)
Long-term care benefits are funded by mandatory contributions from all employees in Germany (currently 3,4% – 4% of your annual salary). The scheme is either provided by your statutory health insurance or your private health insurance. The type of long-term care support you receive depends on your situation and the type of insurance you have.
The following information primarily applies to people who are covered by statutory long-term care insurance (Pflegepflichtversicherung), rather than the supplemental long-term care insurance (Pflegezusatzversicherung) provided by private insurance companies.
Long-term care requirements
To be eligible for long-term care benefits, you need to fulfil the following requirements:
- You are covered by statutory health insurance or private health insurance and have been contributing to a long-term care insurance scheme.
- You must demonstrate a “need for long-term care” (Pflegebedürftigkeit) – defined as exhibiting health-related restrictions to your independence or abilities that require the help of others. This need must also be expected to last at least six months (if the expected duration is less than this and you are employed, you may qualify for sickness benefit instead).
Your need of care will be assessed individually and classified with a “care grade” from 1 – 5 that reflects how severely your independence and abilities are impaired.
If you have taken out private long-term care insurance, you may be subject to different requirements; check your policy documents or speak to your insurer to make sure.
Long-term care benefits (Pflegegeld)
The long-term care provision recognises that most people in need of care want to stay in familiar surroundings for as long as possible. The focus is therefore on providing benefits that can keep you out of hospital, improve home care and lighten the load of family carers.
The exact type and value of the benefits you receive depend on your personal situation, including any pension or other benefits you are receiving, and which care grade you have been allocated.
These long-term care insurance benefits can be broadly divided into three categories:
Mobile care (Pflege zu Hause / ambulante Pflege)
If the person in need of care decides to remain at home, long-term care insurance provides support in the form of subsidies and allowances. Generally, the choice is between care benefits in kind – for instance interventions from approved outpatient care services – or cash benefits such as the care allowance, but in certain cases these benefits can be combined. Other benefits could include:
- Contributions towards the cost of independent caregivers
- Vacation and sickness replacement benefit
- Stays in day- and night-care facilities
- Contributions to social security for the caregiver
- Nursing courses for relatives
- Contributions towards the costs of care aids
- Subsidies for home adaptations (up to 4.000 euros)
Inpatient care(Pflege im Heim)
Inpatient care is also subsidised by long-term care insurance, including both care expenses and medical expenses. The subsidy is capped according to the care level of the person in need of care:
- Care level 1: Up to 125 euros per month
- Care level 2: Up to 770 euros per month
- Care level 3: Up to 1.262 euros per month
- Care level 4: Up to 1.775 euros per month
- Care level 5: Up to 2.005 euros per month
As well as full-time care, people in need of care can also opt for so-called partial inpatient care: temporary care in a facility either during the day or the night, for example. Short-term stays in care are also covered.
Most of the time, this benefit is not enough to cover the full cost of inpatient care; the person in need of care therefore also has to pay a contribution.
Alternative forms of living (alternative Wohnformen)
More and more people now choose to live as independently as possible in old age. This is made possible by new forms of living, such as assisted living or retirement homes, which offer the opportunity to live together with people of a similar age and receive support together, without having to completely forego one’s privacy and independence. Residents of these facilities have their own apartments, but can make of communal areas to socialise.
Long-term care insurance supports these assisted forms of living with the care benefit, outpatient care benefits in kind, and a flat rate benefit of 214 euros per month.
Additional benefits
Individuals who have taken out supplemental or private long-term care insurance policies may be eligible for additional benefits like full coverage of nursing home fees. Check your policy documents for more details.
How to apply for long-term care benefits
To apply long-term care, you will need to submit an application to your long-term care insurance fund, which is an arm of your health insurance fund. Your family members, neighbours or close friends can also submit an application on your behalf if you authorise them to do so.
Once the application is received, the long-term care insurance fund will pass it on to the Medical Service of the German Health Insurance Funds (Medizinische Dienst der Krankenversicherung) or an independent assessor to assess your individual care needs, depending on whether you have statutory or private insurance. This will usually include a visit to your home by a carer or a doctor, who considers things like your mobility, cognitive and communication abilities and self-care.
Within 25 working days, the long-term care insurance fund will then respond with a written assessment notice, sent to you by post. This will include the outcome of their assessment and details of any benefits due to be paid to you.