Benefits Provided by the Long-Term Care Insurance Fund

To receive long-term care insurance benefits, you must submit an application to the appropriate long-term care insurance fund. The long-term care insurance fund is part of the health insurance provider. A family member, neighbor, or close friend may also submit the application on your behalf if they are authorized to do so. In general, it is possible to submit an informal application to the long-term care insurance fund. After the application is submitted, the fund commissions the Medical Service of the Health Insurance Funds (MDK) to conduct an assessment to determine the need for long-term care. Privately insured individuals submit an application to their private insurance company; the assessment is conducted there by “MEDICPROOF.”

To be fully eligible for long-term care insurance benefits, the insured person must have paid into the long-term care insurance fund as a member for two years during the ten years prior to submitting the application or have been covered under family insurance. The need for long-term care must be permanent, expected to last at least 6 months.

Long-Term Care Assessment
During the assessment, the Medical Service of the Health Insurance Funds (MDK) evaluates how independent a person is. The degree of independence is measured across six different areas and—with varying weightings—combined into an overall assessment. This results in a classification into a specific long-term care level.

These six areas are:

1. Mobility (10%)
2. Cognitive and communicative skills (15%)
3. Behaviors and Mental Health Issues
4. Self-sufficiency (40%)
5. Coping with and independently managing the demands and stresses associated with illness or treatment (20%)
6. Organizing Daily Life and Social Interactions (15%)

Care Levels for Children

As with adults, the assessment is based on the degree of independence, the presence of abilities, and the extent of the impairment. The assessment takes into account deviations from the level of independence typical of healthy children of the same age. Long-term care insurance benefits are paid regardless of income and assets.

An Overview of the Services Provided Under the Five Levels of Care (PG)

Home care is often provided by family members. It is important for family caregivers to take breaks so they can have time for themselves. Attending a cultural event, going for a walk, or taking a short vacation can help them step away from the daily routine of caregiving, recharge, or prevent isolation. In addition, caregivers may also fall ill themselves and need time to recover. For this purpose, long-term care insurance provides short-term and respite care, as well as day and night care.

Effective July 1, 2025, a new combined annual amount for respite care and short-term nursing care was introduced for all individuals in need of care with care levels 2–5. This amount is 3,539 euros.

Benefit amounts already used in the first half of 2025 for respite care or short-term care services will be counted toward the new joint annual amount for the 2025 calendar year; that is, a total of up to 3,539 euros will be available for respite and short-term care for the calendar year.

The advantage: The combined annual amount allows for flexible use of the services, since there is no need to transfer funds from individual budgets.

Additional Regulations:

• The current eligibility requirements for respite care and short-term care will be harmonized and simplified as much as possible. For example, the maximum duration of respite care will be increased to up to eight weeks per calendar year, bringing it in line with the maximum duration of short-term care. The same applies, for example, to the period during which half of a previously received (pro-rated) care allowance continues to be paid, both during respite care and during short-term care—this, too, will then apply for up to eight weeks per calendar year in each case.
• Effective July 1, 2025, the requirement for a six-month preliminary care period prior to the first use of respite care will also be eliminated. This means that the entitlement to respite care—just like the current entitlement to short-term care—can be exercised immediately upon being assigned at least Care Level 2.
• At the same time, information and transparency regulations will be introduced to ensure that individuals in need of care can keep track at all times of the amounts billed by service providers through the Joint Annual Amount.

Short-Term Care

: Many people in need of care require inpatient care only for a limited time. The long-term care insurance fund covers up to €3,539.00 of the costs of care, social support services, and medical treatment at a short-term care facility.

Important Note: In addition to the costs listed above, there are daily rates for room and board, the amounts of which are determined individually by each facility. These costs must be paid by the person requiring care. Copayments related to short-term care may be reimbursed by the long-term care insurance fund within the limits of the €131.00 relief allowance.

Half of the care allowance will continue to be paid for the entire period.

The age limit for children and adolescents who can provide short-term care, including in appropriate facilities for people with disabilities, has been raised from 18 to 25.

The right to short-term care also applies in licensed inpatient rehabilitation facilities under Section 111 of SGB V if the caregiver is providing preventive care or rehabilitation services there and the person requiring care must be accommodated at the facility at the same time.

Respite Care

If the caregiver takes a vacation or is temporarily unable to provide care due to illness, the long-term care insurance fund will cover the costs of substitute care for up to 56 days. A maximum amount of €3,539.00 per calendar year is available for this purpose.

For substitute care provided by close relatives, expenses are limited to twice the amount of the care allowance corresponding to the determined care level.

Special Provision: Respite
Care on an Hourly Basis: If respite care is used for only a few hours a day (less than 8 hours) (e.g., volunteer groups, care groups), the care allowance is not reduced. The substitute caregiver may not be related to or by marriage to the person in need of care up to the second degree of kinship, nor may they live in the same household as that person.

Care Allowance

: If family members, friends, or other non-professional caregivers provide care, the person in need of care receives a care allowance, which they can pass on to the caregiver. This type of care is considered voluntary. Therefore, the care allowance is not considered income and is not subject to taxation.

Care allowance cannot be paid in the following cases:

• For inpatient hospital treatment, inpatient medical rehabilitation services, or home health care (including basic care and household assistance), coverage is provided by the health insurance company starting in the 5th week.
• when receiving the full range of benefits in kind, as well as in cases of full-time inpatient care.
• in the case of similar benefits provided by other government agencies and institutions (e.g., the nursing allowance under the Federal Pension Act)

To ensure the quality of home care, regular assessment visits are necessary.

As of January 1, 2026, assessment visits are mandatory only once every six months for all care levels. For care levels 4 and 5, assessment visits may continue to take place quarterly on a voluntary basis. The costs for these visits are covered by the long-term care insurance funds. The service is provided by accredited home care agencies or care consultants.

In-Kind Long-Term Care Benefits: Home

care can also be provided by a home care agency as an in-kind benefit. In this case, the home care agency bills the respective long-term care insurance fund directly. The home care agency supports individuals in need of care and their family members with care at home. During home visits, the care service’s staff provides professional and knowledgeable assistance with daily care. Outpatient care enables those in need to remain in their familiar surroundings despite requiring care.

The range of home care services covers the following areas:

• Basic care activities (e.g., personal hygiene, nutrition, mobility assistance)
• Home nursing care (as a benefit under statutory health insurance pursuant to Section 37 of Book V of the Social Code (SGB V))
• Providing advice to individuals in need of care and their family members on care-related issues
• Assistance in arranging support services (e.g., meal delivery)
• Household chores (e.g., grocery shopping, cooking, cleaning the home)

Combined Benefits

: To ensure optimal care tailored to individual needs, family members and home care services may share the responsibility for providing care. Specifically, this means that a proportional care allowance is paid if the in-kind care benefit is not utilized in full.

Calculation example: Combination of care allowance and in-kind care benefit

A person in need of care at Care Level 2 (796.00 euros) receives in-kind benefits from a care service totaling 398.00 euros.

He has thus used up 50 percent of his in-kind benefits. This means that they are still eligible to receive 50 percent of the care allowance allocated for Care Level 2 (347.00 euros). Consequently, they are still entitled to 173.50 euros (50 percent of 347.00 euros) in care allowance.

People in need of long-term care are entitled to assistive devices if these make care easier, help them live independently, or can alleviate their symptoms. A list of assistive devices is available from long-term care insurance providers or medical supply stores, which specifies which assistive devices are covered by long-term care insurance when needed.

The list of assistive devices includes devices

• to facilitate care, e.g., nursing beds, nursing bed tables, nursing recliners
• for personal care/hygiene, e.g., bedpans, urinals, shower carts
• to support independent living, such as in-home emergency call systems
• to relieve discomfort, e.g., positioning aids, positioning rolls
• intended for consumer use, e.g., disinfectants, protective clothing

Consumable assistive devices are obtained directly from an authorized provider (medical supply stores, pharmacies) and billed to the applicable long-term care insurance fund. The long-term care insurance fund covers the costs of this in-kind benefit up to 42.00 euros per month. Any amounts exceeding this must be paid by the insured person.

Technical assistive devices are usually provided to the person in need of care by the long-term care insurance fund on a loan basis. Approval may be contingent upon the person in need of care having the assistive devices fitted or receiving training in their use. The person in need of care must pay a copayment of 10%

toward the costs of technical assistive devices, up to a maximum of 25 euros per device. Larger technical care aids are often provided on a loan basis, so no copayment is required.

The respective care aid is generally supplied by the long-term care insurance fund’s contracted provider. If the service is provided by another service provider, the insured person must cover the additional costs themselves. It is therefore advisable to ask a long-term care insurance fund to provide a list of its contracted providers in advance.

If the person is not eligible for benefits, an application can be submitted to the responsible social services office under SGB XII. However, these benefits are means-tested.

For assistive devices and care aids that are particularly important for the independence of those in need of care or that serve to facilitate care, it is no longer necessary to submit a separate application. As soon as an MDK assessor recommends a specific assistive device and the person in need of care agrees to its provision, this is considered an application to the long-term care insurance fund. A doctor’s prescription is no longer required in these cases. The recommendations are recorded in the assessment report and are thus automatically forwarded to the long-term care insurance fund. The fund is then responsible for arranging the provision of the appropriate assistive or care device.

Caregivers are individuals who, pursuant to Section 19 of SGB XI, provide non-professional care to persons in need of care for at least 10 hours per week in their home environment.

If family members or other individuals in the person’s immediate circle are available to provide home care, they must be listed as caregivers when applying for the care allowance.

Anyone who cares for a family member or volunteers to care for people in need of care can take a caregiving course funded by the long-term care insurance fund. In some cases, the long-term care insurance funds themselves offer these courses. They provide practical guidance and information, as well as advice and support on a wide range of topics.

Caregiving courses are also designed to reduce the physical and emotional strain associated with caregiving. In addition, these courses offer family caregivers the opportunity to share experiences with others and build connections. If a care level has been assigned, there is also the option to receive care instruction in the caregiver’s or care recipient’s own home environment. This allows, for example, on-site instruction in the use of assistive devices or training in specific caregiving tasks. Contact your long-term care insurance provider!

Since September 2024, the German Red Cross (DRK) in Fulda, in cooperation with the Barmer Long-Term Care Insurance Fund, has been offering courses to support family caregivers. Participation is free for family caregivers (all long-term care insurance providers). Topics covered include “In need of care? What now?”, preventive care/personal hygiene, repositioning patients without straining the back, and designing a care-friendly environment.

If a caregiver provides care for one or more people in need of care, the person in need of care’s long-term care insurance fund will cover the caregiver’s pension insurance contributions upon application to the long-term care insurance provider. The amount of the pension insurance contributions depends on the care level of the person in need of care as well as the number of hours per week that the individual volunteer caregiver spends providing care.

The minimum care time is ten hours per week. When caring for multiple individuals in need of care, the care hours may be combined. The

following requirements must be met for the long-term care insurance fund to pay contributions to the statutory pension insurance:

• The caregiver works no more than 30 hours a week
• Care is provided for at least ten hours a week in the home environment
• The person in need of care has long-term care insurance
• A person in need of long-term care is entitled to benefits under long-term care insurance
• The care is provided on a volunteer basis, meaning that the compensation for the care does not exceed the amount of the care allowance.

For example, if the caregiver needs to cover a period of time or be relieved of duties due to other responsibilities, care at a day or night care facility may be a suitable option. In such cases,

the long-term care insurance fund contributes toward the costs of care, medical treatment, and transportation. In addition to the care allowance or in-kind care benefits for home care, monthly amounts of 721, 1,357, 1,685, and 2,085 euros are available for care levels 2–5.

The long-term care insurance fund contributes toward the costs of age-appropriate or barrier-free home modifications with the goal of ensuring that

• home care is only possible because of
• significantly facilitates home care, or
• the person in need of care is able to resume an independent lifestyle.

If the requirements are met, the home modification may be subsidized by the long-term care insurance fund with up to 4,180.00 euros.

If several individuals requiring care live in the same apartment, the total amount is capped at 16,720.00 euros.

This benefit is available to all individuals requiring care who are classified in care levels 1 through 5.

Important: It is recommended that construction work not begin until the benefit has been applied for and approved, as the long-term care insurance fund will not cover any costs incurred retroactively.

All individuals requiring care who are classified in care levels 1 through 5 are entitled to a uniform monthly budget of 131.00 euros. This benefit can be used to pay for low-threshold care and respite services. These include household assistance, particularly meal preparation, shopping for daily necessities, routine cleaning of living spaces, and handling laundry. It also includes activities related to scheduling appointments and leisure time—such as transportation services and accompaniment to appointments (e.g., doctor’s visits), going for walks and having conversations together, accompanying the person on outings and visits, as well as engaging in board games, singing, crafts, etc.

The additional care and relief allowance does not cover professional nursing tasks (e.g., basic care) or medical tasks (e.g., wound care), as well as gardening and handyman services.

Any remaining balances that have not been used by the end of a calendar year may be carried over to the following year and used until June 30.

The budget can be used not only for respite care services, but can also be allocated to the following services:

• Increasing the standard benefit for short-term and respite care, or reimbursement of copayments for short-term care
• Increasing the standard benefit for semi-inpatient care/day care or reimbursing copayments for semi-inpatient care

The additional care and respite services are provided only as benefits in kind and cannot be paid out in cash, unlike the care allowance. The services must be provided by an approved provider.

Recognized providers are:

• Home Care Services
• service providers recognized under state law in the field of caregiving and housekeeping
• qualified neighborhood volunteers