Pflegeversicherung in Germany: long-term care insurance

What else does the insurance cover besides the monthly payments

Apart from the financial allowance and care services, there are separate budgets that are often unknown and simply go unused.

What is important here in practice. Prior approval for respite care is not required — you can pay for the service and submit documents for reimbursement. The deadline for submitting a reimbursement claim is the end of the following calendar year. If care is provided by relatives up to the second degree of kinship or cohabiting persons, the reimbursement cap is lower: a cash allowance for two months plus documented expenses.

Care home: how much the family really pays

The insurance payout for residential care (ranging from €805 to €2,096 per month depending on the Pflegegrad) only covers care. Accommodation, board and the facility’s investment costs must be paid by the individual themselves.

Averages according to the Verband der Ersatzkassen (association of substitute health insurers) as of 01/07/2026. The regional variation is significant: ranging from approximately €2,891 in Saxony-Anhalt to €3,761 in Bremen.

A supplement that reduces this amount over time

The longer a person lives in a care home, the greater the proportion of their own contribution towards care costs that is covered by the Pflegekasse (long-term care fund) under § 43c SGB XI:

The supplement applies only to the resident’s own share of care costs. It does not reduce accommodation, board or investment costs. It applies from Pflegegrad 2.

New from 1 July 2026: The Pflegekasse calculates the supplement itself, based on the care home’s data, and transfers it directly to the care home. The resident is billed an already reduced amount – there is no need to submit a separate application.

Are children responsible for the costs of caring for their parents

This is one of the most common fears, and it is largely outdated. Since 2020, the rule has been: maintenance claims against children (and against parents) are not taken into account, if the annual aggregate income of the respective person does not exceed €100,000 — Section 94, subsection 1a of the Twelfth Book of the Social Code (SGB XII).

• The threshold is calculated on an individual basis, and not in total for all children.
• There is a presumption: It is assumed that the income does not exceed the threshold. The social welfare authority is entitled to request information only if there are sufficient grounds to believe otherwise.
• It is about the total annual income within the meaning of Section 16 of the Fourth Book of the Social Code (SGB IV), and not the gross salary under the employment contract.

In other words: at a standard level of income, children are not required to contribute towards the costs. Proceedings only commence once this threshold is exceeded.

How to obtain a Pflegegrad: procedure and timeframes

1. Application to the Pflegekasse. Submit it to the Pflegekasse at your Krankenkasse, either verbally or in writing. The date of submission is important: payments are calculated from the month in which the application is submitted, not from the date of the medical examination.
2. Examination. For those insured in the public system, it is carried out by the MD medical service, and for private patients, by Medicproof. The examination takes place at the place of residence. Refusal to let the expert in gives the Pflegekasse the right to refuse services.
3. Assessment across six areas: mobility, cognitive and communication skills, behaviour and mental health, self-care, coping independently with the demands and challenges of treatment, organising daily life, and social interactions.
4. The decision must be made no later than 25 working days from the date the application is received, in writing (§ 18c SGB XI). In the event of a delay, the Pflegekasse must pay the applicant 70 euros for each commenced week of delay if the delay is its fault.
5. The expert report is sent together with the decision, if you do not mind it being forwarded. Always request it: without an expert report, it is almost impossible to challenge the decision.
6. An objection must be submitted within one month of receiving the decision. Rejections and too low a Pflegegrad are common, and objections are frequently upheld.

A tip that noticeably increases the chances: One to two weeks before the assessment, keep a care diary detailing how much time is spent on each activity every day. An expert only sees a person once for an hour, and in the presence of strangers, people often demonstrate more independence than on a normal day.

Additional insurance: three types and state subsidy

Pflege-Bahr: state-subsidised care policy

This is a separate tariff with fixed conditions set by law (§§ 126, 127 SGB XI). The main thing you need to know is:

• State top-up: €5 a month with a personal contribution of at least €10 per month. The top-up does not count towards the minimum contribution.
• The insurer is obliged to accept anyone: no medical questions, no risk loadings and no pre-existing condition exclusions. This is a key benefit for people with chronic conditions who cannot get standard policies.
• Benefits are paid at all Pflegegrade, with at least €600 a month at Pflegegrad 5.
• The waiting period is up to 5 years. This is the main drawback: if the need for care arises in the first few years, there will be no payouts.
• The state top-up is not payable to persons under 18 years of age and those who at the time of concluding the contract are already recognised as being in need of care.
• Only one subsidised contract per person.

How to choose between Pflege-Bahr and a standard tariff: If you are healthy and under 50, a standard tariff usually provides better cover for the same money. If you have medical conditions that lead standard insurers to refuse cover or charge higher premiums, Pflege-Bahr is often the only available option.

Who is required to be insured

• State system: Everyone who is compulsorily insured with a statutory Krankenkasse (§ 20 SGB XI) is insured. Care insurance automatically follows health insurance.
• Private medical insurance: obligation to take out private long-term care insurance with the same insurer (§ 23 SGB XI). The benefits must be equivalent to those of the statutory scheme: instead of benefits in kind, a cash reimbursement of the same amount is paid. Another insurer can be chosen within six months.
• Children and non-working spouses are insured free of charge in the state system as part of family insurance. In the private system, children are insured free of charge and adults pay their own contribution.

What else to read

• Personal accident insurance — covers a different risk, but is often considered together
• Private liability insurance
• Pensions in Germany — how the system works
• Rürup-Rente and Riester-Rente — retirement savings
• Unit-linked life insurance
• Home contents insurance

Sources

• § 36 SGB XI — Care services: gesetze-im-internet.de
• § 37 SGB XI - care allowance: gesetze-im-internet.de
• Section 42a SGB XI — general annual budget of €3,539: gesetze-im-internet.de
• Section 43 SGB XI — residential care: gesetze-im-internet.de
• § 43c SGB XI – cap on the personal contribution: gesetze-im-internet.de
• Section 45b SGB XI – relief amount: gesetze-im-internet.de
• Section 55 SGB XI – Contribution rates and surcharge for childless persons: gesetze-im-internet.de
• PBAV 2025 — the regulation under which the rate has been 3.6 % since 01/01/2025 (§ 55 SGB XI itself still says 3.4 %): gesetze-im-internet.de
• § 18c SGB XI — time limit of 25 working days and compensation of €70: gesetze-im-internet.de
• §§ 126, 127 SGB XI — Pflege-Bahr (state-subsidised private long-term care insurance): gesetze-im-internet.de
• Section 94 SGB XII — income threshold of €100,000: gesetze-im-internet.de
• Federal Ministry of Health — care guide: bundesgesundheitsministerium.de
• Verband der Ersatzkassen — contribution rates and care home co-payment: vdek.com