Long-Term Care (Pflegeversicherung)

What Is Pflegeversicherung?

Pflegeversicherung (long-term care insurance) is Germany's mandatory insurance for nursing and care needs. Introduced in 1995 as the "fifth pillar" of social insurance, it provides financial support when you can no longer manage daily life independently — whether due to age, illness, or disability.

Everyone with health insurance in Germany automatically has Pflegeversicherung. If you're in public health insurance (GKV), you're in the soziale Pflegeversicherung (SPV). If you're privately insured (PKV), you must have private Pflegepflichtversicherung (PPV) — your private insurer offers an equivalent mandatory plan.

Contribution Rates 2026

Pflegeversicherung contributions are calculated as a percentage of your gross salary, up to the Beitragsbemessungsgrenze (contribution ceiling). The rates depend on whether you have children and how many:

The employer and employee each pay roughly half of the base rate. However, the Kinderlosenzuschlag (childless surcharge of 0.6%) is paid entirely by the employee. In Sachsen, the split differs — employees pay a larger share due to historical reasons (no public holiday was eliminated when Pflegeversicherung was introduced).

Pflegegrade 1-5: The Care Levels

Since 2017, Germany uses five Pflegegrade (care grades) to classify the severity of care needs. These replaced the old three-tier Pflegestufen system and better account for cognitive and psychological impairments (such as dementia), not just physical limitations.

The 6 Modules of Assessment (Begutachtungsinstrument)

The points score is determined by evaluating six modules, each weighted differently:

1. Mobility (Mobilität) — 10%: Getting out of bed, walking, climbing stairs, changing position
2. Cognitive & communicative abilities (Kognitive und kommunikative Fähigkeiten) — 15%*: Orientation, understanding situations, recognizing people, communicating needs
3. Behavioral & psychological problems (Verhaltensweisen und psychische Problemlagen) — 15%*: Aggression, anxiety, nighttime restlessness, self-harming behavior
4. Self-care (Selbstversorgung) — 40%: Washing, dressing, eating, using the toilet — this is the most heavily weighted module
5. Managing medical demands (Bewältigung krankheitsbedingter Anforderungen) — 20%: Medication management, wound care, doctor visits, therapies
6. Organizing daily life (Gestaltung des Alltagslebens) — 15%: Structuring the day, maintaining social contacts, planning activities

*Modules 2 and 3 are not added together — only the higher-scoring one counts toward the total (combined weight: 15%).

The MDK/MD Assessment

To receive a Pflegegrad, you must apply to your Pflegekasse (care insurance fund, administered by your Krankenkasse). They then send the Medizinischer Dienst (MD) — formerly MDK — to assess your care needs. This is a home visit by a trained assessor (usually a nurse or doctor).

How the process works:

1. Apply: Submit an Antrag (application) to your Pflegekasse — a simple letter or phone call is enough. The Pflegekasse must process it within 25 working days.
2. Schedule: The MD contacts you to schedule a home visit (or care facility visit). You'll receive a letter with the date.
3. Assessment visit: An assessor visits for 1-2 hours, observes your abilities, and interviews you and your caregivers about daily challenges.
4. Report: The MD sends a Gutachten (report) with point scores and a Pflegegrad recommendation to the Pflegekasse.
5. Decision: The Pflegekasse issues the Bescheid (decision). Benefits begin from the date of application.

Points-to-Pflegegrad conversion:

The assessor scores each module, and the weighted total determines your Pflegegrad: under 12.5 points = no Pflegegrad; 12.5-26.9 = PG1; 27-47.4 = PG2; 47.5-69.9 = PG3; 70-89.9 = PG4; 90-100 = PG5. The detailed Gutachten shows exactly how many points you received in each module, making it possible to challenge specific assessments if you believe they're inaccurate.

Home Care Benefits

Most people in Germany receiving care are cared for at home — either by family members, professional care services, or a combination. Pflegeversicherung offers two main types of home care benefits:

Pflegegeld (Cash Allowance for Informal Care)

If you're cared for by family members, friends, or other non-professional caregivers, you receive a monthly cash payment to use as you see fit — typically given to the caregiver as compensation:

Pflegegeld recipients must have regular advisory visits (Beratungseinsatz) by a professional care service: every 6 months for PG2-3, every 3 months for PG4-5. This ensures the care situation is adequate.

Pflegesachleistungen (Professional Home Care Services)

Instead of (or in addition to) cash, you can receive professional home care from an ambulanter Pflegedienst (outpatient care service). The Pflegekasse pays the service directly:

Kombinationsleistung (Combining Both)

You can mix Pflegegeld and Sachleistungen through Kombinationsleistung. If you use, say, 60% of your Sachleistungen budget on professional care, you still receive 40% of the Pflegegeld amount as cash. This is ideal for families who provide most care themselves but need professional help for specific tasks like wound care or bathing assistance.

Nursing Home (Pflegeheim)

When home care is no longer sufficient, residential nursing homes (Pflegeheime) provide full-time professional care. Pflegeversicherung contributes a fixed monthly amount toward the care costs:

Leistungszuschlag: Reducing the Eigenanteil Over Time

Since January 2022, nursing home residents receive a Leistungszuschlag(benefit surcharge) that reduces the care-related portion of the Eigenanteil based on how long they've been in the facility:

• Year 1: 15% reduction of the care-related Eigenanteil
• Year 2: 30% reduction
• Year 3: 50% reduction
• Year 4+: 75% reduction

This helps long-term residents, but it only reduces the care portion of the Eigenanteil — room, board, and investment costs remain unchanged. Even with 75% off the care share, residents still pay substantial monthly fees.

Additional Benefits

Beyond the main care payments, Pflegeversicherung offers several important supplementary benefits:

Verhinderungspflege (Respite Care)

When the primary caregiver needs a break — vacation, illness, personal matters — Pflegeversicherung covers replacement care up to €1,612 per year for up to 6 weeks. Available from PG2. Can be provided by another family member (lower rates apply) or professional services. Up to 50% of unused Kurzzeitpflege budget (€887) can be added, bringing the total to up to €2,499.

Kurzzeitpflege (Short-Term Residential Care)

Temporary stay in a care facility — e.g., after hospital discharge, during caregiver absence, or in a crisis — up to €1,774 per year for up to 8 weeks. Available from PG2. Up to 100% of unused Verhinderungspflege budget (€1,612) can be added, bringing the total to up to €3,386.

Entlastungsbetrag (Relief Amount)

€125 per month for all Pflegegrade (including PG1). Can be used for day/night care, short-term care, approved support services, or care services. Unused amounts carry over within the calendar year and into the first half of the following year. Must be used for recognized services — not paid out as cash.

Pflegehilfsmittel (Care Supplies)

Up to €40 per month for consumable care products: disposable gloves, bed protectors, disinfectant, face masks, etc. Easy to claim — many suppliers offer a monthly Pflegebox delivered to your door. Simply submit a one-time application.

Wohnraumanpassung (Home Modifications)

Up to €4,000 per measure for adapting your living space: walk-in shower installation, stairlifts, door widening, ramps, anti-slip flooring, etc. Can be claimed multiple times if care needs change. For shared care apartments (Pflege-WG), up to 4 residents can each claim €4,000 for the same modification.

Tages- und Nachtpflege (Day and Night Care)

Partial residential care — the care recipient spends the day (or night) at a care facility and returns home for the rest. Benefits are provided in addition to Pflegegeld and Sachleistungen (not deducted). Available from PG2 with the same benefit amounts as Sachleistungen. Ideal for working family caregivers who need daytime coverage.

Pflegezusatzversicherung (Supplementary Care Insurance)

Given that Pflegeversicherung is explicitly a Teilleistung, private supplementary care insurance is becoming increasingly essential. There are several types:

Pflegetagegeldversicherung (Daily Care Allowance)

The most popular type. Pays a fixed daily amount (e.g., €50-100/day) for each Pflegegrad, which you can use however you wish — no receipts needed. Premiums depend on entry age and chosen daily amount. A 35-year-old might pay €30-50/month for €1,500 monthly benefit at PG5.

Pflege-Bahr (State-Subsidized Insurance)

A state-subsidized option introduced in 2013: you pay at least €10/month in premiums, and the state adds €5/month as a subsidy. Key features:

• No health screening — guaranteed acceptance regardless of pre-existing conditions
• Minimum benefit of €600/month at PG5
• Available to anyone in the SPV (not PKV)
• Criticism: Many experts consider the benefits too low for the premiums. The guaranteed acceptance means high-risk individuals are overrepresented, driving up costs.

Pflegekostenversicherung (Care Cost Insurance)

Reimburses actual care costs (against receipts) up to a contractual maximum. Less flexible than Pflegetagegeld but can cover specific gaps like the Eigenanteil in a nursing home.

Caring for Family Members

Germany recognizes that most care is provided by family members and offers several protections and benefits for caregivers:

Pflegezeit (Care Leave)

• Short-term emergency leave: Up to 10 working days off to organize care in an acute situation (e.g., parent has a stroke). You receive Pflegeunterstützungsgeld (care support payment) as wage replacement from the Pflegekasse.
• Pflegezeit (up to 6 months): Full or partial leave from work to care for a close relative. Available at companies with 15+ employees. Unpaid, but you're protected from dismissal. You can take an interest-free government loan to cover the income gap.

Familienpflegezeit (Family Care Leave)

Reduce your working hours to a minimum of 15 hours/week for up to 24 months to care for a close relative at home. Available at companies with 25+ employees. Again, you can access an interest-free loan to partially offset the reduced income. Pflegezeit and Familienpflegezeit can be combined for a maximum of 24 months total.

Pension Credits (Rentenversicherung)

If you care for someone with PG2 or higher for at least 10 hours per week across at least 2 days, the Pflegekasse pays Rentenbeiträge (pensioncontributions) on your behalf. The amount depends on the Pflegegrad and whether professional care is also used. This can add several hundred euros per month to your future pension entitlement. You must not be employed more than 30 hours/week to qualify.

Accident Insurance (Unfallversicherung)

Family caregivers are automatically covered by statutory accident insurance (gesetzliche Unfallversicherung) during care activities and on the way to/from the care recipient's home. This covers you if you injure yourself while providing care — no application needed.

The Funding Gap Crisis

Pflegeversicherung faces a structural problem that's getting worse every year: the gap between what it pays and what care actually costs continues to widen.

The numbers are stark:

• Insurance covers roughly 50% of actual nursing home costs — often less
• Eigenanteile have been rising significantly year over year, driven by higher wages for care workers (necessary and justified, but increasing costs)
• Average Eigenanteil in a nursing home is now around €2,200-2,500/month in many states — more than many pensions
• Home care gaps are less visible but equally real — professional home care costs easily exceed the Sachleistungen budget

When savings run out: Sozialamt (Welfare)

If a care recipient cannot afford the Eigenanteil from their pension, savings, or other income, the Sozialamt (social welfare office) steps in with Hilfe zur Pflege (assistance for care). This is means-tested — the person's assets must be largely depleted first (a protected amount of around €10,000 is preserved, plus the family home if a spouse still lives there).

Elternunterhalt: Children's Liability

Since the Angehörigen-Entlastungsgesetz of January 2020, children are only liable for their parents' care costs (Elternunterhalt) if they earn more than €100,000 gross per year. This was a major relief for middle-income families who previously feared being financially devastated by a parent's nursing home costs. Below that threshold, the Sozialamt covers the gap without recourse to the children.