Applying for care aids

Care aids are specific products and devices that are used to provide care to care recipients and to support them on a daily basis. They are intended to foster independence and to facilitate care at home. All people in need of care are entitled to care aids, regardless of their assigned care grade. 

The difference between care aid and other medical aids is that care aids facilitate long-term care and are designed to relieve symptoms or to allow care recipients to lead more independent lives. They are a long-term care insurance benefit. Medical aids are designed to compensate for health impairments. They are a health insurance benefit.

What care aids are available? 

A distinction is made between technical and digital care aids and those intended for consumption.

Technical aids are medical aids with a technical component, which are used in long-term care. Examples include wheelchairs, care beds, shower trolleys and stand-up supports.

Technical care aids also include digital products. These comprise technological solutions to support care on an everyday basis, such as electronic medication dispensers, sensors for detecting falls, smart home emergency call systems and apps that provide reminders about medication or appointments.

In the case of technical and digital aids, the long-term care insurance fund will check in each case whether the purchase is essential.

Consumable care aids are products that are only used once for hygiene reasons. Examples include bed pads, disinfectants, aprons and disposable gloves. These require an informal application only.

What rules apply to people with private long-term care insurance? 

The same entitlements and criteria apply to people with private long-term care insurance and those with statutory long-term care insurance.

More information about care aids and private long-term care insurance is available from Compass private Pflegeberatung gGmbh.

For the register of approved care aids and medical aids used by private long-term care insurance providers, consult the German Association of Private Health Insurers (Verband der Privaten Krankenversicherung e.V.).

The costs of care aids are covered by statutory health insurance (funds) if: 

• the care recipient is assigned care grade 1 or higher 
• care is being provided in the home recipient’s home or in another domestic setting 
• a technical or digital care aid is required (as determined on a case by case basis) 

An application must be submitted to the long-term care insurance fund to have the cost of a care aid covered. The insurance fund tasks the Medical Service to assess whether the purchase of technical products is essential on a case by case basis. 

More information about this assessment is available from the Medical Service.

If the long-term care insurance fund approves the application, they may purchase the care aid that has been applied for on behalf of the insurance policyholder or provide them with it on loan. The latter is the case, for example, for very expensive and large care aids, as well as those that do not require individual adaptations (e.g. care beds).

For all types of aids, the statutory long-term care insurance fund or health insurance fund will only cover the costs of products that are listed in the register of approved aids published by the National Association of Statutory Health Insurance Funds (GKV-Spitzenverband).

The register of approved aids also lists digital care aids, such as digital medication dispensers and fall detection systems.

Tips on applying for digital care aids are available from consumer advice centers.

Any aids not listed on the register normally have to be paid for by the individuals themselves. Examples include care bed with special features for added comfort or certain aids that go above and beyond what is required.

However, it is possible to apply to the long-term care insurance fund to cover the cost of an individual aid that is not listed on the register if a sound reason can be provided as to why it is needed.

All medical aids and care aids for which cost coverage by insurance funds is possible are listed online in the register of approved aids published by the National Association of Statutory Health Insurance Funds (GKV-Spitzenverband).

A home emergency call system is a popular digital care aid that is subsidized by long-term care insurance funds.

Consumer advice centers provide information about the situations in which a home emergency system is appropriate and points to consider when concluding a contract.

Additional information about aids in care facilities is available from consumer advice centers.

Applications for care aids must be made in writing. It is helpful to specify a reason why you require the care aid.

A medical prescription is not required for care aids. However, to get an application approved by the long-term care insurance fund, it may be helpful to have a doctor specify the reason why it is needed.

Care aids that are recommended by the Medical Service in a care assessment are automatically viewed as an application for this benefit, provided that the insurance policyholder agrees. This saves time, as a professional verification of necessity is not then required. It may be helpful to speak to the assessor directly in relation to whether and which care aids may be suitable.

Similarly, a verification of necessity is not required if care aids are recommended by qualified care staff, such as those employed by a professional care service. This written recommendation must be made not more than two weeks in advance of submitting the care aid application.

You will find the form for applying to your long-term care insurance fund for care aids via the insurance fund navigator offered by the National Association of Statutory Health Insurance Funds (GKV-Spitzenverband). 

A pharmacy, mail-order company or medical store may submit an application for a care aid on your behalf. They require your completed application for cost coverage in order to do so.

Don’t worry if you are unsure whether to apply to your health insurance fund or long-term care insurance fund for a particular care aid – the insurance funds can settle the matter among themselves. You can submit the application to your long-term care insurance fund or your health insurance fund. However, you can save time by ensuring that the application is sent directly to the right fund. 

If the insurance fund is unable to adhere to these deadlines, they will inform you promptly in writing or electronically, explaining the reason for the delay. If you do not receive any notification indicating a reason, you can assume that your application has been approved once the specified period of time has elapsed.

If a decision is made in your favor, the care aid will be approved and the costs will be covered. The decision you receive will also specify the provider (e.g. medical store) that will supply the care aid.

It is recommended that you have a consultation with your long-term care insurance fund or with an independent advisor before you submit an application. This will clear up any questions you may have about how care aids are applied for and financed. 

What can I do if my application is rejected? 

If the long-term care insurance fund rejects your application, you have a period of one month in which to lodge an appeal. 

While it is not mandatory to specify a reason, it increases the chance of success. You can also obtain a care aid assessment from the Medical Service. The reason should explain why the aid is necessary in your individual case. It may also be useful to ask your doctor to write a report and attach this to your appeal.

If the insurance fund rejects your appeal, you can file a complaint with the Social Court where relevant.

The long-term care insurance fund covers the costs of care aids provided that the relevant prerequisites have been met. These costs usually comprise the purchase price as well as any the cost of any necessary service charges, such as charges for adaptation, assembling, regular maintenance, repairs and accessories.

The long-term care insurance fund also verifies that the selected variant of the care aid is appropriate and cost-efficient. They may suggest a more cost-efficient alternative or may not cover the cost in full if the selected aid is too expensive or if its scope is considered to be beyond what is necessary.

Co-payments may need to be paid by care recipients themselves in the case of some care aids. A co-payment amounts to 10 percent of the price of the care aid, up to a maximum of 25 euros. Co-payments do not apply in the case of consumable care aids. You can ask your long-term care insurance provider to clarify co-payment rules in advance. 

Private supplementary care insurance covers additional costs for care aids. Your reimbursement options will depend on the level of cover agreed in your insurance policy. 

For consumable products, you must apply to your long-term care insurance fund for care aid cover at a flat rate. You are entitled to apply if you have been assigned care grade 1 or higher and are being cared for at home. You do not need to fulfill any additional prerequisites. 

Your long-term care insurance fund pays a monthly subsidy of up to 40 euros per month for consumable care aids. In other words, an annual subsidy of 480 euros is available for consumable items. 

Flat-rate payments do not mean that you will receive direct payment of the monthly amount. In fact, you need to submit monthly receipts for all items purchased to your long-term care insurance fund and will be reimbursed retroactively. 

You may be able to transfer your entitlement to a supplier of care aids, which would mean that the supplier bills your long-term care insurance fund directly and only bills you for any additional costs that you need to cover yourself. The supplier will need to conclude a contract with the long-term care insurance fund for this purpose. 

To find out which products are covered by flat-rate payments for care aids, check the register of approved aids published by the National Association of Statutory Health Insurance Funds (GKV-Spitzenverband) (product group 54, consumable care aids).  

Where can I purchase consumable care aids? 

These products are on sale everywhere, for example, in pharmacies or medical stores, drugstores or discount stores, and special offers may be available. All you have to do is submit the receipts to your long-term care insurance fund.

For more information about flat-rate payments for care aids, refer to the Pflegewegweiser NRW care guide.

Advice and support relating to medical aids is available, for example, from social associations, self-help organizations and welfare associations. They provide independent advice about suitable products and financing. They can also help you determine where exactly to submit your application.

In the event of any uncertainties, individual questions or problems in relation to your application for a care aid, the Independent Patient Advice Service for Germany (UPD) is a source of useful advice and support. 

Long-term care insurance funds and home care services can also advise you on care aids. 

A database of relevant advice centers in your area is provided on the website of the Center for Quality in Care foundation.

Some consumer advice centers offer legal advice on healthcare and long-term care.