Long-term care insurance supports people when they need care. To this end, it provides various benefits, both for care at home and in a residential nursing home. However, the insurance does not cover all costs.
At a glance
- Long-term care insurance provides financial support and assistance for care at home or in an inpatient facility.
- Care benefits are only given to policyholders who are in need of care as defined under the terms of long-term care insurance.
- Statutory and private long-term care insurance policyholders receive the same benefits.
- Long-term care insurance is a partial costs insurance: depending on the level of care need, policyholders are entitled to lump sums, although they do not cover all the care costs.
- People in need of care have the right to a self-determined life. All benefits and assistance be must geared towards bringing this about.
What is long-term care insurance for?
Anyone who is in need of care and can no longer take care of themselves needs support from professional nursing staff, relatives or other voluntary carers. Social care insurance supports people in need of care and their carers financially. This assistance is called care benefits.
Since everyone may need care at some point in their life – be it in old age, after an accident or because of an illness or disability – long-term care insurance is obligatory. That means that all people residing in Germany have to have long-term care insurance.
As with health insurance, there is a statutory long-term care insurance and a private long-term care insurance. However, the benefits are equivalent in both types of insurance: statutory and private long-term care insurance policyholders are entitled to the same benefits at the same rate. Only with non-cash benefits do private insurance policyholders receive reimbursement of costs. That means they have to make advance payments first.
Social care insurance is part of statutory social insurance policies that financially support people in various areas of life when they need support. The essential regulations are laid out in the long-term care insurance act, the Eleventh Book of the German Social Code (SGB XI).
Reasons for care insurance
People can become in need of care at any age. However, the likelihood increases with age. Specifically, this means that in the age group from 60 to 65 around 2 percent, from 80 to 85 around 23 percent, from 85 to 90 around 45 percent, and over 90 as much as 71 percent of people are in need of care.
Long-term care insurance was introduced in 1995 because the age and family structure in Germany had changed so much that coverage of people in need of care and carers was needed.
The average age of the population has been increasing for many years – and with it the number of people in need of care. Also, there are no or few children in many families these days. In adulthood, they may often not be able to look after their parents or other family members in need of care very easily due to work or job mobility.
Long-term care insurance is also intended to reduce dependence on social assistance. Previously, this was the only help available if people in need of care could not afford to pay for it. This was increasingly the case due to the high costs of care. As a result, the local authorities were increasingly burdened as providers of social assistance.
Who is entitled to care benefits?
Only people who are in need of care as defined in the long-term care insurance act receive care benefits. Policyholders must therefore make an application for care benefits.
People are deemed to be in need of care if they are likely to be dependent on nursing support in certain areas of day-to-day living because their independence or their physical or mental abilities have been impaired for health reasons. It is expected that the person will have had these impairments for at least 6 months and for them to be of a certain severity.
A care assessment will determine whether there is a need for care and how high it is. The care grade determines which benefits can be claimed. The gradations range from mild impairments at care grade 1 to the most severe impairments at care grade 5.
A further criterion is for the policyholder to have paid into the care fund for at least two years within the last ten years or to have had family insurance. If that is not the case, social assistance can also step in under certain circumstances.
Who is entitled to care benefits?
The following video explains when a person has a long-term care need and is therefore entitled to care benefits.
This and other videos can also be found on YouTubeWatch now
What benefits does long-term care insurance cover?
Long-term care insurance provides benefits both for care at home or in residential care homes by relatives or nursing services and for care in an inpatient facility by nursing staff.
Benefits can include:
- Non-cash benefit: budget that is available for using a home care service or a home care support service
- Care allowance: amount of money provided if the care is undertaken by relatives or voluntary carers
- Combination benefit: combination of cash and non-cash benefits
- Respite care: budget for engaging a nursing service or another person for home care when the caregiver is unavailable
- Short-term respite care: budget for accommodating the person in need of care for a short time in a residential facility when care at home is temporarily unavailable
- Therapeutic appliances and grants to adapt the living environment to special needs
- An additional budget for people in need of care who live together in supported outpatient group homes
- Amount for using and supporting the use of digital care applications (DiPA) in home care
- Nursing and care in a day care facility (day or night care)
- Nursing and care in a residential care facility
- Social security benefits for caring relatives, such as for example social security grants and compensation for lost salary (earnings replacement benefits)
- Care courses for caring relatives and voluntary carers
- Care advice for people in need of care and caring relatives
- Entitlement to use part of the budget for non-cash benefits for offers of support in everyday life
- Additional relief: budget for relieving caring relatives
Who can claim which care insurance benefits depends on a range of factors:
- Where does the person in need of care receive it?
- Who provides care to the person in need of care?
- How high is the care grade?
Details on care benefits are also available at consumer advisory centers.
Partial costs insurance
Long-term care insurance is a partial costs insurance. That means that every benefit contains a certain lump sum that does not cover the actual care costs. How high this amount is depends on the care grade.
Partial benefit insurance and part comprehensive cover are also often spoken of in this context.
The additional care costs have to be borne by the person in need of care or their relatives themselves.
In the case of benefits such as short-term respite care or accommodation in an inpatient care facility, accommodation, catering and investment costs, for example, must be paid for out of their own pocket.
So that the remaining costs are also covered, it is possible to take out private supplementary care insurance, for example, daily allowance insurance or pay a supplementary tariff for care costs. The government funds certain insurance products through a subsidy of 60 euros per year.
The consumer advisory centers provide information about what should be taken into account when purchasing private supplementary care insurance.
Help with care costs
If your own income and assets are not sufficient to cover the care costs, or if the person in need of care does not have health and care insurance, assistance from the social services department can be requested.
What rights and obligations do people in need of care have?
What form the benefits and assistance should take is also regulated by law. For example, the following rights are important:
- the right to self-determination and independence
- the right to express individual wishes and make individual choices
- the priority of care at home
Specifically, this means that people in need of care have the right to live as independently as possible with as much human dignity as possible – even if they need a lot of help and support in basic areas of everyday life.
All benefits, support and assistance therefore need to be structured or organized in such a way as to ensure that the abilities and the independence of the person in need of care are maintained or regained. People in need of care need to be involved in planning their care, as far as it is possible for them. They must not be patronized or have their basic rights curtailed, such as the right to respect, privacy, liberty and security.
People in need of care can also decide themselves, within a certain framework, how, where and from whom they want to receive care. For example, they can choose whether they want to receive care at home or in a facility, whether they are to be cared for by professional nurses or would prefer people from their circle of relatives, friends or neighbors. They can also choose between different care services or facilities.
How they wish the support to be structured or organized must also be considered. This includes the desire for same-sex and culturally sensitive care, and the consideration of religious needs. The desire for a person to be cared for in their own four walls has priority over inpatient care.
The wishes must be implemented if they are appropriate, economical and feasible.
Charter for People in Need of Long-term Care
The rights of people in need of care are also made up of other laws and regulations, such as the Basic Law and the Guardianship Law.
The Charter for People in Need of Long-term Care summarizes these rights, explains them using specific examples and also mentions possible limitations. The Charter was developed by representatives from all areas of care.
If people in need of care receive a care allowance and are only cared for by relatives, they are obliged to take regular care advice. Otherwise, the care allowance may be reduced.
This advisory service is intended to ensure the quality of home care. But it is also very helpful because it gives individual support to carers in their often demanding everyday life: professional nursing staff give tips and instructions on practical topics, such as back-friendly lifting, administration of medication and the care and support of people with dementia. But information on further support options and care courses for relatives can also be part of the advice.
Good to know: The person in need of care can now request every other consultation to take place via video conference. This arrangement is time limited until June 30, 2024.
How can a person get long-term care insurance?
In principle, all people in Germany have care insurance in the same way they have health insurance: statutory health insurance policyholders (SHI) are automatically insured with social care insurance (SCI). People with private health insurance must also get obligatory private care insurance (PPV).
As with health insurance, there are different ways of a person getting insured in the event that they need care.
Statutory health insurance
All people who have statutory health insurance (SHI) automatically have social care insurance (SCI), too – and always automatically with the health insurance company with which they also have health insurance. The contribution to the social care insurance is based on income and is borne by employees and employers.
Family members can be included in the insurance via a family member who is a regular member of a health and care insurance fund. They do not pay their own contributions to the long-term care insurance.
The criteria for family insurance include the regular monthly total income of the co-insured person not exceeding 485 euros per month. For people employed in “minijobs” (marginal employment), the income threshold is 520 euros per month (figures valid as at January 2023). The income limit changes at the start of every year. All co-insured people must also have their residence and habitual abode in Germany.
The following people can be co-insured via family insurance:
- children entitled to education
- children of children with family insurance
- a married couple
- civil partners
People who have voluntarily taken statutory health insurance must also pay contributions for social care insurance.
They have the option instead of taking out private long-term care insurance – but only within the first three months of purchasing the voluntary insurance. This exemption from the obligation to obtain insurance cannot be undone.
Private health insurance
People with private health insurance must take out obligatory private care insurance (OPCI) with an insurance company of their choice. Every family member must have their own contract drawn up.
The insurance premium is based on individual health risk, among other things. Employees with private insurance also receive a contribution grant from their employer.
Obligatory insurance for other groups
People who, for example, are covered by the Federal Health Care Act in the event of illness or who are members of a community of solidarity must also have social care insurance.
Benefits without health and care insurance
People who do not have health or care insurance may receive care benefits from the social services department.
The Federal Ministry of Health provides more information on financing long-term care insurance as well as information on contributions, additional premiums and upper earnings limits.
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Reviewed by the Consumer Advice Center of North Rhine Westphalia (Verbraucherzentrale Nordrhein-Westfalen e.V. – VZ NRW)As at: