With a care level (Pflegegrad), you receive benefits from long-term care insurance – from the care allowance (Pflegegeld) to care aids for care at home. This is how you apply, how the assessment works and which deadlines your long-term care insurance fund (Pflegekasse) must meet.
In Germany, long-term care insurance is a separate branch of social insurance that pays benefits to people who need care.
Key points
- You apply to the long-term care insurance fund at your statutory health insurance fund (Krankenkasse) – a phone call is enough. If you have private insurance, contact your insurance company.
- Benefits are paid at the earliest from the month in which your application is received. It does not pay to put it off.
- The assessment looks at how independently you manage everyday life. Help with incontinence, a catheter or an ostomy expressly counts.
- The long-term care insurance fund must decide no later than 25 working days after your application. Otherwise, it usually pays 70 euros for each week or part of a week.
- Even care level 1 brings benefits, such as consumable care aids worth up to 42 euros a month.
Who counts as being in need of care?
You are in need of care if, because of health problems, you depend on help from others in everyday life – probably for at least six months (§ 14 SGB XI, Social Code Book XI). So what matters is not the diagnosis, but what you can still manage in everyday life without support.
Five steps to a care level
1. Submit the application
The long-term care insurance fund at your health insurance fund is responsible; a phone call is enough. Relatives or friends can also apply if you authorise them. If you have private insurance, contact your insurance company; there, the assessment is carried out by Medicproof.
The date is what counts: if the application is only made in a later month, benefits start from that month – there is nothing for earlier months (§ 33(1) SGB XI). You must also have had long-term care insurance for at least two years within the last ten years, which can include cover through family insurance. After your application, the long-term care insurance fund offers free care counselling within two weeks, at your home if you wish (§ 7b SGB XI).
2. The long-term care insurance fund commissions the assessment
Within three working days, the long-term care insurance fund passes the request on to the Medical Service (Medizinischer Dienst) or to independent assessors. If no assessment has taken place 20 working days after the application, it must offer you a choice of at least three independent assessors, provided it is responsible for the delay (§ 18 SGB XI).
3. The appointment at your home
The appointment is announced in advance, with a time window of no more than two hours. A nurse or a doctor comes to see you; the conversation lasts up to an hour. The first assessment usually takes place in your home. Later assessments can also be carried out by phone or video with your consent; if you would like a home visit, this takes priority (§ 142a SGB XI).
If it is urgent, shorter deadlines apply: in hospital, in rehabilitation or in a hospice, in certain cases the fifth working day; at home, ten working days if relatives are taking care leave (Pflegezeit) or family care leave (Familienpflegezeit) (§ 18a SGB XI).
4. The decision
No later than 25 working days after receiving the application, the long-term care insurance fund must make a decision in writing; the assessment report is enclosed unless you object (§ 18c SGB XI). If the fund is late, it pays you 70 euros for each week or part of a week – unless it is not responsible for the delay or the person already lives full-time in a care home with at least care level 2. This also applies to private long-term care insurance.
5. Do you disagree? Lodge an objection
You can lodge an objection (Widerspruch) against the decision within one month (§ 84 of the Social Courts Act, Sozialgerichtsgesetz). A decision sent by post is usually deemed to have been notified on the fourth day after posting; the deadline runs from then (§ 37 SGB X). Check the assessment report point by point against your everyday life. More in the article Lodging an objection (in German).
What the assessment looks at
Six areas, called modules, are assessed. They carry different weights (§ 15 SGB XI):
| Area | For example | Weight |
|---|---|---|
| Mobility | turning over in bed, moving from bed to chair, walking around the home, climbing stairs | 10 per cent |
| Cognitive and communication skills | finding your way around, remembering, everyday decisions | 15 per cent together with the next area – the higher value counts |
| Behaviour and psychological problems | restlessness at night, anxiety, resisting care | see above |
| Self-care | washing, dressing, eating, using the toilet, incontinence, catheter, ostomy | 40 per cent |
| Coping with demands arising from illness and treatment | medicines, dressings, ostomy care, intermittent catheterisation, visits to the doctor | 20 per cent |
| Everyday life and social contacts | daily routine, sleeping, keeping in touch with people | 15 per cent |
Incontinence, catheters and ostomies are included
This is important for many of the people PharmaCare supplies: the law expressly mentions excretion and ostomies. Self-care includes, among other things:
“… using a toilet or commode chair, coping with the consequences of urinary incontinence and managing an indwelling catheter and urostomy, coping with the consequences of faecal incontinence and managing an ostomy …”
§ 14(2) No. 4 SGB XI (our translation)
Under the demands arising from illness, ostomy care, regular intermittent catheterisation and methods of bowel evacuation also count (§ 14(2) No. 5 SGB XI). So describe exactly who changes the pad or bag, how often, and whether this is also needed at night.
How points become a care level
The weighted points add up to a number between 0 and 100 (§ 15(3) SGB XI):
| Care level | Total points | Impairment of independence |
|---|---|---|
| 1 | 12.5 to under 27 | minor |
| 2 | 27 to under 47.5 | considerable |
| 3 | 47.5 to under 70 | severe |
| 4 | 70 to under 90 | most severe |
| 5 | 90 to 100 | most severe, with special requirements for care |
The government bill (Gesetzentwurf der Bundesregierung) adopted by the Federal Cabinet on 30 September 2026 provides for higher thresholds from 1 January 2027, for example from 15 points for care level 1. The law in force at the time of the application is to be decisive; anyone who already has a care level should not lose it for this reason alone. The Bundestag and Bundesrat have not yet decided. More in the article on the planned care reform (in German).
Well prepared for the assessment
- Make notes: What is difficult, what do you need help with, what can you do on your own? If you have kept a care diary, have it ready.
- Have documents ready: doctors’ and hospital reports, your medication plan and, if a nursing service visits you, the care records. You do not need to request any missing reports specially.
- Ask someone you trust to be there: ideally the person who mainly cares for you. With dementia, the assessor first talks to the person in need of care and then to the others present.
- Mention medical aids: if the assessor recommends medical aids (Hilfsmittel) or care aids (Pflegehilfsmittel) and you agree, this already counts as an application (§ 18b(3) SGB XI).
What even care level 1 brings
Even the lowest care level is worthwhile, with benefits including (§ 28a SGB XI):
- care counselling and a counselling visit at home once every six months
- consumable care aids worth up to 42 euros a month – see Care package (in German)
- grants for adapting your home, up to 4,180 euros per measure
- the relief amount (Entlastungsbetrag) of up to 131 euros a month
- free care courses for relatives
Frequently asked questions
Do I need a doctor’s certificate to apply?
No. The application goes directly to the long-term care insurance fund. Existing doctors’ or hospital reports help with the assessment, but you do not need to obtain them specially.
Does the procedure cost anything?
No. No fees or expenses are charged for the procedure at the long-term care insurance fund (§ 64 SGB X). Care counselling is also free of charge.
What if the condition gets worse?
Then you apply for a higher care level. The long-term care insurance fund arranges a new assessment – possibly also by phone or video, if you agree.
Can a care level be granted for a limited period?
Yes, if the Medical Service expects an improvement – for no more than three years in total. Before it expires, the long-term care insurance fund must check in good time how things will continue (§ 33(1) SGB XI).
How PharmaCare helps
If you have a care level, PharmaCare supplies consumable care aids in monthly packages; the long-term care insurance fund pays up to 42 euros a month. You will find the application forms under forms and free envelope (in German) – we also supply people with private insurance.
For medical aids for incontinence or an ostomy, send us your prescription (Rezept): we arrange approval with your health insurance fund, advise you on suitable products and deliver discreetly to your home. You can reach our medical specialists free of charge, Monday to Friday from 8 am to 5 pm, also via WhatsApp and Signal.
0800 74 222 73WhatsAppSignalSources
- § 14, § 15, § 28a and § 33 SGB XI – Need for care, care levels, benefits with care level 1, conditions for benefits, Federal Ministry of Justice (in German)
- § 7b, § 18, § 18a, § 18b, § 18c and § 142a SGB XI – Counselling, assessment, decision and deadlines, Federal Ministry of Justice (in German)
- § 84 SGG, § 37 SGB X and § 64 SGB X – Deadline for objections, notification, no charges, Federal Ministry of Justice (in German)
- How to apply for benefits, Federal Ministry of Health (in German)
- Information on the care assessment and checklist, Medical Service (in German)
- Assessment guidelines (Begutachtungs-Richtlinien), Medizinischer Dienst Bund, in force since 26 September 2024 (in German)
- Care Reorganisation Act (Pflegeneuordnungsgesetz), government bill of 30 September 2026 and progress of the procedure, Federal Ministry of Health (in German)
Note: This article gives a general overview and does not replace medical or legal advice. Your health insurance fund or long-term care insurance decides on your entitlement. The text was written with the help of artificial intelligence; all information has been checked against the sources listed. As of: 1 October 2026.