In Germany, various social insurance schemes ensure that people are covered in an emergency or in difficult times. An important pillar is the care insurance. But what is meant by long-term care insurance and why is long-term care insurance necessary? Through the regularly paid contribution, this statutory insurance secures the risk if you one day need nursing care. In this situation, long-term care insurance will pay part of the costs incurred for your care and assistance, up to certain maximum limits. We provide an overview of long-term care insurance benefits and answer the most frequently asked questions about long-term care insurance.
Statutory and private long-term care insurance
The statutory nursing care insurance, together with health, accident, pension and unemployment insurance, is one of the so-called social insurances in Germany. These social insurances serve to provide care and protection for serious threats to existence – i.e., for example, prolonged unemployment or long and severe illness. All members of the social community pay into the insurance system and jointly finance the benefits paid out to recipients.
The aim of long-term care insurance is to cover the risk of needing long-term care. Those who are in need of assistance and can no longer manage their daily lives on their own receive benefits from long-term care insurance to (at least partially) offset the associated costs. Decisive for the benefits of long-term care insurance are..
- Duration of the need for care
- Type of care and assistance required
- Care degree
Since the benefits of long-term care insurance are seldom sufficient to cover the entire cost of care, you can take out supplementary insurance with private insurance companies. This private nursing care insurance covers the gap between what the statutory nursing care insurance pays and the actual costs.
You pay in a monthly amount and receive benefits from private long-term care insurance to cover the costs incurred in the event of a need for care. However, such private supplementary long-term care insurance can have quite high premiums, which in turn not everyone can afford.
Long-term care insurance: compulsory for all insured persons
In Germany, long-term care insurance is regarded as the fifth pillar of social insurance and is playing an increasingly important role in this context. It is therefore a mistake and an incorrect assessment to place long-term care insurance behind unemployment insurance or other parts of social insurance and to regard it as less important.
For several decades now, there has been a clear trend: people are getting older and older, life expectancy is rising, and demographic change is still in full swing. Already, almost one in four Germans is over 60, and estimates and forecasts predict that by 2040, more than 21 million people will be over 67 – and by 2060, one in three Germans will be over 65.
Since 1995, long-term care insurance has been an independent branch of the social insurance system. There is a comprehensive obligation to insure, which is carried out via the health insurers. Anyone with statutory health insurance is automatically included in long-term care insurance as well. For privately insured persons, an additional private nursing care insurance must be taken out. Long-term care insurance is therefore a duty for all insured persons.
Long-term care insurance as protection for relatives
While the higher life expectancy is basically good and speaks for a good medical system and other positive aspects, it also means: More and more people are in need of care – outpatient as well as inpatient – and thus require benefits from long-term care insurance.
As more and more people reach an advanced age at which the risk of needing long-term care is particularly high, long-term care insurance is needed to support those affected and their families.
In particular, family caregivers used to be left alone with the costs. In addition to the physical and psychological burden, the financial burden was added for them. The nursing care insurance cushions this at least to a large extent. This applies in particular to cases where relatives have to temporarily take a break from their job due to time constraints.
Long-term care insurance carrier: advice from the health insurance fund
The legislator has designated the statutory health insurance funds (AOK, Ersatzkassen, Betriebskrankenkassen or similar) as the providers of long-term care insurance.
The reason was that these insurers already had the structures and knowledge of the subject, and setting up separate long-term care insurers would have cost time, tax money and premiums unnecessarily.
This means that your health insurance company is the point of contact for your questions on the subject of care and care insurance. The employees will advise you in detail as soon as care is necessary.
Benefits of long-term care insurance: Table
Those who receive benefits from long-term care insurance usually receive a combination of various measures and options, the form of which initially depends on the exact type of care required. For example, some of the costs of inpatient care may be covered by long-term care insurance, or – as is the case for the majority of recipients – costs for outpatient care may be covered.
Confusion arises again and again with the terminology. It is therefore important to differentiate precisely between care allowance and care benefits in kind:
- Care allowance
If you do not use a professional care service, but are cared for by relatives, friends or volunteers, for example, you can apply for the so-called care allowance. The amount of the claim depends on the care degree – how exactly this turns out you can see in the table below. For the Important prerequisite for the care allowance is that home care is ensured in a suitable manner. This can be checked by an expert and monitored by regular quality assurance visits.
- Care benefits in kind
In the case of outpatient care at home by a nursing service, the nursing care insurance covers so-called care benefits in kind. Here, too, the amount depends on the degree of care determined for the insured person.
In practice, combination benefits of care allowance and care benefits in kind are often used. This is the case, for example, if the daily body care is carried out by an outpatient care service, but other parts of the care and support can be taken over by relatives. The amount of the benefits is shown in the following table:
- Care degree 1: 0 Euro care allowance and 0 Euro care benefits in kind
- Care level 2: 316 euros care allowance and 689 euros care benefits in kind (from 2022, this amount increases to 724 euros), 770 euros in inpatient care
- Care degree 3: 545 Euro care allowance and 1.298 euros care benefits in kind (from 2022, this amount will increase to 1.363 Euro), 1.262 euros for inpatient care
- Care level 4: 728 euros care allowance and 1.612 euros of care benefits in kind (from 2022, this amount will increase to 1.693 Euro), 1.775 euros for inpatient care
- Care degree 5: 901 Euro care allowance and 1.995 euros in care benefits (from 2022, this amount will increase to 2.095 Euro), 2.005 in inpatient care
Who receives the long-term care insurance benefit?
In the course of the second Care Strengthening Act (Pflegestarkungsgesetz), at the beginning of 2017 the care levels that had applied until then were replaced by so-called care degrees. These indicate to what extent a need for care exists and thus also determine how high the benefits of long-term care insurance will be.
As you can see from the table for the benefits of long-term care insurance, there is no entitlement to care allowance or care benefits in kind in the case of a classification in care degree 1, since there are only slight restrictions on independence. However, you can already receive a so-called relief amount of 125 euros per month, which you can use, for example, for a home help. In addition, you are entitled to consulting services.
In the case of a combination of care allowance and care benefit in kind, the maximum entitlement in each case is taken into account on a pro rata basis. That sounds more complicated than it actually is, therefore a simple example: "With care degree 3 you have requirement on 545 euro care money or 1.298 euros Care benefits in kind. An outpatient care service is commissioned for daily personal care, with the costs amounting to 649 euros. This is exactly 50 percent of the maximum entitlement for care benefits in kind – you can receive the remaining 50 percent as care allowance for private care. In the example, this makes 272.50 euros (50 percent of the 545 euros maximum care allowance)."
The person in need of care is always entitled to the benefits and must apply for them on his or her behalf. Of course, the relatives can help with the application process.
Apply for care degree: When do you get care degree 1??
Before you receive the benefits of long-term care insurance, you must apply for them at the health insurance company. You should submit this written application as soon as possible, as soon as it is foreseeable that the need for care will exist for a longer period of time. Long-term care insurance benefits can be received from the time you file your claim.
After the application is received by the health insurance company, an expert from the Medical Service of the Health Insurance Companies (MDK) will classify you according to certain criteria for independence. This takes place through a personal visit to the home, where the assessor can get a very precise picture of the situation.
For example, persons who are only slightly impaired in their independence are classified in care degree 1. The assessor then passes on his assessment to the health insurance company, which in turn determines the final care level. With this you can then receive the respective benefits of long-term care insurance.
If, in your opinion, the care degree classification is too low or if the application or individual benefits were rejected, you can file a written objection within four weeks.
How the need for care is measured?
With the introduction of the new degrees of care, new and clear criteria were also defined that are taken into account in the classification by the Medical Services of the health insurance funds. Physical, mental and psychological limitations are to be recorded and taken into account. The focus is on determining the independence of the insured person in order to be able to assess the extent to which he or she is dependent on care and assistance.
According to paragraph 14 of the Eleventh Social Code (SGB XI), six criteria are assessed in different weightings for determining the degree of care:
This includes the ability to move around independently in one's own living area. Climbing stairs, changing positions in bed and maintaining a stable sitting position are also part of mobility.
- Cognitive and communicative abilities
For example, a person's orientation in time and place, memory of events, making everyday decisions and recognizing hazards or risks are all important. The ability to communicate clearly and to recognize people is also included in this point.
- Behavioral and psychological problems
These can be motor disorders, for example, but aggressive behavior, great anxiety, depression or a lack of social behavior are also considered to be such problem situations.
The most important point in the assessment is the ability to self-care. This includes independent personal hygiene, dressing and undressing, providing food and drink, and using the restroom.
- Coping with the demands of illness
Above all, it is a matter of taking the necessary medication correctly and dealing with injections, measuring devices or other aids. Independent dressing changes or adherence to a diet or other therapy-related behaviors are also considered.
- Organization of everyday life and social contacts
Can the insured person manage his or her daily life alone? This involves maintaining the daily rhythm and maintaining social contacts.
Relief amount: Who may provide services according to 45b SGB XI?
In addition to the care benefits, there is the already mentioned relief amount for those in need of minor care.
Paragraph 45b of the Eleventh Social Code states: "Persons in need of care in the home are entitled to a relief amount of up to 125 euros per month." In order to have a requirement on this Entlastungsbetrag, consequently not compellingly a claim of a professional care service is necessary. This paragraph is intended to relieve the burden on family caregivers or to ensure that people in need of care can be supported in the home.
The payment is therefore not linked to any specific conditions regarding education or profession, but can be used by the care recipient at his or her own discretion.
When does the care insurance start to pay?
Long-term care insurance does not take effect immediately if you are dependent on care or support in everyday life for a short period of time. Initially, this is the responsibility of your normal health insurance fund.
Only if the need for care is expected to last six months or longer does this fall within the scope of long-term care insurance.
What happens if the benefits of long-term care insurance are not enough??
Long-term care insurance provides cover, but only bears part of the actual costs. The rest must continue to contribute the insured person himself – and this is not an amount to be underestimated.
If you are unable to cover the shortfall in nursing care in any other way, you have the option of receiving what is known as assistance with nursing care as a social benefit. The state uses this to compensate those in need of care who are unable to finance the costs of care either themselves or through their relatives. In January 2020, the Relatives Relief Act went into effect, under which children in the course of parental support are not eligible for contributions until their annual income exceeds 100.000 euros gross to cover the costs.
Nursing care insurance contribution rate
How much is the statutory long-term care insurance? The contribution to long-term care insurance is calculated according to the taxable portion of your income. Both you as an employee and your employer pay contributions in equal shares. Currently, long-term care insurance contributions for insured persons with at least one child are 3.05 percent – so you and the employer each pay 1.525 percent.
Childless employees pay a surcharge of 0.25 percent for long-term care insurance and pay contributions of 1.775 percent for long-term care insurance. The employer's contribution remains unaffected at 1.525 percent. Employees without children thus pay a total of 3.3 percent into the long-term care insurance scheme.
As is usual in social insurance, there is a maximum contribution. This amounts to 147.54 euros per month in long-term care insurance. High-earning employees are therefore given preference above a certain income level.
What is deducted from the pension each month?
Contribution payments don't just affect the working population. Pensioners must also pay their contributions to long-term care insurance – even if they are already receiving benefits.
And not only that: Since there is no employer's contribution to the pension, pensioners have to pay the full contribution rate for long-term care insurance. That's 3.05 percent (or 3.3 percent for those without children) of the pension. Only former civil servants who are entitled to assistance pay the same contribution as in their working days.