Pflegeversicherung: Germany’s long-term care insurance explained

What Pflegeversicherung covers

Pflegeversicherung covers the cost of help with everyday life, not medical treatment. It applies to nearly 5.7 million people, according to Destatis, the Federal Statistical Office, which counted that many as care-dependent within the meaning of SGB XI in December 2023, up from around 5.0 million two years earlier. Treatment itself is what your health insurance is for. Care insurance starts where the question is no longer “what is the diagnosis” but “can this person wash, dress, eat and move around without help”.

That distinction has a consequence worth absorbing early. Someone can be seriously ill and still not qualify, and someone with a stable long-term condition can qualify for years.

The scheme is written into the Eleventh Book of the Social Code, SGB XI, which is why almost every figure on this page carries a section number. Those numbers matter more than any provider brochure. The amounts are set by law, they are identical at every Pflegekasse, and no insurer can offer you a better statutory rate.

Who pays, and how much

The rate is 3.6% of the income on which contributions are calculated, and 4.2% if you have no children. The Federal Ministry of Health confirms both figures and dates them to 1 January 2025. There is a wrinkle worth knowing: section 55 (1) SGB XI still names 3.4% as the statutory rate, because the government is allowed to adjust it by ordinance rather than by amending the law each time. The 3.6% you actually pay comes from such an ordinance.

Employees never carry the whole rate. In most federal states the split leaves 1.8% with the employee who has a child and 2.4% with the childless employee, while the employer pays 1.8%. Saxony works differently for historical reasons, with 2.3% on the employee and 1.3% on the employer. For example, on a gross salary of 3,000 euros a month outside Saxony, an employee with one child carries 1.8% of that, so 54 euros, while a childless employee carries 2.4%, so 72 euros. If you read a headline saying contributions rose by a certain amount, halve it before applying it to your own payslip.

The surcharge for members without children is 0.6 percentage points and starts after the month in which you turn 23, under section 55 (3) SGB XI. Parents get the opposite treatment. The same provision reduces the rate by 0.25 percentage points for each child from the second to the fifth, and the reduction lasts until the month in which that child turns 25. A parent of three children under 25 therefore pays 3.10% rather than 3.6.

Contributions are only charged on income up to the contribution assessment ceiling, which section 55 (2) SGB XI ties to the figure used in statutory health insurance. Earnings above that line do not increase what you pay.

The five care grades

A Pflegegrad is a number from 1 to 5 that describes how much independence a person has lost. It is not a diagnosis and not an age bracket. Section 15 SGB XI requires the Medical Service to use a standard assessment instrument with six modules, and those modules mirror the six areas listed in section 14 (2). An assessor visits, scores each area, and the total decides the grade.

Two things surprise people about this system. The first is how much weight the cognitive and behavioural modules carry, which is why dementia can produce a high grade in someone who is physically mobile. The second is that a grade can be granted for a fixed period. Section 33 (1) allows the Pflegekasse to limit the award when the Medical Service expects the impairment to improve, for a maximum of three years in total, and the Pflegekasse has to review it before the deadline runs out.

What the law pays out

At home you choose between money and services. Pflegegeld is a cash payment to the person needing care, who then organises help themselves, typically through relatives, and no receipts are required. Pflegesachleistung is a budget spent with a registered care service, which bills the Pflegekasse directly. The two can be combined proportionally.

Amounts under sections 36 and 37 SGB XI. Both benefits require Pflegegrad 2 or higher.

Pflegegrad 1 is not empty, it is just different. What it gives you is the Entlastungsbetrag, a relief amount of up to 131 euros a month under section 45b SGB XI, which everyone receiving care at home can claim regardless of grade. The money is earmarked. You can spend it on day or night care, short-term care, services from an outpatient care provider, or recognised everyday support offers, and unused amounts can be carried into the following half-year.

In a nursing home the Pflegekasse pays a flat monthly amount towards the care costs under section 43 (2) SGB XI:

Amounts under section 43 (2) and (3) SGB XI.

How to apply

Care benefits are paid from the beginning of the month in which your application reaches the Pflegekasse, under section 33 (1) SGB XI. That single rule decides how much money is on the table, so apply the moment the need becomes clear rather than once the paperwork is tidy. If care needs started in March and you apply in June, March to May are gone. A phone call or a short letter is enough to set the date; the detail can follow.

Your Pflegekasse sits at your health insurer, so the application goes to the same organisation you already pay. The Medical Service then arranges an assessment, usually at home, covering mobility, cognitive and communication skills, behaviour and psychological problems, self-care, dealing with illness and treatment, and everyday life and social contact. Keeping a short diary of what genuinely needs help on an ordinary day, including nights, tends to describe the situation better than a single visit can.

One condition catches people out. Section 33 (2) SGB XI requires at least two years of insurance within the ten years before the application, either as a member or as a family member covered under section 25. Children are treated generously here: the requirement counts as met for an insured child if one parent meets it.

If you are privately insured

Private long-term care insurance is a legal duty, not an option. Section 23 (1) SGB XI requires anyone holding private health insurance in Germany to take out a matching private care contract with the same company and to keep it running. Private cover does not release you from care insurance; it moves you into a parallel one. The contract must provide benefits equivalent in type and scope to the statutory ones, and the duty extends to family members who would have been covered by family insurance in the statutory system.

One structural difference is worth planning around. In the private system, benefits in kind are replaced by cash reimbursement, so you tend to pay the care service first and claim afterwards. If you are weighing up private cover in general, our guide to private health insurance in Germany covers how the two contracts sit together.

The part you pay yourself

Statutory care insurance is a partial-cost scheme, and that is a deliberate design choice rather than a funding failure. The amounts in section 43 (2) are fixed sums towards the care portion of a nursing home bill. Accommodation, board and the home’s investment costs are charged separately and stay with the resident.

The law does soften this over time. Section 43c SGB XI grants a supplement that covers a growing share of the resident’s own contribution to the care costs, and it rises with the length of stay:

• 15% of the personal share during the first twelve months of inpatient care
• 30% of the personal share after more than twelve months
• 50% of the personal share after more than twenty-four months
• 75% of the personal share after more than thirty-six months

The burden is therefore heaviest at the start, which is the opposite of what most people assume when they first read about the care gap.

Private top-up policies exist to cover the remaining share. The state-subsidised variant, known as Pflege-Bahr, is regulated in sections 126 and 127 SGB XI: pay at least 10 euros a month into a qualifying contract and the state adds 5 euros. In exchange the insurer must waive health screening, may not exclude pre-existing conditions or add risk surcharges, and has to pay at least 600 euros a month at Pflegegrad 5. Unsubsidised policies are underwritten normally and can be broader. What a specific contract costs depends on age and health, so the only reliable figure is a personal quote.

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Arriving in or leaving Germany

Two rules decide what a move across the border does to your cover:

• Arriving: contributions start with your first payslip, but benefits require two years of insurance within the previous ten under section 33 (2) SGB XI.
• Switching systems: uninterrupted time in private long-term care insurance counts towards those two years under section 33 (3) SGB XI.

For most people arriving in mid-career the qualifying period is a theoretical concern, since two years pass before anyone thinks about care. For someone arriving with an existing care need in the family, it is the first thing to check.

Care needs are also not the only risk worth understanding before retirement age. Loss of earning capacity through illness is statistically the more likely event during a working life, which is covered separately by a Berufsunfähigkeitsversicherung, and retirement income has its own rules under German pension insurance.

Frequently asked questions about Pflegeversicherung

More guides

• Private health insurance in GermanyWho may switch, what it costs and why the care contract follows the health contract.
• Insurance overviewAll insurance guides we publish in English, including income and health cover.
• German pension insuranceHow retirement income is built up and what it means for later care costs.
• All insurance guidesAn overview of the German insurance lines and a sensible order to tackle them in.