Who pays for the care?

It is mandatory for every person in Germany to have healthcare and nursing care insurance. But how do I know for which areas the health insurance company is responsible and which services the nursing care insurance provider covers?

The health insurance and nursing care insurance providers have different responsibilities: Health insurance ensures that the health of the insured persons is maintained or restored. Nursing care insurance helps people in need of care. For people in need and their relatives, it is often difficult to distinguish between the two: We will gladly advise you on this in the Berlin Pflegestützpunkt locations.

Duration matters

Some services overlap: body care and nutrition, for instance. Whether the health insurance or nursing care insurance provider covers the costs depends on how long you or your relative need help dealing with the illness-related burdens. If the need for long-term care is only temporary, the health insurance provider covers the medically necessary services. If long-term care is needed for longer than six months, it becomes the responsibility of the nursing care insurance provider. Key facts: you cannot receive double benefits.

A woman in a wheelchair and a man receive consultation by a Pflegestützpunkt member.

Level of care or medical prescription 

You have to file an application to get money from the nursing care insurance. If you or your relative receive Care Level 2 or higher and hire a licensed nursing service, the nursing care insurance pays the benefits up to the maximum amount. This is called benefit-in-kind or non-cash benefit. If the care is provided by a relative or neighbour, you will receive a cash payment instead. This is called care allowance. To receive health insurance benefits, you need a doctor’s prescription.

Differences between assistive devices

Which costs the health insurance or nursing care insurance providers will cover depends largely on the type of assistive devices required.

1 – Home Care

Anyone needing nursing care does not necessarily have to receive it in a hospital setting, for example, in a clinic. In many cases, these treatments can also be received in the home environment via outpatient care services. The legal basis...

Read more Fact sheet no. 1 (193 KB)
2 – Criteria for need for care

People who are limited in their abilities and independence because of a physical, mental or emotional illness are considered to be in need of care. If the need for care is likely to last longer than six months, they can...

Read more Fact sheet no. 2 (337 KB)
4 – Offers for support in everyday life

The offers for support in everyday life is meant to provide support and burden relief to caregiving relatives and other related caregivers. This enables people who are in need of assistance to be more independent and self-reliant in everyday life....

Read more Fact sheet no. 4 (115 KB)
7 – Co payments for health insurance services

The law requires co-payment for certain services of the health schemes from the insured person: Health scheme serviceCo payment amount Medicines, dressing materials, aids, travel costs, socio therapy, domestic help10% of the price, a minimum of 5 €, a maximum...

Read more Fact sheet no. 7 (212 KB)
8 – Respite Care –“ Short-term Care

Domestic care when the care provider is unavailable (respite care) When a private caregiver is unavailable due to holidays, sickness or for other reasons prevented to perform care, the nursing care insurance covers the costs of the required substitute care...

Read more Fact sheet no. 8 (209 KB)
9 – Outpatient care

People who are in need of care have the option to be cared for outside of the family for part of the day. In this case, day-patient care can be provided. The right to day-patient care is not limited in...

Read more Fact sheet no. 9 (175 KB)
16 – Home Environment Adaptation

Aside from obtaining aids, adapting your home can involve structural reconfigurations such as removal of thresholds, making the bathroom and kitchen handicap friendly, or elevating the balcony. Even small changes can make life much easier in your own home, help...

Read more Fact sheet no. 16 (187 KB)
17 – For the use of certain care aids

For the use of certain care aids intended for general hygiene, the protection of caregivers and which simplifies care giving. Generally, due to the material properties or for hygienic reasons, they can be used only once. Which aids are available...

Read more Fact sheet no. 17 (205 KB)
18 – Aids and Nursing Care Products

Aids are objects which compensate for physical impairments. There is a difference between aids and nursing care products. The cost for aids is covered in full or in part by the health insurance fund in order to support a medical...

Read more Fact sheet no. 18 (181 KB)
19 – Emergency Call System

If you are afraid that you won–™t be able to get help after a fall or an accident in your home, installing an emergency call system can be a good solution. Which home emergency call systems are available? The emergency...

Read more Fact sheet no. 19 (213 KB)
23 – Rehabilitation

The aim of medical rehabilitation is either to enable the patient to cope with the challenges of everyday life again or to maintain their current condition. Rehabilitation services are designed to remove, reduce or prevent impairment of bodily functions so...

Read more Fact sheet no. 23 (210 KB)
32 – Social Security for Caregivers

Through the Care Insurance Act (§ 44 SGB XI), options for social security protection of caregivers has been created: Pension insurance scheme Many people can pursue only in a limited capacity or no longer pursue their jobs due to the...

Read more Fact sheet no. 32 (144 KB)
33 – Laws regarding reconciliation of nursing care and working life

If close family members want to care for a person in need of care for a certain period, they have the opportunity to seek leave of absence from work. Under the law to improve reconciliation of work and care there...

Read more Fact sheet no. 33 (27 KB)
36 – Payments for outpatient care 2020 Read more Fact sheet no. 36 (167 KB)
41 – 24 – hour nursing care and supervision at home

Many persons in need of care want   / or require 24-hour care in their home. Often, however, this exceeds the mental and physical capabilities of the relatives. The following options are available as full-time care and care can be organized...

Read more Fact sheet no. 41 (118 KB)