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

If you need nursing treatment, this does not mean that you need to be admitted to an inpatient facility such as a clinic. In many cases, this kind of treatment can also be provided at home by outpatient nursing services....

Read more Fact sheet no. 1 (132 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 (130 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 (85 KB)
7 – Co payments for health insurance services

The law requires co-payment for certain services of the health schemes from the insured person: Insured persons up to age 18 are exempt from co-payment (except: travelling expenses) For every calendar year all insured persons from the age of 18...

Read more Fact sheet no. 7 (139 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 (215 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 (93 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 (221 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 (137 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?  

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

Rehabilitation services are designed to remove, reduce or prevent impairment of bodily functions so that the onset of a disability or the need for long-term care can be averted. Various treatment options help to restore the patient–™s ability to do...

Read more Fact sheet no. 23 (307 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 (28 KB)
36 – Payments for outpatient care 2022 Read more Fact sheet no. 36 (166 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 (142 KB)