Applying for a Care Level: Step by Step
When a family member requires care or you yourself need support in daily life, it is necessary to apply for a care level. Since 2017, the five care levels have replaced the old system of three care stages. The care level determines which benefits you receive from long-term care insurance. This guide takes you through the entire process.
The Five Care Levels at a Glance
Care Level 1: Minor impairment of independence (12.5 to under 27 points). Benefits: Relief allowance of 125 euros per month, counseling services and subsidies for home modifications.
Care Level 2: Considerable impairment (27 to under 47.5 points). Care allowance: 332 euros per month or care benefits: 761 euros.
Care Level 3: Severe impairment (47.5 to under 70 points). Care allowance: 573 euros or care benefits: 1,432 euros.
Care Level 4: Most severe impairment (70 to under 90 points). Care allowance: 765 euros or care benefits: 1,778 euros.
Care Level 5: Most severe impairment with special requirements for care provision (90 to 100 points). Care allowance: 947 euros or care benefits: 2,200 euros.
Step 1: Submitting an Application to the Long-Term Care Insurance Fund
The application for a care level is submitted to the long-term care insurance fund, which is affiliated with the respective health insurance company. An informal application is sufficient – in writing, by phone, or in person. The long-term care insurance fund will then send you an application form. The person requiring care or authorized family members are entitled to apply. Submit the application as early as possible, as benefits are only granted from the month the application is submitted.
Step 2: Preparation for the Assessment
After submitting the application, the long-term care insurance fund commissions the Medical Service (MD, formerly MDK) to conduct an assessment. Prepare thoroughly: Keep a care diary for at least two weeks, documenting all care activities, their duration and frequency. Collect all relevant medical reports, findings and hospital discharge reports. Note aids already in use and list medications.
Step 3: The Assessment by the Medical Service
An assessor from the Medical Service visits the person requiring care at home or in a care facility. The assessment usually takes 60 to 90 minutes. The assessor evaluates six areas of life: Mobility, cognitive and communicative abilities, behaviors and mental health issues, self-care, managing disease-related and therapeutic requirements, and structuring daily life and social contacts.
Important: Describe the situation honestly and depict a typical difficult day, not your best day. Do not downplay the impairments. It is advisable that a familiar care provider be present during the assessment to provide supplementary information.
Step 4: Decision and Objection
The long-term care insurance fund must issue a decision within 25 working days of submitting the application. If you disagree with the result, you can file an objection within one month. First, request the complete assessment report and review it carefully. Provide written justification for your objection and attach supplementary medical documents. Independent care counseling centers can support you in this process.
Tips for Successful Classification
Document care needs comprehensively in the care diary. Include all limitations, including cognitive and mental health ones. Provide the assessor with all current medical reports and diagnoses. Prepare the person requiring care for the assessment without exaggerating. Consult with a care support center – this advice is free of charge. Information about care facilities in your area can be found via the care home search on sanoliste.de.
Increase in Care Level
If the health condition deteriorates, you can apply for a higher classification at any time. The procedure is identical to the initial assessment. Document the deterioration with medical certificates and an updated care diary. An application for higher classification carries the risk of downgrading if the assessor determines a lower care need – however, this rarely occurs.
Using Support Services
In addition to the care allowance, people requiring care are entitled to numerous other benefits: day and night care, short-term care, respite care, care aids and subsidies for home modifications. Care support centers and the health department provide free information about all services available in your region. Use these counseling services to ensure the best possible care.
Frequently Asked Questions
- Who can apply for a care level?
- Any person requiring care who is insured with statutory or private long-term care insurance and is limited in daily life due to physical, cognitive or mental impairments. People with dementia, mental health conditions or disabilities can also apply for a care level.
- How do I apply for a care level?
- Submit an informal application to your long-term care insurance fund (affiliated with your health insurance company). After receipt of the application, the long-term care insurance fund has 25 working days to make a decision. For care at home, the Medical Service (MD) visits the affected person at home.
- What does the Medical Service assessor examine?
- The MD assessor evaluates six areas of life: Mobility, cognitive and communicative abilities, behaviors/mental health issues, self-care, managing therapeutic and disease-related requirements, and structuring daily life. The care level results from the weighted point values.
- What should I do if the care level is rejected or too low?
- You can file an objection within 4 weeks. Get advice from a care support center or VdK/social association. Keep a care diary as evidence. If the decision remains negative, you can file a lawsuit at the social court.
- How quickly do I receive the care level after submitting the application?
- The long-term care insurance fund must decide within 25 working days. In urgent cases (e.g., after hospitalization), a preliminary decision must be made within one week. Delays entitle you to compensation of 70 euros per week or part thereof.
Note: This article is for informational purposes only and does not replace medical advice.