Wegweiser Seniors · Rights & Benefits Deutsch

📋 Applying for a care level

Care benefits are only available after a care level (Pflegegrad) has been recognised – the application to the Pflegekasse is informal and can preserve the deadline even by phone.

care level (Pflegegrad) long-term care insurance fund (Pflegekasse) Medical Service (Medizinischer Dienst) 18c SGB XI new assessment procedure (Neues Begutachtungsassessment) objection (Widerspruch)

In brief

To receive care allowance (Pflegegeld), care benefits in kind or other benefits from long-term care insurance, a care level (Pflegegrad) must first be determined. You submit the application informally to the Pflegekasse (long-term care insurance fund), which is attached to your health insurer – a phone call is enough at first to preserve the deadline. After that, the Medizinischer Dienst (Medical Service; Medicproof for privately insured persons) usually assesses, using a nationwide standard procedure, how independent you still are.

Step by step

  1. Submit an informal applicationCall the Pflegekasse or write a short application – benefits are provided retroactively from the month of application, not before.
  2. Keep a care diaryOver a few days, note what you need support with and how often – this makes the assessment easier.
  3. Prepare for the assessment appointmentMake sure a trusted person is present at the appointment with the Medizinischer Dienst and that medication plans and medical reports are at hand.
  4. Check the noticeCheck the care level determined and the reasoning in the assessment report carefully.
  5. File an objection if rejectedIf something does not add up, file an objection within one month, if necessary with the support of a Pflegestützpunkt (care support centre).

Deadlines

generally 25 working days
Standard deadline for the Pflegekasse to decide after receiving the application§ 18c SGB XI
1 week
Shortened assessment deadline, e.g. in case of a hospital stay or hospice or palliative care§ 18c SGB XI
1 month
Objection deadline against the Pflegekasse's notice§ 84 SGG
Watch out – common mistakes
  • Care benefits are not paid retroactively from before the application – an early, informal application therefore secures your entitlements.
  • If the Pflegekasse does not meet the deadlines under § 18c SGB XI, a flat-rate delay payment may become due – ask about it if the decision is significantly delayed.
  • A rejection or a care level that you feel is too low should not be accepted without comment; an objection with the support of a Pflegestützpunkt or a welfare association is often worthwhile.
In depth · legal basis, figures and practice – for advisers and professionals

Assessment under the New Assessment Procedure (NBA)

The Medizinischer Dienst evaluates independence in six modules (including mobility, cognitive and communicative abilities, behaviours and psychological problems, self-care, coping with illness- or therapy-related demands, and organising everyday life and social contacts). The weighted total score results in one of five care levels (§§ 14, 15 SGB XI).

Processing deadlines (§ 18c SGB XI)

The Pflegekasse must generally decide within 25 working days of receiving the application. Shorter deadlines of one week apply, among other cases, in case of a hospital stay, outpatient palliative care, hospice care or if a family carer has announced care leave under the Pflegezeitgesetz (Caregiver Leave Act). If the deadline is exceeded, the law provides for a flat-rate delay payment in favour of the applicant.

Objection

An objection against the notice is possible within one month (§ 84 SGG); a new, better-documented assessment or an assessment report from an independent advice centre is often worthwhile.

Who is responsible
  • Pflegekasse at the health insurer
  • Medizinischer Dienst or Medicproof (privately insured persons)
Further reading
Care benefits and care allowanceAssisted living and nursing homesAdvice and points of contact for seniors

Quick questions

Worum geht es bei „Applying for a care level“?
Care benefits are only available after a care level (Pflegegrad) has been recognised – the application to the Pflegekasse is informal and can preserve the deadline even by phone.
Which deadlines and figures matter?
  • generally 25 working days: Standard deadline for the Pflegekasse to decide after receiving the application (§ 18c SGB XI)
  • 1 week: Shortened assessment deadline, e.g. in case of a hospital stay or hospice or palliative care (§ 18c SGB XI)
  • 1 month: Objection deadline against the Pflegekasse's notice (§ 84 SGG)
What should I do first?
  • Submit an informal application: Call the Pflegekasse or write a short application – benefits are provided retroactively from the month of application, not before.
  • Keep a care diary: Over a few days, note what you need support with and how often – this makes the assessment easier.
  • Prepare for the assessment appointment: Make sure a trusted person is present at the appointment with the Medizinischer Dienst and that medication plans and medical reports are at hand.
What do I need to watch out for?
  • Care benefits are not paid retroactively from before the application – an early, informal application therefore secures your entitlements.
  • If the Pflegekasse does not meet the deadlines under § 18c SGB XI, a flat-rate delay payment may become due – ask about it if the decision is significantly delayed.
  • A rejection or a care level that you feel is too low should not be accepted without comment; an objection with the support of a Pflegestützpunkt or a welfare association is often worthwhile.
Evidence
  • §§ 14, 15, 18c SGB XI (gesetze-im-internet.de)
  • § 84 SGG (gesetze-im-internet.de)
As of

As of: September 2026 · Sources and method

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