Health and long-term care insurance are mandatory in Germany. How do the two insurances differ and why is this important for family caregivers to know?
Home care is provided by relatives for the majority of people in need of care. According to the Federal Statistical Office, 4.17 million people in need of care were cared for at home in 2021. Of these, 3.12 million people in need of care (75%) were cared for primarily by relatives.
And which insurance company is responsible now?
The task of health insurance is to maintain, improve or restore health with the aim of preventing the need for long-term care.
The task of long-term care insurance is to provide care for people in need of long-term care.
- SGB 5 (Social Security Code )
- Health insurance benefit
- Is prescribed by the doctor and carried out by a nursing service
- Can be prescribed with and without care degree
- Replacement or avoidance of hospital treatment
- Carried out in the home environment or also in an assisted living facility
- SGB 11 (Social Security Code)
- Care insurance benefit
- Usually performed by family caregivers,
partly with the support of a nursing service (care benefits in kind)
- Requires a care degree
What if home health care AND home care are needed?
The presence of two or more different medical conditions is called comorbidity. If a mental illness and a physical illness are present at the same time, this is referred to as mental comorbidity.
It is quite possible, not only but especially in the presence of (mental) comorbidities, that both home health and home care services may be needed.
Certain services are provided by both insurers, such as basic care (personal hygiene and nutrition). Which insurance company is responsible depends on how long the care is needed. In the case of a permanent need for care, the long-term care insurance pays, otherwise the health insurance pays. A person is permanently in need of care if he or she is dependent on care for at least six months.
Those who have a nursing degree and are cared for by a nursing service therefore do not necessarily have to offset the home nursing care against the nursing care benefits of the nursing care insurance. It is possible to receive both home health care benefits AND home health care benefits!
Health insurance benefits:
- Treatments with general practitioners or specialists
- Hospital stay
- Rehab (outpatient or inpatient)
- Medicines and remedies
- Auxiliary means
- Cancer screening
Long-term care insurance benefits:
- Care allowance
- Care benefits in kind
- Nursing substitution:
Preventive or short-term care
- Relief amount
- Nursing aids
- Barrier-free conversion
Recommendation: Get advice at a care support centernearyou.
All municipalities and counties in Baden-Württemberg have care support centers. A care support point is an independent and free advice center on the subject of care and is primarily aimed at people in need of care and their relatives.