German care allowance and benefits by care grade, 2026

How the German system decides what you get

Almost everything the German long-term care insurance pays depends on the care grade (Pflegegrad). It is not tied to a diagnosis. The Medical Service (Medizinischer Dienst, often still called MDK) visits and scores 64 criteria in six modules: moving around, understanding and communicating, behaviour, washing and eating, coping with medication and appointments, and organising the day. The result is converted into a score out of 100. From 12.5 points the person has grade 1, from 27 grade 2, from 47.5 grade 3, from 70 grade 4 and from 90 grade 5 (section 15 SGB XI). If you do not know the grade yet, the care grade calculator works through the same criteria.

Only the first line is money paid into an account. Everything else is a budget the fund spends on your behalf: it pays the care service or the day centre directly, or it refunds receipts you send in. That is why two families with the same grade can end up with very different totals. One takes the allowance and never claims anything else; the other also uses the relief amount for a cleaner from a registered service, orders gloves and bed pads through the consumables allowance, and books two weeks of replacement care so the main carer can take a holiday.

Allowance, services, or a mix

The care allowance is meant for families who organise care themselves. If you bring in a registered home care service (ambulanter Pflegedienst), you use the services in kind budget instead, which the service bills to the fund. The budgets differ: at grade 3 the allowance is €599 while the services budget is €1,497, because professional care costs more than the recognition paid to relatives.

Most families combine both. The combined benefit works by percentage: a care service billing €600 at grade 3 uses 40.1 % of the services budget, so the allowance drops by the same share to €358.92. A bill above the services budget is the family’s to pay, and the allowance then disappears entirely.

How much allowance is left next to a care service

Care gradeCare grade 2Care grade 3Care grade 4Care grade 5

Care service bill

€

Allowance per month

€358.92

Services budget used	40.1 %
full allowance	€599
you pay	€0

Work out the combined benefit in detail →

The budgets expat families most often miss

• The relief amount of €131 a month applies at every grade, including grade 1. It pays recognised everyday helpers, day centre fees and household help from a care service. Unused money carries over until 30 June of the following year (section 45b SGB XI).
• Consumable care aids such as gloves, disposable bed protectors and disinfectant are covered up to €42 a month with no co-payment.
• Since 1 July 2025, respite care and short-term care share one annual budget of €3,539 (section 42a SGB XI). It covers a replacement carer when you travel or fall ill, or a temporary bed in a care facility after a hospital stay.

Grade 4 with relatives doing the caring means €9,600 of allowance a year. Add the relief amount, consumables and the joint budget and the household can use €15,215. For someone flying in from abroad to support a parent, knowing that a replacement carer is paid for can decide whether a trip home is possible at all.

From application to first payment

1. Apply. Contact the parent’s Pflegekasse, which sits with their health insurer. A phone call or email counts and benefits start from that month. See applying for a care grade.
2. Assessment. The Medical Service, or Medicproof for privately insured people, assesses at home, in some cases by phone or video.
3. Decision. The fund decides within 25 working days and sends the assessment report (section 18c SGB XI).
4. Check it. If the grade looks too low you have one month to object; later deterioration is handled with a request for a higher grade.
5. Choose benefits. Allowance, services or a mix, plus relief amount, aids and up to €4,180 per home adaptation.

When home care is no longer enough

In a care home there is no allowance. The fund pays the home a fixed amount and a supplement on the care part of the co-payment, rising from 15 percent in the first year to 75 percent from the fourth (section 43c SGB XI). Board, lodging and investment costs stay with the resident. On the vdek figures of 1 July 2026 the national average was €3,364 a month in year one and €2,111 from year four. The care home calculator uses the average for each state, and pages such as North Rhine-Westphalia or Saxony-Anhalt explain what differs there.

Protecting the carer

A relative who cares for at least ten hours a week over two days and works no more than 30 hours earns German state pension entitlements paid by the fund; the carer pension calculator shows how much. Carers can also claim the carer’s tax lump sum and up to ten days of carer’s leave allowance in an emergency.

The 2027 reform is still a draft

On 30 September 2026 the federal cabinet adopted the draft Care Reorganisation Act (Pflegeneuordnungsgesetz, ministry press release). It would replace the relief amount for everyday support with a local support budget, add a bridging budget for emergencies and change assessment rules for grades 1 to 3. Parliament has not passed it; until it is published in the Federal Law Gazette, the current law used here applies. See the 2027 care reform.