Applying for a care level: Explained step by step

Anyone who permanently needs help in everyday life is often entitled to benefits from long-term care insurance. The key to this is a care level. Many families apply too late because the process seems complicated. Yet it is clearer than you think.

This guide explains step by step how to apply for a care level and what matters during the assessment.

Step 1: Submit the application

The application goes to the long-term care fund (Pflegekasse). It is part of the health insurance company; the address can be found on your insurance card or on the health insurance company's website.

The person concerned can submit the application themselves. Relatives can take it over if they hold power of attorney or are appointed as a legal guardian.

The date is particularly important. Benefits are not provided from the day help became necessary, but from the date of application. Anyone who has needed help for some time therefore loses money by waiting.

The application can be submitted informally, including by phone, email, or letter. However, a call has a disadvantage: you cannot prove later when you called. A short email or a letter with a date is better. The long-term care fund will then send the detailed form.

Step 2: Use care advice

With the application, you are entitled to free care counseling. The long-term care fund must assign you a contact person within two weeks. Local care advice centers (Pflegestützpunkte) also offer guidance on site.

Take advantage of this. The counseling helps with the form, preparing for the assessment, and answering questions about what other support is available.

Step 3: Prepare for the assessment

The long-term care fund assigns an assessor. For state-insured individuals, this is usually the Medical Service (Medizinischer Dienst), for privately insured individuals, Medicproof. The assessment usually takes place at home, or under certain conditions by phone or video.

What is evaluated is not the illness itself, but independence in daily life. For this, there are six areas that carry different weights:

• Mobility (10 percent)
• Cognitive and communication skills as well as behavior and psychological well-being (15 percent combined, counting the more severely affected area)
• Self-care, i.e., washing, dressing, eating, and drinking (40 percent)
• Dealing with illness and therapy, such as medication or doctor visits (20 percent)
• Managing everyday life and social contacts (15 percent)

The care level is determined by the score:

• Care level 1: from 12.5 points
• Care level 2: from 27 points
• Care level 3: from 47.5 points
• Care level 4: from 70 points
• Care level 5: from 90 points

How to prepare well:

• Keep a care diary. For one to two weeks, record what help is provided and how long it takes. Including at night.
• Have documents ready. Doctor's letters, discharge reports, medication plan, care aids.
• Do not gloss over things. Many older people pull themselves together during the appointment and show themselves at their best. Describe a normal day, including a bad one.
• Bring someone along. A trusted person is allowed to be present during the assessment and add anything that might be forgotten.

Step 4: The notice of decision

The long-term care fund must generally decide within 25 working days after receiving the application. In urgent cases, shorter deadlines apply, for example during a hospital stay or in palliative care.

If the long-term care fund fails to meet the deadline and is responsible for the delay itself, it pays 70 euros for each week of delay started.

You can request the assessment report if it is not enclosed with the notice of decision. Read it carefully and compare it with your care diary.

Step 5: If you disagree with the decision

You can lodge an objection against the decision within one month. The objection is free of charge.

Explain where the assessment report differs from daily reality and attach new documents. Care counseling or a social association can help with this.

A look ahead

For the year 2027, the Federal Government has initiated a reform. Its draft foresees higher point thresholds for care levels 1 to 3 for new assessments. This has not yet been decided (as of October 22, 2026), and according to the draft, existing care levels are to be maintained until the next assessment.

Regardless of this: Anyone who needs help today should not delay the application. Benefits begin with the application.

For relatives

A care level opens the door to further assistance, such as the relief amount starting from care level 1. Keep track of appointments such as the assessment and the deadline for an objection in a place where the whole family can see them. Then nobody has to make follow-up phone calls.

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This article provides general information and does not replace legal advice. Deadlines and rules may change. The information provided by your long-term care fund or a care counseling service is binding.