Long-term Care Insurance: Obligation or Choice? What You Need to Know in 2025
1 Jun 2025
5
Minutes
Katrin Straub
CEO at nextsure
Is a care insurance mandatory? Yes, in Germany there is a comprehensive insurance obligation for everyone. This article explains the legal framework, highlights differences in benefits, and provides concrete action recommendations for your provision.
The topic in brief and concise terms
In Germany, there is a legal requirement for nursing care insurance for everyone with health insurance, either through the social care insurance (SPV) or a private care insurance (PPV).
The mandatory long-term care insurance is designed as a partial coverage insurance and often does not cover all care costs, making private additional insurance important.
Contributions to long-term care insurance vary: In statutory long-term care insurance, they are income-dependent (from 2025: 3.6% or 4.2% for those without children), while in private long-term care insurance, they are risk-based and age-dependent.
Compulsory Long-Term Care Insurance: Understanding the Legal Framework
In Germany, long-term care insurance is a mandatory insurance for every citizen. This has been stipulated in the Eleventh Book of the Social Code (SGB XI) since 1 January 1995. The principle is: Long-term care insurance follows health insurance. This means that anyone who is legally insured for health care is also automatically insured in the social long-term care insurance (SPV). Those privately insured for health care must take out private mandatory long-term care insurance (PPV). This regulation ensures that the financial risk of needing care is covered for all residents of Germany; currently, this includes over 70 million insured individuals in the SPV. Its introduction was prompted by an aging population.
Quick Facts: The Key Points About Mandatory Care Insurance at a Glance
Long-term care insurance is mandatory for everyone in Germany with health insurance coverage. Here are the key facts in brief:
Mandatory insurance for all: Everyone with statutory or private health insurance must have long-term care insurance.
Legal basis: The Eleventh Book of the Social Code (SGB XI) has governed long-term care insurance since 1995.
Two systems: There is social long-term care insurance (SPV) for those with statutory insurance and private mandatory long-term care insurance (PPV) for those with private insurance.
Equal benefits: The legally mandated benefits are fundamentally equal in both systems.
Contribution differences: The calculation of contributions differs between SPV (income-dependent) and PPV (risk-based, age).
Not full coverage: Long-term care insurance usually only covers part of the costs (partial coverage).
These points illustrate the basic structure and obligation. As an insurance portal, we offer you comprehensive advice on long-term care insurance.
Practical Part: How the care insurance works in everyday life
The long-term care insurance comes into effect when care needs are identified, classified into one of five care levels. The benefits are diverse and range from care allowance for home care by relatives (e.g., €332 at care level 2) to care benefits in kind for professional services (e.g., €761 at care level 2). Importantly, the care insurance is designed as a partial coverage insurance; it does not cover all incurred costs. The difference often has to be borne by those in need of care or their relatives themselves. For example, the average cost of care in a nursing home can quickly exceed €3,500 per month, of which the insurance often covers only about half. A private supplementary care insurance can help fill financial gaps here. Contributions to the statutory care insurance are income-based; from 1 January 2025, the general contribution rate is 3.6 percent, and 4.2 percent for childless persons from the age of 23. Employees and employers share the contribution equally (except for the childless surcharge).
Contribution amount and benefit entitlement: What does the insurance cover?
Social long-term care insurance (SPV) contributions are based on the gross income, up to the contribution assessment ceiling (2025: 5,512.50 euros monthly). The contribution rate for insured individuals with children is 3.6 percent, and childless individuals over the age of 23 pay 4.2 percent. For those privately insured (PPV), the contribution depends on age of entry and health status, but is capped for the basic rate. The benefits are specified in SGB XI and are fundamentally the same for SPV and PPV. They include, for example:
Care allowance for home care (e.g., care level 3: 573 euros monthly).
Care benefits for outpatient services (e.g., care level 4: 1,778 euros monthly).
Benefits for semi-residential care (day or night care, e.g., care level 3: 1,298 euros).
Full residential care (covering care-related costs up to maximum amounts, e.g., care level 5: 2,200 euros).
Relief amount of 125 euros monthly for all care levels.
Please note that accommodation and meals in the nursing home are usually paid privately. A state-subsidized Pflege-Bahr can be an option for topping up. The exact benefit levels are regularly adjusted, most recently by January 1, 2025, by 4.5 percent.
Expert Depth: Legal Foundations and Recent Rulings on Compulsory Care Insurance
The central legal basis for long-term care insurance is the Eleventh Book of the Social Code (SGB XI). Since 1995, it has defined the insurance obligation (§ 20 ff. SGB XI for statutory insured persons, § 23 SGB XI for privately insured persons). Our expert tip: Check your insurance status carefully, especially when changing status (e.g. from employed to self-employed). Self-employed individuals are also subject to health and long-term care insurance requirements. They can choose between statutory (voluntarily) and private health and thus long-term care insurance. Civil servants receive aid for care costs and must ensure residual cost coverage through a private compulsory long-term care insurance. Current judgments often concern the precise interpretation of benefit entitlements or the delineation of benefits from other social security providers (§ 13 SGB XI). The compulsory insurances in Germany form a complex system. In case of uncertainties regarding the obligation for health insurance and the resulting obligation for long-term care insurance, consultation is advisable.
Special cases and exceptions: Who is insured how?
Although the obligation to have care insurance is comprehensive, there are specific regulations for certain groups of people. Students are often covered by family insurance without paying contributions until the age of 25, or they pay reduced contributions. Pensioners remain in their existing care insurance; the contributions are calculated based on pension income and other earnings. Self-employed individuals have a choice between statutory and private care insurance, with the contribution amount being calculated differently. Civil servants and those entitled to assistance must cover care costs not covered by assistance through a private compulsory care insurance; special rates are available here. A special feature is the contribution-free family insurance in the SPV, which applies to spouses and children under certain conditions. Those who live permanently abroad and are insured there are generally no longer subject to the German care insurance obligation. If you have questions about health and care in detail, we are happy to advise you.
Consequences of Not Having Nursing Care Insurance: What Happens Then?
Since there is a compulsory insurance obligation in Germany, the absence of long-term care insurance is hardly possible as long as there is health insurance. Those who fail to comply with their obligation to take out health and therefore long-term care insurance must expect considerable back payments. These can be imposed for the entire non-insured period, plus late payment surcharges. In the event of a claim, i.e., when care dependency arises, no benefits would be paid from the care insurance without coverage. The entire cost of outpatient or inpatient care would then have to be borne privately, which can quickly lead to financial overwhelm—care home costs of over €3,000 per month are not uncommon. Although social assistance (help for care) steps in in an emergency, it scrutinises the neediness very closely and can also involve relatives obliged to provide maintenance. Information on short-term care or co-payments for short-term care already highlights aspects of the costs. A private health insurance always includes the compulsory care insurance.
Optimisation of Your Protection: The Role of Supplemental Nursing Insurance
Your next step towards optimal protection
More useful links
Wikipedia offers a comprehensive overview of long-term care insurance in Germany.
Federal Ministry of Health provides an online guide to long-term care insurance.
Federal Ministry of Health offers an overview of the services of long-term care insurance.
Federal Statistical Office (Destatis) delivers extensive information on the subject of care.
Federal Statistical Office (Destatis) provides a statistical report on care in Germany for download.
Federal Statistical Office (Destatis) informs about demographic change and its impact on care.
gesund.bund.de (Federal Health Portal) provides information on long-term care insurance.
Federal Ministry of Health presents figures and facts on long-term care insurance.
Wikipedia explains the Eleventh Book of the Social Code (SGB XI), the legal framework of long-term care insurance.
Wikipedia describes the function and tasks of the long-term care funds.
FAQ
What are the contributions to long-term care insurance in 2025?
From 1 January 2025, the standard contribution rate to long-term care insurance will be 3.6% of gross income. Childless insured persons over the age of 23 will pay a surcharge of 0.6%, making a total of 4.2%. Employers and employees share the contribution equally; the surcharge for the childless is borne solely by employees.
What is the difference between social and private long-term care insurance?
Individuals with statutory health insurance are automatically included in the social care insurance (SPV). Those with private health insurance must take out private long-term care insurance (PPV). The benefits are legally standardized and largely similar, but the contribution calculations differ (SPV: income-dependent; PPV: risk and age-dependent).
Is the statutory long-term care insurance sufficient in the event of needing care?
The long-term care insurance is designed as basic insurance and generally only covers a portion of the actual care costs (partial cover principle). A private supplementary long-term care insurance is often recommended to fill coverage gaps.
Who determines the need for care?
The need for care is assessed upon request by the Medical Service (MD) for those with statutory insurance or by Medicproof for privately insured individuals. Based on the assessment, classification into one of the five care levels is made.
Are children and spouses automatically insured?
In the statutory long-term care insurance, children and spouses are co-insured without contributions under certain conditions (family insurance). In private compulsory long-term care insurance, a separate contract must be concluded, and a separate contribution must be paid for each person, although there are often reduced rates for children.
What does the principle 'care follows the sick' mean?
This principle means that the responsibility for long-term care insurance follows that of health insurance. If you have statutory health insurance, you are insured with the long-term care fund of your health insurer. If you have private health insurance, you must also take out a private compulsory long-term care insurance there.
