Long-term care insurance: compulsory or optional? What you need to know in 2025
01.06.25
9
Minutes
Katrin Straub
Managing Director at nextsure
Is long-term care insurance compulsory? Yes, in Germany there is a comprehensive insurance obligation for everyone. This article explains the legal foundations, highlights differences in benefits and gives you specific recommendations for planning ahead.
The topic in brief and concise terms
In Germany, there is a legal requirement for long-term care insurance for everyone insured under health insurance, either through statutory long-term care insurance (SPV) or private mandatory long-term care insurance (PPV).
Mandatory long-term care insurance is designed as partial cover and often does not cover all care costs, which makes private supplementary provision important.
The contributions to long-term care insurance differ: in statutory long-term care insurance (SPV), they are income-dependent (from 2025: 3.6% or 4.2% for people without children), while in private long-term care insurance (PPV) they are risk-based and age-dependent.
Mandatory long-term care insurance: understanding the statutory basis
In Germany, long-term care insurance is mandatory for every citizen. This has been set out in Book Eleven of the Social Code (SGB XI) since 1 January 1995. The principle is: long-term care insurance follows health insurance. This means that anyone insured under the statutory health insurance scheme is automatically also covered by social long-term care insurance (SPV). Privately insured health policyholders 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, that is over 70 million insured persons in the SPV. It was introduced against the backdrop of an ageing population.
Quick Facts: The key facts about the long-term care insurance obligation at a glance
Long-term care insurance is compulsory for everyone in Germany with health insurance cover. Here are the key facts in brief:
Compulsory insurance for everyone: Anyone with statutory or private health insurance must have long-term care insurance.
Statutory basis: Book Eleven of the Social Code (SGB XI) has regulated long-term care insurance since 1995.
Two systems: There is social long-term care insurance (SPV) for those with statutory insurance and private compulsory long-term care insurance (PPV) for privately insured individuals.
Equal benefits: The benefits required by law are essentially the same in both systems.
Contribution differences: Contribution calculation differs between SPV (income-based) and PPV (risk-based, age).
No full coverage: Long-term care insurance usually covers only 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 section: How long-term care insurance works in everyday life
The long-term care insurance applies when a need for care has been assessed and classified into one of five care levels. The benefits are varied and range from care allowance for home care provided by relatives (e.g. 332 euros at care level 2) to in-kind care benefits for professional services (e.g. 761 euros at care level 2). It is important to note that long-term care insurance is designed as partial cover insurance; it does not cover all costs incurred. The difference often has to be borne by the person needing care or their relatives themselves. For example: average care home costs can quickly exceed 3,500 euros per month, of which the insurance often covers only around half. A private supplementary long-term care insurance can help close financial gaps here. Contributions to statutory long-term care insurance are income-dependent; from 1 January 2025, the general contribution rate will be 3.6 per cent, and for childless people aged 23 and over, 4.2 per cent. Employees and employers each share the contribution equally (except for the childlessness supplement).
Contribution amount and entitlement to benefits: What does the insurance pay?
Contributions to statutory long-term care insurance (SPV) are based on gross income, up to the contribution assessment ceiling (2025: EUR 5,512.50 per month). The contribution rate for insured persons with children is 3.6 per cent; those without children over the age of 23 pay 4.2 per cent. For privately insured persons (PPV), the contribution depends on the age at entry and health status, but is capped for the standard tariff. Benefits are set out in SGB XI and are, in principle, identical for SPV and PPV. They include, for example:
Care allowance for home care (e.g. care level 3: EUR 573 per month).
Care services in kind for outpatient care (e.g. care level 4: EUR 1,778 per month).
Benefits for part-residential care (day or night care, e.g. care level 3: EUR 1,298).
Full inpatient care (coverage of care-related costs up to maximum amounts, e.g. care level 5: EUR 2,200).
Relief allowance of EUR 125 per month for all care levels.
Please note that accommodation and meals in a care home are usually payable privately. A state-subsidised Pflege-Bahr can be an option for topping up coverage. The exact benefit levels are adjusted regularly, most recently on 1 January 2025 by 4.5 per cent.
In-depth expert analysis: Legal foundations and recent rulings on the long-term care insurance obligation
The central legal basis for long-term care insurance is Book Eleven of the Social Code (SGB XI). Since 1995, it has defined the insurance obligation (§ 20 et seq. SGB XI for those insured under the statutory scheme, § 23 SGB XI for those privately insured). Our expert tip: Check your insurance status carefully, especially when your status changes (e.g. from employee to self-employed). Self-employed people are also required to have health and long-term care insurance. You can choose between statutory (voluntary) and private health insurance and, accordingly, long-term care insurance. Civil servants receive allowances towards care costs and must ensure cover for remaining costs through private compulsory long-term care insurance. Recent judgments often concern the precise interpretation of entitlement to benefits or the distinction from benefits provided by other social welfare bodies (§ 13 SGB XI). The compulsory insurance schemes in Germany form a complex system. If there is any uncertainty regarding the obligation to have health insurance and the resulting obligation to have long-term care insurance, seeking advice is advisable.
Special cases and exceptions: Who is covered and how?
Although long-term care insurance is compulsory in general, there are specific rules for certain groups of people. Students are often covered under family insurance free of charge until the age of 25, or pay reduced contributions. Pensioners remain in their existing long-term care insurance; contributions are calculated based on pension income and other income. Self-employed people can choose between statutory and private long-term care insurance, with contribution levels calculated differently. Civil servants and those entitled to allowance must cover long-term care costs not covered by the allowance through private compulsory long-term care insurance; special tariffs are available here. A special feature is the contributory-free family insurance in the SPV, which applies to spouses and children under certain conditions. Anyone who lives permanently abroad and is insured there for health insurance purposes is generally no longer subject to the German long-term care insurance obligation. If you have any detailed questions about health and care, we will be happy to advise you.
As compulsory insurance applies in Germany, it is hardly possible to be without long-term care insurance as long as health insurance exists. Anyone who fails to meet their obligation to take out health insurance and thus long-term care insurance must expect significant back payments. These can be charged for the entire period without insurance cover, plus late payment surcharges. In the event of a claim, i.e. when the need for care arises, no benefits would be paid from long-term care insurance without cover. The full costs of home care or inpatient care would then have to be paid privately, which can quickly become a financial burden – nursing home costs of over 3,000 euros per month are not uncommon. Social welfare assistance (help with care) does step in in an emergency, but it examines need very carefully and can also call on relatives liable for maintenance. Information on short-term care or co-payments for short-term care already illustrates some aspects of the costs. Private health insurance always also includes compulsory long-term care insurance.
Optimising your protection: The role of long-term care supplementary insurance
Statutory or private long-term care insurance provides only basic cover. Benefits often cover only part of the actual care costs, which can quickly amount to several thousand euros per month. To close this funding gap and minimise the financial burden in the event of needing care, a private long-term care top-up insurance is a sensible addition for many people. There are various options, for example:
Long-term care daily allowance insurance: Pays an agreed daily rate in the event of a claim, regardless of the actual costs.
Long-term care cost insurance: Reimburses a percentage of the documented remaining costs.
Long-term care annuity insurance: Pays a lifelong monthly annuity in the event of needing care.
Our expert tip: The earlier you take out additional cover, the lower the contributions are usually. A supplementary health insurance can round off the portfolio. Let us advise you on which form of cover best suits your individual situation and financial means.
Your next step towards optimal protection
Long-term care insurance is an indispensable mandatory safeguard in Germany, providing financial support in an emergency. However, the statutory benefits often form only a basic foundation. Comprehensive cover and avoiding high out-of-pocket costs require an individual assessment of your own provision needs. Early planning and, where appropriate, taking out suitable additional long-term care insurance can be crucial. This helps secure your financial independence and relieves your family members. Take advantage of professional advice to identify any gaps in your cover and find tailored solutions. At nextsure, we help you put together the cover that is right for you.
Request your personalised risk analysis now: Have your insurance situation reviewed free of charge and receive specific suggestions for improvement.
More useful links
Wikipedia provides 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 provides an overview of the benefits of long-term care insurance.
Federal Statistical Office (Destatis) provides comprehensive information on care.
Federal Statistical Office (Destatis) provides a statistical report on care in Germany for download.
Federal Statistical Office (Destatis) provides information on demographic change and its impact on care.
gesund.bund.de (Bundesgesundheitsportal) offers information on long-term care insurance.
Federal Ministry of Health presents figures and facts on long-term care insurance.
Wikipedia explains Book XI of the Social Code (SGB XI), the legal basis of long-term care insurance.
Wikipedia describes the functions and responsibilities of the long-term care insurance funds.
FAQ
How high are the long-term care insurance contributions in 2025?
From 1 January 2025, the standard contribution rate for social long-term care insurance is 3.6 per cent of gross income. Insured persons without children aged 23 and over pay a surcharge of 0.6 per cent, i.e. a total of 4.2 per cent. Employers and employees each share the contribution equally; employees alone bear the surcharge for childless insured persons.
What is the difference between social and private long-term care insurance?
People with statutory health insurance are automatically covered by social long-term care insurance (SPV). People with private health insurance must take out private compulsory long-term care insurance (PPV). The benefits are set by law and are largely the same, but the way contributions are calculated differs (SPV: income-based; PPV: based on risk and age).
Is statutory long-term care insurance sufficient if care is needed?
Mandatory long-term care insurance is designed as basic cover and generally only covers part of the actual care costs incurred (partial cover principle). Private supplementary long-term care insurance is often recommended to close coverage gaps.
Who determines the need for care?
The need for care is assessed upon application by the Medical Service (MD) for people with statutory insurance or by Medicproof for privately insured people. Based on the assessment, classification is made into one of the five care levels.
Are children and spouses automatically covered?
In statutory long-term care insurance, children and spouses are insured free of charge under certain conditions (family insurance). In private mandatory long-term care insurance, a separate contract must be concluded and an individual premium paid for each person, although children often benefit from reduced rates.
What does the principle 'Care follows patients' mean?
This principle means that responsibility for long-term care insurance follows responsibility for health insurance. If you are covered by statutory health insurance, you are insured with the long-term care insurance fund of your health insurance provider. If you are privately insured for health insurance, you must also take out private mandatory long-term care insurance there.
