Short-term care and health insurance: How to secure your entitlements and optimise the funding
09.04.25
11
Minutes
Katrin Straub
Managing Director at nextsure
When home care suddenly is no longer sufficient, short-term care steps in. But who pays the costs and how does support from the health insurance fund or long-term care insurance fund work? This article explains your entitlement to benefits and shows you how to minimise the financial burden.
The topic in brief and concise terms
The care insurance fund covers up to €1,854 per year for care costs for short-term care (from care level two), which can be combined with respite care for up to €3,539.
Costs for accommodation, meals and investment costs (personal contribution) must be borne by the person concerned, but can be reduced by the relief allowance (€131/month) and half of the care allowance.
Without a care level or with care level 1, the health insurance fund can provide benefits for short-term care under certain conditions (e.g. after a hospital stay).
Quick Facts: The key facts about respite care and cost coverage
Short-term care provides time-limited full inpatient care for people in need of care. From care grade two onwards, the care insurance fund covers up to 1,854 euros per year for care-related expenses. This amount can be topped up by up to 1,685 euros using unused respite care funds, so that a total of up to 3,539 euros per year is available. The benefit is limited to a maximum of eight weeks, i.e. 56 days, per calendar year. For people without a care grade or with care grade one, the health insurance fund can also step in under certain circumstances, for example after a hospital stay. The monthly relief allowance of 131 euros can also be used for any out-of-pocket contributions incurred.
Eligibility requirements: When does the care insurance fund cover short-term care?
To receive short-term care benefits from the care insurance fund, there must generally be at least care level two. The need can arise in various situations: for example, as a bridge after a stay in hospital, if home care is temporarily not assured. An acute worsening of care needs, which requires more intensive support, can also give rise to an entitlement. Another common reason is to relieve family carers who need a break or are themselves ill. The care insurance fund then covers the care-related costs, the costs of medical treatment care and social support up to the maximum amount of 1,854 euros. A long-term care insurance policy is the central anchor here. These regulations ensure that adequate care is provided in times of crisis.
Costs in detail: Which amounts are covered by the insurer, and what remains as your own contribution?
The care insurance fund covers care-related costs, expenses for social support and medical treatment care up to €1,854 per year. By combining this with respite care funds, this amount can rise to up to €3,539. It is important, however, that costs for accommodation and meals as well as the facility's investment costs are not covered by this budget. These so-called hotel and investment costs make up the personal contribution that the person in need of care must pay themselves. The amount of this personal contribution varies considerably depending on the facility and federal state. On average, this personal contribution can be between €20 and €50 per day. To close this financial gap, the monthly relief amount of €131 can be used. The care allowance, which continues to be paid at half rate during short-term care (for up to eight weeks), can also be used to cover it. A supplementary long-term care insurance can help cushion these remaining costs.
Practical example: How the grant and own contribution are calculated
Mr Müller (care level three) requires short-term care for four weeks (28 days). The care facility charges a daily rate of 120 euros. Of this, 70 euros are for care costs, 30 euros for accommodation/board and 20 euros for investment costs.
The total costs for 28 days amount to 3,360 euros (28 days * 120 euros/day). The pure care costs amount to 1,960 euros (28 days * 70 euros/day). The long-term care insurance fund covers a maximum of 1,854 euros of this. Mr Müller still has 500 euros unused from respite care, which he can also use. Thus, the full 1,960 euros in care costs are covered by the long-term care insurance fund (1,854 euros KZP + 106 euros from VHP transfer). The personal contribution for accommodation, board and investment costs amounts to 1,400 euros (28 days * 50 euros/day). Mr Müller can use his accumulated relief allowance, for example for three months (3 * 131 euros = 393 euros), for this. His care allowance of 590 euros (assumed amount for care level 3) is continued at half rate for the 28 days (approx. 295 euros). The remaining personal contribution is therefore reduced significantly. An exact calculation is always recommended in advance.
Application made easy: step by step to the benefit
The application for short-term care should ideally be submitted to the responsible long-term care insurance fund before the measure begins. The long-term care insurance fund is usually attached to the health insurance fund of the person needing care. The following steps should be observed:
Obtain the application form: You can get this directly from your long-term care insurance fund, often also online for download. Many funds offer forms for short-term care through the health insurance fund and long-term care insurance fund.
Complete the details: In addition to the person needing care’s personal details, the desired period and the reason for the short-term care must be provided.
Choose a facility: If known, name the desired approved care facility. The long-term care insurance fund can provide lists of contracted facilities.
Combination with respite care: Indicate whether you would like to transfer unused respite care funds to increase the benefit amount to up to 3,539 euros.
Medical certificate of necessity: In some cases, especially for short-term care without a care grade via the health insurance fund, a medical certificate may be required.
Our expert tip: Arrange a place early, as these fill up quickly, especially during holiday periods. The hospital social services department can help with the application after a hospital stay.
Special case: short-term care without care grade or with care grade 1
It is not always the case that an officially recognised care grade two or higher is already in place when temporary inpatient care becomes necessary. For people without a care grade or with care grade one, there are special provisions under which the health insurance fund steps in. This is regulated in Section 39c SGB V and is referred to as “short-term care in the absence of a need for care”. The usual requirement is a serious illness or a significant deterioration in health, often following hospital treatment, when home nursing care is not sufficient. In this case, the health insurance fund covers the costs of nursing care, basic care and household assistance for up to eight weeks per calendar year, up to an amount of EUR 1,854. Here too, costs for accommodation and meals must be paid for by the individual. The relief amount of EUR 131 per month can be used to finance the personal contribution for care grade one. The same principles apply to health insurance for pensioners. Early contact with the health insurance fund is crucial here.
The statutory basis for short-term care through the care insurance fund is primarily § 42 of Book Eleven of the Social Code (SGB XI). This defines eligibility requirements, benefit level and duration. The option of combining it with respite care arises from § 39 SGB XI. The relief amount is regulated in § 45b SGB XI. § 37 SGB XI is relevant to the continued payment of care allowance. Short-term care charged to statutory health insurance is legally based on § 39c of Book Five of the Social Code (SGB V). An important change is on the way: from 1 July 2025, the benefit amounts for respite care and short-term care will be combined into a single annual amount. This will then total €3,539 and can be used flexibly for both types of benefit. For people in need of care under the age of 25 with care grade four or five, this rule has applied since 1 January 2024. This flexibilisation makes needs-based use significantly easier. Find out from your private health insurance about specific tariff benefits.
Optimisation tips: How to make the most of the services
To make the most of financial support for short-term care, you should bear a few points in mind. Make full use of the combined short-term care and respite care budget options to receive up to €3,539 for the pure care costs. Plan ahead and apply for the benefits in good time with your care insurance fund or health insurance fund. Consistently use the monthly relief amount of €131 to cover your personal contributions (accommodation, meals). Bear in mind that the care allowance continues to be paid at half rate for up to eight weeks during short-term care and can also help with financing. Check whether you can claim the costs you have covered yourself as extraordinary burdens in your tax return. Our expert tip: Ask your care insurance fund or a care support point for advice so that you can make full use of all options and find the right health and care solution. If you are facing financial difficulties, applying to the social welfare office for "assistance with care" may also be an option.
Your next step towards protection
The regulations surrounding short-term care and the role of the health insurance fund can seem complex. Good preparation and a clear understanding of your entitlements are crucial to minimising financial burdens and ensuring the best possible care. Combining different entitlements, such as those from the care insurance fund and, where applicable, the voluntary health insurance, often offers more scope than initially assumed. Make use of advisory services and plan ahead.
Request an individual risk assessment now: Have your insurance situation reviewed free of charge and receive concrete recommendations for optimisation.
More useful links
The Federal Ministry of Health provides detailed information on the benefits of short-term care under long-term care insurance.
The National Association of Statutory Health Insurance Funds provides recommendations on short-term care in accordance with Section 88a of Book XI of the Social Code.
A directory of item numbers for short-term care services is available on the GKV data exchange website.
The Federal Statistical Office (Destatis) provides comprehensive data and statistics on care in Germany.
Current tables on people requiring care, broken down by care grades, can be found at the Federal Statistical Office (Destatis).
The Consumer Advice Centre explains when short-term care is an option if care at home cannot be guaranteed temporarily.
Information on the combined annual contribution for respite care and short-term care is provided by the Consumer Advice Centre.
The AOK provides an overview of short-term care as one of the forms of care.
Find out more about the benefits of the Barmer in the area of short-term care.
FAQ
Who is entitled to short-term care from the health insurance fund?
People without a care grade, or with care grade 1, are entitled to short-term care through their health insurance if, after a serious illness or a stay in hospital, temporary inpatient care is necessary and home nursing care is not sufficient. This is regulated in Section 39c of the German Social Code, Book V.
Which costs are not covered by short-term care?
The long-term care insurance fund or health insurance fund covers the care-related costs for short-term care. As a rule, the costs for accommodation and meals (so-called hotel costs), as well as the care facility’s investment costs, are not covered. These must be paid by the individual as an out-of-pocket contribution.
How is care allowance paid during short-term care?
During the use of short-term care, the care allowance previously received continues to be paid at half rate for up to eight weeks per calendar year. This half-rate care allowance can be used to finance the personal contribution.
Do I need to submit the short-term care application in advance?
Yes, it is strongly recommended to submit the application for short-term care before the start of the measure to the responsible care or health insurance fund. In acute emergencies, retrospective application may be possible, but this should be clarified in advance.
What is the difference between short-term care and respite care?
Short-term care is always provided in a residential care facility. Respite care, by contrast, serves to relieve a private caregiver and can also be provided at home by a domiciliary care service or other private individuals. However, both services can be combined financially.
What happens if the budget for respite care is not enough?
If the care insurance budget (even when combined with respite care) is not sufficient to cover the care costs, or if the personal contributions cannot be met, it may be possible in some circumstances to apply to the social welfare office for „care assistance“. Private supplementary long-term care insurance can also help to close these gaps.
