Short-term care and health insurance: How to secure your claims and optimise financing
9 Apr 2025
6
Minutes
Katrin Straub
CEO at nextsure
When home care suddenly becomes insufficient, short-term care comes into play. But who bears the costs and how does support from the health insurance or care insurance work? This article sheds light on your entitlement to benefits and shows you how to minimise the financial burden.
The topic in brief and concise terms
The care fund covers up to €1,854 annually for care costs in short-term care (from care level two), which can be combined with preventive care up to €3,539.
The costs for accommodation, meals, and investments (personal contribution) must be borne by oneself, but they can be reduced by the relief amount (€131/month) and half the care allowance.
Without a care level or at care level one, the health insurance can provide short-term care services under certain conditions (e.g., after a hospital stay).
Quick Facts: Key Information on Short-Term Care and Cost Coverage
Short-term care offers temporary full-time care for individuals in need. From care level two, the nursing care fund covers up to €1,854 annually for care-related expenses. This amount can be increased by up to €1,685 using unused funds from respite care, making a total of up to €3,539 available per year. The service is limited to a maximum of eight weeks, i.e., 56 days per calendar year. For individuals without a care level or with care level one, the health insurance may step in under certain circumstances, such as following a hospital stay. The monthly relief amount of €131 can also be used for any personal contributions incurred.
Eligibility requirements: When does the nursing care fund provide for short-term care?
To receive benefits for short-term care from the nursing care fund, usually at least care level two must be present. The need can arise from various situations: for instance, to bridge the gap after a hospital stay when home care is temporarily unavailable. An acute deterioration in the condition requiring more intensive care can also establish a claim. Another common reason is to relieve caregiving relatives who need a break or are unwell themselves. The nursing care fund then covers care-related expenses, the costs for medical treatment care, and social support up to a maximum of 1,854 euros. A care insurance is the central anchor here. These regulations ensure that adequate care is provided in times of crisis.
Detailed costs: What amounts are covered by the insurance, and what remains as a personal contribution?
The care fund covers the costs of care, expenses for social care, and medical treatment care up to 1,854 euros per year. By combining it with funds for respite care, this amount can increase to up to 3,539 euros. However, it is important to note that costs for accommodation and meals, as well as the establishment's investment costs, are not covered by this budget. These so-called hotel and investment costs constitute the personal contribution that the care recipient must bear. The amount of this personal contribution varies significantly depending on the facility and federal state. On average, this personal contribution can range between 20 and 50 euros per day. To bridge this financial gap, the monthly relief payment of 131 euros can be used. Additionally, the care allowance, which is continued to be paid at half during short-term care (for up to eight weeks), can be used to cover expenses. A supplementary care insurance can help mitigate these residual costs.
Case Study: How to Calculate Grant and Personal Contribution
Mr Müller (care level three) requires short-term care for four weeks (28 days). The care facility charges a daily rate of 120 euros, which breaks down into 70 euros for care costs, 30 euros for accommodation/meals, and 20 euros for investment costs.
The total cost for 28 days amounts to 3,360 euros (28 days * 120 euros/day). The pure care costs are 1,960 euros (28 days * 70 euros/day). The care insurance covers up to 1,854 euros of this. Mr Müller has an unused amount of 500 euros from respite care that he can also use. Thus, the full 1,960 euros of care costs are covered by the care insurance (1,854 euros STC + 106 euros from respite care transfer). The self-contribution for accommodation, meals, and investment costs is 1,400 euros (28 days * 50 euros/day). Mr Müller can use his accumulated relief amount from, for example, three months (3 * 131 euros = 393 euros). His care allowance of 590 euros (assumed amount for care level 3) will be continued at half the rate for the 28 days (approx. 295 euros). The remaining personal contribution is thus significantly reduced. It is always advisable to have an exact calculation in advance.
Applying made easy: Step by step to success
The application for short-term care should ideally be submitted to the responsible care fund before the start of the measure. The care fund is usually located with the policyholder's health insurance. The following steps should be observed:
Obtain application form: You can get this directly from your care fund, often also available for online download. Many funds offer forms for short-term care provided by the health and care insurance.
Complete details: In addition to personal data of the care recipient, the desired period and the reason for short-term care must be provided.
Select facility: If known, specify the desired approved care facility. The care fund can provide lists of contract facilities.
Combination with preventive care: Indicate if you want to transfer unused funds from preventive care to increase the benefit amount to up to €3,539.
Medical necessity certificate: In some cases, particularly for short-term care without a care level via the health insurance, a medical certificate may be required.
Our expert tip: Arrange for a place early, as these get booked up quickly, especially during holiday periods. The hospital social service can assist with the application process after a hospital stay.
Special case: Short-term care without a care level or with care level one
It is not always the case that a recognised care level of two or higher is already in place when temporary inpatient care becomes necessary. There are specific regulations for persons without a care level or with care level one, where the health insurance takes over. This is regulated in § 39c SGB V and is referred to as “short-term care in the absence of care dependency”. A severe illness or a significant deterioration in health, often following a hospital treatment, when domestic care is insufficient, is usually required. The health insurance then covers the costs for treatment care, basic care, and domestic support for up to eight weeks per calendar year, up to an amount of 1,854 euros. Here, too, the following applies: costs for accommodation and meals must be borne by oneself. The relief amount of 131 euros per month can be used to finance the personal contribution for care level one. The same principles apply to health insurance for pensioners. Early contact with the health insurance company is crucial here.
Expert Knowledge: Legal Foundations and Future Changes
The legal basis for short-term care provided by the care insurance fund is primarily § 42 of the Eleventh Book of the Social Code (SGB XI). This section defines the eligibility criteria, amount of benefits, and duration. The option to combine with respite care is outlined in § 39 SGB XI. The relief amount is regulated in § 45b SGB XI. § 37 SGB XI is relevant for the continued payment of care allowance. Short-term care at the expense of the health insurance fund is based on § 39c of the Fifth Book of the Social Code (SGB V). An important change is coming: From the first of July 2025, the benefit amounts for respite care and short-term care will be combined into a single annual amount. This will then amount to a total of 3,539 euros and can be used flexibly for both types of benefits. This regulation already applies from the first of January 2024 for care recipients under 25 years of age with care level four or five. This flexibility significantly facilitates needs-based access. Get information from your private health insurance about specific tariff benefits.
Optimization Tips: How to Maximize the Benefits
Your next step towards security
More useful links
The Federal Ministry of Health provides detailed information about short-term care benefits under the care insurance scheme.
The GKV Spitzenverband offers recommendations for short-term care in accordance with § 88a SGB XI.
A directory of position 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 the topic of care in Germany.
Current tables on people in need of care, broken down by care levels, can be found at the Federal Statistical Office (Destatis).
The Consumer Advice Centre provides information on when short-term care is an option if home care cannot be temporarily ensured.
Information about the combined annual contribution for preventive and short-term care is provided by the Consumer Advice Centre.
The AOK offers an overview of short-term care as one of the forms of support.
Learn more about the Barmer's services in the area of short-term care.
FAQ
Who is entitled to short-term care from the health insurance?
Individuals who do not have a care level or have care level one are entitled to short-term care from their health insurance if temporary residential care is necessary following a serious illness or hospital stay and home nursing is insufficient. This is regulated in § 39c SGB V.
What costs are not covered by short-term care?
The care insurance or health insurance covers the care-related expenses for short-term care. Normally, the costs for accommodation and meals (so-called hotel costs) as well as the investment costs of the care facility are not covered. These must be borne by yourself as a personal contribution.
How is the care allowance paid during short-term care?
During the utilization of short-term care, the previously received care allowance will continue 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 application for short-term care in advance?
Yes, it is strongly recommended to submit the application for short-term care to the relevant nursing or health insurance before the measure begins. In urgent emergencies, it may be possible to apply retroactively, but this should be clarified in advance.
What is the difference between short-term care and respite care?
Short-term care always takes place in a residential facility. Preventive care, on the other hand, is intended to relieve a private caregiver and can also be provided at home by a mobile service or other private individuals. However, both benefits can be financially combined.
What happens if the budget for short-term care is not sufficient?
If the budget of the nursing care fund (even when combined with respite care) is insufficient to cover the care costs, or if the personal contributions cannot be managed, an application for "care assistance" can sometimes be submitted to the social services department. A private supplementary nursing care insurance can also help to bridge these gaps.
