What Is Pflegeversicherung?
Pflegeversicherung (nursing care insurance) is a mandatory social insurance in Germany that covers long-term care needs. Introduced in 1995 as the "fifth pillar" of German social insurance, it provides financial support when you can no longer manage daily life independently due to illness, disability, or old age.
It is not a standalone policy — it is always paired with your health insurance. If you have public health insurance (GKV), nursing care insurance is automatically included. If you have private health insurance (PKV), you must purchase a corresponding private nursing care policy (Pflegepflichtversicherung) separately.
Why It Matters for Expats
People in Germany currently receive nursing care benefits
Euros per month — typical cost of a nursing home in Germany
Mandatory — every resident with health insurance must have it
Germany has one of the oldest populations in Europe, and care costs are rising sharply. Statutory nursing insurance covers only a portion of actual care expenses. Without additional planning, you could face a significant financial gap — often 1,500 to 2,500 euros per month out of pocket for residential care.
How It Works in GKV (Public Insurance)
In the public system, nursing care insurance is automatically deducted from your salary alongside your health insurance contributions. The costs are shared between you and your employer.
Current Contribution Rates
- 1Base rate: 3.4% of gross income (split between employee and employer)
- 2Childless surcharge: +0.6% if you are 23 or older and have no children (paid entirely by the employee)
- 3Multi-child discount: -0.25% for each child beyond the second (up to 5 children)
How It Works in PKV (Private Insurance)
If you have private health insurance, you must purchase a separate mandatory nursing care policy (Pflegepflichtversicherung) from your PKV provider. This is not optional — it is legally required.
Private nursing care premiums are not income-based like GKV. Instead, they depend on your age at entry and health status. Benefits are identical to the public system by law — the minimum coverage must match GKV levels. However, premiums are typically higher for older entrants and lower for those who join young.
Key Differences from GKV Nursing Insurance
- Premiums based on entry age and health, not income
- Aging reserves (Alterungsruckstellungen) built into premiums
- No free family co-insurance — each family member needs coverage
- Employer contributes up to 50% of the premium
The 5 Care Levels (Pflegegrade)
Since 2017, Germany uses five care grades (Pflegegrade) to classify care needs. Each grade determines the level of benefits you receive. Assessment is conducted by the MDK (for GKV) or Medicproof (for PKV).
Minor impairment
Advisory visits and care aids. No cash benefit for home care.
Considerable impairment
Cash benefit for home care, or up to 761 euros for professional home care services.
Severe impairment
Cash benefit for home care, or up to 1,432 euros for professional home care services.
Most severe impairment
Cash benefit for home care, or up to 1,778 euros for professional home care services.
Most severe impairment with special care needs
Cash benefit for home care, or up to 2,200 euros for professional home care services.
Additional Private Nursing Insurance (Pflegezusatzversicherung)
Statutory nursing care insurance — whether through GKV or PKV — covers only a portion of actual care costs. The gap between what insurance pays and what care actually costs can be substantial, often 1,500 to 2,500 euros per month for residential care.
This is where supplementary nursing insurance comes in. It tops up your statutory benefits to reduce or eliminate the financial gap.
Government-Subsidized (Pflege-Bahr)
The government subsidizes private nursing insurance with 5 euros per month if you contribute at least 10 euros per month. No health checks required. Available to anyone with mandatory nursing insurance.
Typical Costs
- Age 25-30: 15-25 EUR/month
- Age 35-40: 25-40 EUR/month
- Age 45-50: 40-70 EUR/month
- Age 55+: 70-120+ EUR/month
The younger you start, the lower your premiums. For expats planning to remain in Germany long-term, taking out supplementary nursing insurance in your 30s is one of the smartest financial decisions you can make.
What Happens If You Leave Germany?
This is a critical consideration for expats. Your nursing care benefits depend on where you live and what type of insurance you have.
Moving within the EU/EEA
Cash benefits (Pflegegeld) can generally be received abroad within the EU. In-kind benefits (professional care services) are available through the healthcare system of your new country of residence under EU coordination rules.
Moving outside the EU
Statutory nursing care benefits are generally not payable outside the EU/EEA. Once you deregister from Germany, your entitlements typically end. Private supplementary policies may have different terms — check your contract carefully.
Frequently Asked Questions
Yes. Pflegeversicherung is mandatory for everyone with health insurance in Germany. If you are in GKV, it is automatically included. If you are in PKV, you must purchase a separate Pflegepflichtversicherung policy from your private insurer. There is no opt-out.
Absolutely. It is a legal requirement regardless of age or health status. Moreover, starting early means lower premiums in PKV, and you build up entitlements over time. Accidents or sudden illness can create care needs at any age.
Within the EU/EEA, benefits are generally portable and you can receive cash benefits (Pflegegeld) abroad. Outside the EU, benefits are typically suspended once you deregister from Germany. Private supplementary policies may have different international coverage terms.
The MDK (Medical Service) or Medicproof (for PKV) conducts an in-home assessment. They evaluate six areas: mobility, cognitive/communicative abilities, behavior, self-care, managing illness, and social participation. Points are totaled to determine your Pflegegrad (1-5).
For expats planning to stay in Germany long-term, supplementary nursing insurance (Pflegezusatzversicherung) is highly recommended. The statutory benefits cover only a fraction of actual care costs. A private top-up policy at age 30-35 can cost as little as 15-25 euros per month and provides significant additional coverage.
Understand Your Full Coverage
Nursing care insurance is just one part of the picture. Our comprehensive guide covers everything you need to know about health insurance as an expat in Germany.