Care – Better privately additionally insured

No one wants to deal with it, but anyone can be affected. The care case. Whether it's the parents who become a care case, oneself, or even one's own child. Closing your eyes to the potential care case can be costly. Because the costs associated with care can be immense. Although all affected receive benefits from the statutory long-term care insurance, these are often not enough.

A private supplementary nursing care insurance can close the gap," says Anne-Katrin Schulz, care expert at famPLUS. In the interview, she explains why you should take out supplementary insurance and what to pay attention to.

What costs are covered by the statutory long-term care insurance?

The long-term care insurance fund covers, depending on the awarded level of care, part of the costs for home care by relatives (cash benefit), by an outpatient care service (in-kind benefit), both in combination (combination benefit) or in an inpatient facility such as a nursing home. Additionally, there are other benefits such as the relief amount of 125 euros monthly or respite care with 1,612 euros annually, which can be used for domestic help or support services in the home environment. So fundamentally, all necessary areas, namely care, support, and housekeeping, are supported, but not to a sufficient or necessary extent.

What does that mean?

For the mentioned areas, the long-term care insurance covers about one-third to one-half of the actual necessary costs. However, the area of care or companionship is largely neglected.

Anne Katrin Schulz / Care Specialist

Who has to cover the costs if the money is not enough?

The person in need of care themselves, as well as the children or relatives. However, in an outpatient setting, meaning in-home care, no one can force the children to co-finance. The consequence: The person in need of care or assistance cannot be adequately provided for. They are often alone and unaccompanied. Or the relatives take care of them, which quickly becomes a burden for them—both physically and mentally.

To what extent can the children be held accountable?

If the parents are placed in residential care, the children can be called upon. If the income and assets are not sufficient to pay for a care home, it is checked whether the children can provide parental support. If they are not able to pay, the state steps in in the form of social assistance.

(Editor's note: Also read the interview with Jörn Hauß on the topic of "parental support" titled "When Children Are Liable for Their Parents.")

The monthly costs for outpatient nursing services or a nursing home place can range from around 1000 to 4000 euros. There is no upper limit. On the other hand, how much does private supplementary nursing insurance cost?

This depends on the age at the time of concluding an insurance contract and the choice of insurance type. Additionally, the more additional services are included, the more expensive it becomes.

A 45-year-old woman pays for a Nursing Care Daily Allowance Tariff , which closes the coverage gap, approximately 60 monthly, while at age 55 it is already about 90 euros per month.

What should you be aware of when taking out a private supplementary long-term care insurance?

There are three types of private supplementary long-term care insurance, which can also be combined with each other.

The Nursing care daily allowance insurance is offered in three different forms: as an unsubsidized tariff, a government-subsidized tariff = “Pflege Bahr,” or a combination tariff. The contributions to be paid are mostly provided with a dynamic. Policyholders must therefore consider whether they can still afford this insurance in ten years. The great advantage: If policyholders are cared for at home, they decide for themselves what to use the money for. Whether for an outpatient care service, a caregiver, a household help, or to pay caregiving relatives. But the money can also be used for accommodation in a nursing home if the insurance amount covers the costs for accommodation.

The Care Cost Insurance is the cheapest of the three insurances. For service expenses, evidence of professional care must be provided; caregiving relatives are compensated to a lesser extent.

The Nursing care annuity insurance is the most expensive, but offers several advantages: As with the long-term care daily allowance insurance, the benefit amount is freely available. Contributions can be suspended at any time. Lump sum payments are possible at any time and in the event of cancellation, a portion of the contributions is returned after some time, or a reduced benefit is paid in the event of long-term care.

An important point in decision-making is one's own performance – both at the current time and as one ages. Questions such as "What do I want in old age? What do I need in old age? Can I even afford private long-term care insurance? What other instruments can I use to provide for the future?" are among the topics discussed in a consultation. From this, we then jointly develop a suitable approach or solution.

Keyword "Pflege-Bahr." What does the government's support for such supplementary insurance look like?

The only instance where the state subsidizes the monthly contribution amount with five euros is with daily care allowance insurance in the form of the "Pflege-Bahr" insurance or as a combination tariff. However, this does not necessarily mean that the benefit will be higher in the end. Non-subsidized daily care allowance insurance can be equal or better, and ultimately, the decisive factor is the insurance provider and its services.

Is this a comprehensive insurance or could there be additional costs? If so, for what?

This depends entirely on the scope of the contract concluded. If the insurance confirms the possibility of concluding a contract after the health examination, the next step is to determine what amounts are necessary to completely close the coverage gap. Furthermore, this coverage now depends on the financial monthly capacity of the policyholder.

Are there waiting periods between signing the contract and using the insurance benefits?

A waiting period of three years is quite common. A waiting period of more than five years has been legally prohibited. Depending on the chosen insurance and the amount of premiums, a waiting period may be significantly shorter. There are special regulations in cases of care dependency following an accident.

Since the need for care is legally defined (expected need for care of at least six months, SGB XI), the long-term care insurance fund does not pay if someone requires support for a few weeks or months following an accident. In this case, however, health insurance will cover the costs, possibly supplemented by accident insurance.

Is there a refund if you have not used the supplemental nursing care insurance?

Only in the case of long-term care annuity insurance is there a payout to the heirs – even partially if benefits have been claimed. The other two variants are ultimately risk insurance.

How can famPLUS help?

famPLUS helps in selecting the appropriate insurance or provides information without any pressure. Additionally, other building blocks of provision are discussed and clarified as to whether and how they can be implemented.

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