Costs & payers

Who covers which costs?

An orientation on the different statutory and contractual routes for home care – and why the responsible health insurance fund decides in each individual case.

Home care can be financed through different routes. Which fund is responsible and which services are covered depends on the type of care, the medical prescription, the care degree and the decision of the respective fund in each individual case. This page is a first orientation, not legal or financial advice.

Which service, which route

Treatment nursing

Treatment nursing is a service of the health insurance under SGB V. It is prescribed by a doctor – for example wound care, dressing changes or medication administration. Whether and to what extent the health insurance fund approves the prescribed service is decided by the fund in each individual case.

Basic care and nursing support

Basic care is a service of the long-term care insurance under SGB XI. A care degree is usually required.

Household help

Whether and to what extent the long-term care insurance fund covers household services depends on the individual case – for example the care degree and the type of service. We go through the options with you rather than promising a reimbursement that may not apply in your case.

Advisory visit under § 37 para. 3 SGB XI

Anyone who receives care allowance and is cared for at home by relatives must request an advisory visit at fixed intervals. This visit is a service of the long-term care insurance.

Out-of-hospital intensive care

Out-of-hospital intensive care is a service of the health insurance under SGB V and is prescribed by a doctor. The scope is decided by the health insurance fund in each individual case.

What does this mean for your enquiry?

You don't need to know which fund is responsible or which documents are needed for a first enquiry. We clarify that together with you and tell you which steps are next.

Which documents may be needed later

Medical prescription (for treatment nursing: prescription for home nursing care)
Care-degree notice (for long-term care insurance services)
Details of your health insurance or long-term care insurance fund
For out-of-hospital intensive care: medical prescription and documents on the ventilation situation

The responsible fund decides in each individual case

This page offers general orientation. It does not replace advice in individual cases. Whether and to what extent a fund covers costs is decided by the responsible health or long-term care insurance fund based on the individual situation. For your specific question, call us.

Make an enquiry

A phone call or email is enough. You don't need to prepare anything.