A pair of disposable gloves, a bed protection pad, or a care bed can make everyday life at home much easier. But when does insurance cover care aids? The key factors are not just the diagnosis or age, but above all the officially recognized care grade, the home care situation, and the type of product needed. Knowing these requirements makes it easier to plan care and avoid unnecessary out-of-pocket costs.
When does insurance cover care aids?
As a rule, the responsible body is the long-term care insurance fund, which is part of the statutory health insurance provider. It covers care aids under Section 40 of Book XI of the German Social Code (SGB XI) if the person in need of care has an officially recognized care grade and receives care at home, in a shared living arrangement, or in a comparable home setting. The aids must be necessary to make care easier, alleviate symptoms, or enable the person to live as independently as possible.
In principle, eligibility begins at care grade 1. A doctor’s prescription is not mandatory for many care aids. However, it can help support the case for technical products or when care needs are unclear. The long-term care insurance fund assesses in each case whether the product is covered by long-term care insurance and whether the selected option is cost-effective.
Different rules apply to full-time residential care. Products that are part of the standard equipment and care provided by a nursing home are generally supplied by the facility. Residents usually do not have the same monthly allowance for consumable products as they do when receiving care at home.
Consumable products: up to €42 per month
The long-term care insurance fund reimburses up to €42 per month for consumable care aids. This allowance can be used for products that are regularly used up during daily care and help protect the person in need of care or their family caregivers. Any unused balance is generally not carried over to the following month.
Typical reimbursable consumable products include:
- disposable gloves and finger cots
- Hand sanitizer and surface disinfectant
- Disposable face masks and protective aprons
- absorbent disposable bed protection pads
The specific products and reimbursable quantities must suit the day-to-day care routine. For example, someone who mainly provides help with personal hygiene will often need gloves, hand sanitizer, and bed protection pads. Protective aprons or medical face masks may be useful when a higher level of infection protection is needed. The monthly maximum is not a flat cash payment to spend freely, but reimbursement or direct billing for eligible care aids.
Not every hygiene product is covered. Care creams, laundry detergent, wet wipes, and general household cleaners are generally not reimbursable care aids. Incontinence products such as pads or protective underwear are usually supplied as medical aids through statutory health insurance when there is a medical indication. It is important to distinguish between these categories, as responsibility may lie with health insurance, long-term care insurance, or, in some cases, another benefits provider, depending on the product.
Technical care aids are billed differently
Technical aids for care are durable products that make caregiving safer or promote independence. These may include care beds, standing aids, personal emergency response systems, bath lifts, shower and toilet aids, patient lifts or special positioning aids. If there is an existing risk of pressure ulcers, the provision of suitable pressure ulcer prevention aids can also be assessed. Which solution is appropriate depends, among other things, on mobility, body weight, the living environment, transfer needs and the level of support required by the caregiver.
Long-term care insurance funds often provide technical aids for care on a loan basis. This is particularly useful for products such as care beds or lifts that are needed only temporarily or require regular maintenance. If a product is to be purchased, a person with statutory insurance may have to pay 10% of the cost, up to a maximum of €25 per aid. This co-payment may be waived in cases of hardship.
Being eligible does not automatically mean that every requested model will be funded. Coverage is provided for adequate, appropriate and cost-effective care. Additional features, comfort functions or a particular appearance may incur out-of-pocket costs if they are not medically or care-related necessary. Before placing an order, you should therefore clarify which version will be approved and whether delivery, instruction, maintenance or repair costs are included.
Aids for care or aids covered by health insurance?
These terms are often used interchangeably in everyday conversation, but they are subject to different rules. Aids for care are primarily intended to make caregiving easier or support independent living at home. The long-term care insurance fund decides on coverage under long-term care insurance law.
By contrast, aids covered by statutory health insurance treat, prevent the worsening of, or compensate for an illness or disability. Examples include rollators, compression aids, inhalation and respiratory therapy devices, aspirators, orthopedic aids or medically necessary incontinence products. A doctor’s prescription is often required. Depending on the purpose of the care, some products may fall into different benefit categories. For example, a shower chair is primarily intended to make personal hygiene safer, while a particular therapy device may be used for medical treatment.
How to submit your application correctly
For disposable products, an application or declaration of cost coverage to the long-term care insurance fund is often sufficient. Once approval has been granted, many specialist providers handle the monthly billing directly with the fund. The person requiring care then receives the necessary products at home on a regular basis without having to submit new receipts every month.
It is particularly important to have technical aids for care assessed in advance. Describe the care situation specifically: Is the person unable to get out of bed safely? Can they only transfer into the bathtub with considerable physical effort? Is there an increased risk of falling or a risk of skin damage from lying down for long periods? The more clearly the need is explained, the easier it is for the long-term care insurance fund to assess the provision.
Useful documents include the care level decision, a product description or cost estimate and, where applicable, a doctor’s prescription or statement from the care service. Recommendations from the care assessment report may also be helpful. Measures to improve the home environment, such as bathroom modifications or the installation of a fixed ramp, are subject to separate grant rules. These measures are not considered aids for care and must be applied for separately.
What should you do if the long-term care insurance fund denies your request?
A denial should not be accepted without question. First, check the reasons given: Is proof of the care level missing, has the product been assigned to a different benefit category, or does the insurer consider it unnecessary? An application can often be strengthened with a more precise description of the need, a medical statement or a recommendation from the home care service.
You can appeal a decision within the stated deadline. The appeal should be made in writing and clearly explain why the aid is needed for the specific care situation. General statements are rarely enough. A practical example is more effective, such as explaining that a family caregiver cannot carry out transfers safely and without straining their back without a patient lift, or that without bed protection pads, cleaning and care require considerably more effort.
People with private long-term care insurance should submit invoices and supporting documents to their private mandatory long-term care insurance provider. Reimbursement rules are often based on statutory benefits, but details may depend on the policy and any entitlement to public-sector assistance. Clarifying costs before making a purchase can help avoid surprises here, too.
Review needs regularly
Requirements for medical aids change as a person’s health changes. After surgery, a raised toilet seat may only be needed temporarily. If mobility continues to decline, a care bed, transfer aids or a pressure-relieving mattress may become necessary later on. It is also worth reassessing needs after a hospital stay, before family caregivers become physically overburdened or avoidable risks arise at home.
Care aids are an essential part of care. When chosen well, they protect caregivers’ health, preserve dignity and comfort, and make the home safer. Discuss your needs with the long-term care insurance fund early and choose products that suit the actual care situation—not just a picture in a catalogue.
