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Apply for a care grade (Pflegegrad)

Pflegekasse · Application, assessment and deadlines

InformalAssessment at home

The application for a care grade (Pflegegrad) does not have to take any particular form: a phone call, an email or a line on paper is enough. You do not need to give reasons or provide evidence to submit it – all of that only comes at the assessment stage.

Something else is decisive, namely the date. Benefits are paid from the month the application is submitted, not from the assessment and not from the official notice (Bescheid). Anyone who hesitates for two months to gather documents first gives up two months of benefits – submit the application first and gather documents afterwards.

Then a deadline starts to run that many people do not know about. And there is a rule that hardly anyone knows, even though it is worth real money: under § 18c Abs. 1 SGB XI the long-term care insurance fund (Pflegekasse) must “notify its decision in writing no later than 25 working days after receipt of the application”. If it fails to do so, subsection 5 requires it to pay you “€70 for each week or part of a week by which the deadline is exceeded” – initially within 15 working days of the deadline expiring, and thereafter without delay for every further week. This does not apply if the Pflegekasse is not responsible for the delay, or if you are already receiving full-time residential care with at least Pflegegrad 2.

And there is a second deadline with a consequence of its own: if, under § 18 SGB XI, no assessment has taken place within 20 working days of the application, the Pflegekasse must give you a list of independent assessors to choose from. Here too, hardly anyone will point this out to you unprompted.

Last updated27 August 2026
Legal basis§ 18 SGB XI · § 18c SGB XI · § 15
VerificationChecked against gesetze-im-internet.de (consolidated version)
Written and reviewed byAndrés Sánchez Botta
Independent information page: we are not your Pflegekasse, not an authority and not a paid advisory service — we do not submit applications on your behalf. All information comes from official sources and is explained simply here; binding information always comes from the competent body. Not legal advice. The care grade awarded depends on the assessment of the individual case. All information without guarantee. We are neither lawyers nor tax consultants: we document administrative procedures and check the information against the official source — this is information, not legal or tax advice.
ApplicationFree of charge and informalA phone call is enough
Decision25 working days§ 18c Abs. 1 SGB XI
In case of delay€70 per week§ 18c Abs. 5
Benefits fromMonth of applicationNot from the notice
Required documents

What you need

For the application itself: nothing

The application does not have to take any particular form. A phone call to the Pflegekasse is enough, and the fund then sends you the documents. Have the application date confirmed – it determines from when payment is made.

A care diary over one to two weeks

The single most important document in the whole assessment, and it costs nothing. Note daily what help is needed, how often and for how long – including at night, including prompting and encouragement. What is not written down is usually overlooked on the day of the assessment.

Medical findings and discharge letters

Discharge reports, specialist findings, diagnosis overviews. They document what the assessor cannot see in one hour – in particular fluctuating conditions and illnesses with good and bad days.

Current medication plan

It shows the scope and complexity of care. Also bring the medication itself along if handling it is part of the problem – blister packs, injections, inhalers.

Who should be present at the assessment

A carer or a person you trust should definitely be present. On the day of the assessment, many people present themselves as more capable than they are in everyday life – not deliberately, but out of politeness and pride. Someone who knows their everyday life can correct this.

Health insurance card and identity document

For identification at the appointment. Also have a power of attorney ready if relatives are to handle the matter – without it, the fund gives no information.

Step by step

How to proceed

  1. 1

    Call today, do not gather documents first

    The application is informal and takes effect from the month it is submitted. Call the Pflegekasse, say that you are applying for a care grade, and have the date confirmed. You can prepare everything else afterwards, calmly.

  2. 2

    Request care advice (Pflegeberatung) — you are entitled to it

    After the first application, the Pflegekasse must offer you an advice appointment within two weeks, or issue an advice voucher. Use this before the assessment: the advice explains what the assessor will look at.

  3. 3

    Keep a care diary

    One to two weeks, daily, specific. The Medical Service (Medizinischer Dienst, MD) assesses independence in six modules – mobility, cognitive and communicative abilities, behaviour, self-care, dealing with illness and therapy, everyday life and social contacts. Write something down for each of them.

  4. 4

    Attending the assessment appointment — honestly, not bravely

    The assessment usually takes place at home. The most common mistake is putting on a brave face: “I can manage” leads directly to too low a grading. Describe a bad day, not your best one, and let the carer fill in the gaps.

  5. 5

    Keep the 20-working-day rule in mind

    If no assessment has taken place after 20 working days, the fund must give you, under § 18 SGB XI, a list of independent assessors to choose from. Ask for it – it rarely happens on its own.

  6. 6

    Claim the €70 after 25 working days

    If the written notice has still not arrived by then, an entitlement to €70 for each week or part of a week arises under § 18c Abs. 5 SGB XI. Note the date of the application and keep count. Claim the amount in writing if it is not paid automatically.

  7. 7

    Request the assessment report, even if approved

    You are entitled to a copy of the assessment report. Always request it – even if the notice is positive. Only then can you see how each module was assessed, and only then can you later justify an application for a higher care grade or an objection (Widerspruch).

Fee information

Costs and payment

Costs, deadlines and what you are owed if there is a delayThe application is free of charge — the delay is not
Application and assessmentFree of charge
Form of the applicationInformal, also by phone
Benefits fromMonth of application
Decision of the PflegekasseNo later than 25 working days
If the deadline is missed€70 for each week or part of a week
Without an assessment after 20 working daysEntitlement to a list of assessors

The application and the assessment cost nothing, and the application does not have to take any particular form – a phone call is enough. What matters financially is the application date: benefits are granted from the month the application is submitted, not from the assessment and not from the notice. That is why the rule is: apply first, then prepare. After that, two deadlines run, both in your favour. First: if, under § 18 SGB XI, no assessment takes place within 20 working days, the Pflegekasse must give you a list of independent assessors to choose from. Second, and financially tangible: § 18c Abs. 1 SGB XI obliges the fund to “notify its decision in writing no later than 25 working days after receipt of the application”. If it fails to do so, under subsection 5 it must pay “€70 for each week or part of a week by which the deadline is exceeded” – initially within 15 working days of the deadline expiring, and thereafter without delay for every further week. Exceptions apply where the fund is not responsible for the delay, or where you are already receiving full-time residential care with at least Pflegegrad 2. Note the application date – without it you cannot check the calculation. A point about jurisdiction that explains many misunderstandings: the Pflegekasse is a separate institution, but under § 46 SGB XI it is established at the health insurance fund (Krankenkasse). You write to the same address and often speak to the same office – but legally they are two funds with two different catalogues of benefits. That is why so many benefits end up filed under the wrong one.

Good to know

Important notes

The application is informal. A phone call is enough. Do not wait until you have the documents together – those come later.

Benefits are paid from the month the application is submitted. Not from the assessment, not from the notice. Every month of hesitation is a month lost.

25 working days, otherwise €70 per week. § 18c Abs. 5 SGB XI. Note the application date and do the sums.

After 20 working days without an assessment you are entitled to a list of assessors. § 18 SGB XI – ask for it.

Have someone accompany you to the assessment. Someone who knows your everyday life can correct the overly positive picture that almost everyone presents out of politeness.

The care diary is the strongest document and costs nothing. One to two weeks are enough, but they must be specific.

Always request a copy of the assessment report – even if approved. Without it, you will have nothing to base any later arguments on.

Use care advice before the assessment. After the first application, the fund must offer an appointment within two weeks or issue an advice voucher.

Avoid these mistakes

Common mistakes

Gathering documents first and applying afterwards. The most costly mistake on this page: every month of delay is a month without benefits, and the application is informal.

Putting on a brave face at the assessment. “I can manage” leads to too low a grading. Describe a bad day.

Going to the assessment alone. Without someone who knows everyday life, exactly the part the assessor cannot see is missing.

Not claiming the €70. It arises by operation of law, but is rarely transferred automatically.

Not requesting the assessment report. It is the basis for any later application for a higher care grade and for any objection.

Keeping quiet about help needed at night. It is regularly forgotten and weighs heavily in the assessment.

Frequently asked questions

Questions and answers

How do I submit the application?

Informally. A phone call to your Pflegekasse is enough, as is an email or a short letter: “I hereby apply for long-term care insurance benefits.” You do not need to give reasons or attach any documents; the fund will then send you what it needs. Only one thing matters: have the application date confirmed. Benefits are granted from the month the application is submitted – not from the assessment and not from the notice. The order is therefore: apply first, then prepare. The application can also be submitted by relatives with a power of attorney.

How long is the Pflegekasse allowed to take?

25 working days. § 18c Abs. 1 SGB XI obliges it to “notify its decision in writing no later than 25 working days after receipt of the application”. If it fails to do so, subsection 5 applies: it must pay you “€70 for each week or part of a week by which the deadline is exceeded” – initially within 15 working days of the deadline expiring, and thereafter without delay for every further week. Even the first day of delay triggers the full weekly payment, because every week that has begun counts. Exceptions apply if the fund is not responsible for the delay, or if you are already receiving full-time residential care with at least Pflegegrad 2. Shorter assessment deadlines apply in special situations – for example in hospital or in a hospice.

What happens if nobody comes for the assessment?

Then you have a right to choose that hardly anyone knows about. § 18 SGB XI provides that the Pflegekasse must give you a list of independent assessors if no assessment has taken place within 20 working days of the application – you may then choose from this list. In practice this means: if nothing has happened after four weeks, call and request the list. In parallel, the 25-working-day deadline for the notice continues to run, so in this situation the €70 rule often applies as well.

How does the assessment work?

It generally takes place at home, is carried out by the Medical Service and usually lasts about an hour. What is assessed is independence in six modules: mobility, cognitive and communicative abilities, behaviour and psychological problems, self-care, dealing with illness- or therapy-related requirements, and organising everyday life and social contacts. The weighting of these modules produces a points score, which in turn determines the Pflegegrad. So it is not about diagnoses but about what a person can still do for themselves – a difference on which many expectations founder. Prepare specifically for each module.

Why do I need a care diary?

Because one hour of assessment cannot reflect what adds up over a day or a week – and because much of it has become so routine that nobody mentions it any more. Note down daily for one to two weeks what help is given, how often and for how long: getting up, washing, dressing, eating, medication, toilet visits, getting up at night, reminding and motivating, accompanying to appointments. In particular, night-time needs and the time spent on prompting and guidance are regularly forgotten and weigh heavily in the assessment. The diary costs nothing and is the most effective document in the whole process.

When do I start receiving money?

From the month the application is submitted – retroactively, as soon as the Pflegegrad has been established. So if you apply in March and the notice arrives in May, you also receive payment for March and April. This is why the informal application should be submitted straight away rather than once everything is together. Conversely, there is no benefit for the period before the application, however bad things were at the time. Anyone who spends months wondering whether it is “bad enough yet” loses exactly those months – and the application commits you to nothing.

What if I disagree with the result?

Then you lodge an objection: in writing, within one month of notification of the notice. First, be sure to request the copy of the assessment report, to which you are entitled – without it you do not know how each module was assessed and cannot argue anything specific. The objection is free of charge. This is to be distinguished from an application for a higher care grade: that is the right route if the condition has worsened since the assessment, and there is no waiting period for it.

Do you get anything at all with Pflegegrad 1?

Yes, although considerably less than from Pflegegrad 2 upwards. At Pflegegrad 1 there is no Pflegegeld (long-term care allowance) and no benefit in kind, but there is, among other things, the additional relief allowance (Entlastungsbetrag) of €131 a month, care aids for consumption of up to €42 a month, grants for improving the home environment and care advice. In full-time residential care, people in need of care with grade 1 also receive a grant of €131 a month. So it is worth submitting the application even if only a low grade is expected – not least because Pflegegrad 1 opens the door to a later higher grade without having to start from scratch.

Related official procedures

Objection (Widerspruch)
If the grade is too low
Free of charge
Care advice (Pflegeberatung)
Two weeks or a voucher
Free of charge
Pflegegeld (long-term care allowance)
€347 to €990 per month
From Pflegegrad 2

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