Applying for care aids

No, and this is the most useful rule on this page. § 40 Abs. 5 SGB XI provides that “the benefit institution with which the benefit is applied for checks whether an entitlement exists against the health insurance fund or the long-term care insurance fund and decides on the approval”. So the distinction is not your problem but the funds’ problem – and binding guidelines on this have been adopted for health insurance funds and long-term care insurance funds alike. In practice this means: submit the application to whichever body you would approach anyway, and do not let yourself be turned away. Incidentally, the substantive difference behind this is the purpose: the health insurance fund pays for medical aids (Hilfsmittel) under § 33 SGB V because of illness or disability, while the long-term care insurance fund pays for those that ease care or enable a more independent life.

Care aids for consumption: disposable gloves, bed-protection pads, disinfectant for hands and surfaces, protective aprons and face masks. The amount of €42 a month applies from Pflegegrad 1 and is independent of the grade. In practice this usually takes the form of a monthly delivery to your home, the contents of which you put together yourself – many providers bill the long-term care insurance fund directly, so you neither pay upfront nor submit invoices. Choose according to your actual consumption: products that end up unused in the cupboard use up the same budget as those you actually need.

As a rule nothing or little, because technical care aids are primarily provided on loan – and if they are on loan, there is usually no co-payment. If it does come to a purchase, the co-payment is capped under § 40 Abs. 3 SGB XI: “ten per cent, but no more than €25 per care aid”. So ask explicitly about provision on loan for every technical aid – this applies equally to a care bed, wheelchair, commode, positioning aids and an emergency call system. A side benefit of the loan: maintenance and replacement in the event of a defect are also covered.

Three weeks from receipt of the application – and five weeks if the Medical Service or a care professional is involved. This is set out in § 40 Abs. 7 SGB XI. What matters is the legal consequence: if the fund cannot meet the deadline, it must give you a sufficient reason in writing without delay. If it fails to do so, the requested benefit is deemed approved once the three or five weeks have passed. So note the application date and keep proof that the application was received – without both you cannot rely on the rule.

Yes, and in full. The entitlement under § 40 SGB XI merely requires the person to be in need of long-term care, without distinguishing by grade – the €42 a month for consumable products is available at Pflegegrad 1 just as at grade 5, and technical aids can also be considered. Together with the additional relief allowance (Entlastungsbetrag) of €131 a month and the grants for improving the home environment, this is why it is worth applying for a Pflegegrad even if only grade 1 is expected. Many people with grade 1 assume they are entitled to “nothing yet” and leave these benefits unused.

Not strictly required, but it helps. For consumable products the informal application, or the standing application with the provider, is usually enough. For technical aids, a medical prescription or a professional statement of reasons makes approval considerably easier. The most effective route, however, is one that hardly anyone uses: if the Medical Service recommends an aid in the assessment report, this recommendation acts like an application – you then do not need to apply separately. The same applies to recommendations from the advisory visit. Raise this explicitly at both appointments; it is rarely mentioned unprompted.

Lodge an objection (Widerspruch) – in writing, within one month, and with a statement of reasons based on the three statutory purposes: does the aid ease care, does it relieve discomfort, or does it enable a more independent life? It is enough if one of these applies. A specific description works better than a general one: not “I need a care bed”, but “getting up from the flat bed is not possible without help; the carer has to lift me three times a day and has back pain as a result”. A brief statement from the GP or the care professional on exactly this point carries more weight than a stack of general documents.

For consumable products, largely yes. Most providers let you choose the monthly selection, and it is worth doing so rather than taking a standard box – anyone who needs bed-protection pads but not face masks should allocate the budget accordingly, because unused products use it up just the same. Make sure the provider bills the long-term care insurance fund directly; then you do not have to pay anything upfront. For technical aids the choice is narrower: what matters is that the aid is suitable and necessary – you cannot demand a specific make, but you can argue why a simpler model is not sufficient in the particular case.