Care grades 1 to 5 in Germany: how the points work and what each grade pays

German long-term care insurance (Pflegeversicherung) uses five care grades (Pflegegrade). The grade depends on the total points from the assessment: 12.5 to under 27 points means grade 1, 27 to under 47.5 grade 2, 47.5 to under 70 grade 3, 70 to under 90 grade 4 and 90 to 100 points grade 5 (§ 15 SGB XI, Book XI of the German Social Code). From grade 2, for example, the monthly care allowance ranges from €347 to €990.

The five care grades at a glance

Care grade	Total points	Impairment of independence
1	12.5 to under 27	minor
2	27 to under 47.5	considerable
3	47.5 to under 70	severe
4	70 to under 90	most severe
5	90 to 100	most severe, with special care requirements

Under German law, a person needs care if health problems limit their independence so that they rely on help from others, and if this is expected to last at least six months (§ 14 SGB XI). In cases with an exceptionally high need for help (a so-called special needs constellation), grade 5 can be awarded even below 90 points.

The six assessment modules

An assessor from the Medical Service (Medizinischer Dienst, or Medicproof for people with private insurance) looks at how independent the person is in six areas of life. Each module produces individual points, which are then weighted.

Module	Examples	Weighting
1 Mobility	moving from bed to chair, walking around the home, stairs	10 %
2 Cognitive and communication skills	orientation, memory, everyday decisions	15 % together with module 3
3 Behaviour and psychological problems	restlessness at night, anxiety, refusing help	15 % together with module 2
4 Self-care	washing, dressing, eating, drinking, toilet	40 %
5 Coping with illness- and therapy-related demands	medication, dressings, doctor’s appointments	20 %
6 Everyday life and social contacts	daily routine, sleep, keeping in touch	15 %

For modules 2 and 3, only the higher weighted score counts. Adding up all weighted points gives the total score and therefore the care grade. Housekeeping is not assessed as a separate module but is reflected in the other areas.

Young children

Children are compared with children of the same age who are developing typically. Babies and toddlers up to 18 months are placed one grade higher than their points alone would give.

Benefits per care grade in 2026

All amounts have been unchanged since 1 January 2025.

Benefit	Grade 1	Grade 2	Grade 3	Grade 4	Grade 5
Care allowance (Pflegegeld) / month	-	€347	€599	€800	€990
Benefits in kind (Pflegesachleistung) / month	-	€796	€1,497	€1,859	€2,299
Day and night care / month	-	€721	€1,357	€1,685	€2,085
Relief amount (Entlastungsbetrag) / month	€131	€131	€131	€131	€131
Respite and short-term care / year	-	€3,539	€3,539	€3,539	€3,539
Consumable care aids / month	€42	€42	€42	€42	€42
Home adaptation per measure	€4,180	€4,180	€4,180	€4,180	€4,180

You can work out your own entitlement with the care benefits calculator. The guides on the care allowance and on benefits in kind and the combination benefit explain the main benefits in detail.

What grade 1 includes

Under § 28a SGB XI, grade 1 mainly covers supportive benefits: care advice, a home advisory visit every six months, care aids, home adaptation grants, care courses for relatives and the relief amount of €131 a month. There is no care allowance and no benefits in kind at this grade.

How to get a care grade

You apply to the care insurance fund (Pflegekasse), which sits with the health insurer. A simple informal request is enough to start. The Medical Service then arranges an assessment, usually at home. The guide on applying for a care grade covers the process, preparation and appeals.

Three tips for the assessment:

• Keep a short care diary for a few days, noting what help is needed and how often.
• Have doctors’ letters, medication plans and hospital discharge letters ready.
• Do not play things down. Many people present their best side on the day even though they need much more help in daily life.

Higher grade and appeals

If the person’s condition gets worse, you can apply for a higher grade at any time. If you think a decision is wrong, you can lodge an objection (Widerspruch). The deadline is stated in the notice. Ask for a copy of the assessment report so you can check the points for each module.

Planned reform: stricter thresholds for new assessments

The German government plans changes from 2027 with the Care Reorganisation Act (Pflegeneuordnungsgesetz, PNOG, cabinet draft of 30 September 2026). Among other things, it proposes stricter thresholds for new assessments. People who already have a care grade are meant to keep it. The law has not been passed and details may change. Until it is enacted, the rules described here apply.

Legal sources

• § 15 SGB XI: determining the care grade
• § 28a SGB XI: benefits at care grade 1

This guide gives a general overview and does not replace individual care or legal advice. The decision and information from your care insurance fund are binding.