Long-term care insurance & care grades (Pflegegrade) in the Kenntnisprüfung

The son of Mrs M., 84, notices that his mother has hardly been able to cope on her own for weeks. He asks you where and when he should apply for a care grade. What do you advise?

• At the GP with a medical certificate; the practice forwards the application after the next check-up
• As soon as possible at the Pflegekasse – an informal application is enough; benefits are paid at the earliest from the month of application
• Directly at the Medizinischer Dienst (Medical Service), which after the assessment also decides on the care grade itself
• At the Sozialamt (social welfare office), which arranges the assessment and provisionally covers the costs until the decision

Explanation: The application goes to the Pflegekasse (based at the health insurance fund) and can be made informally. Benefits are not paid retroactively before the month of application – so apply early. The Medizinischer Dienst only assesses; the decision is made by the Pflegekasse.

Mr D., a retired civil servant (Beamter), has private health and long-term care insurance and has applied for a care grade. Who usually carries out the assessment?

• The Medizinischer Dienst of his health insurance fund, on site
• An assessor from the Gesundheitsamt (public health office)
• His GP as part of a home visit
• MEDICPROOF on behalf of the private insurer

Explanation: For privately insured people, MEDICPROOF assesses according to the same criteria and with the same assessment instrument as the Medizinischer Dienst does for those with statutory insurance. The GP at most provides findings but does not assess.