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How Do I Apply for a Care Level? A Step-by-Step Guide

People in need of long-term care may be eligible for benefits under the long-term care insurance program. 
In this article, we’ll walk you through all the necessary steps for applying for a long-term care level—from making initial contact to the visit by the medical service, and including how to file an appeal if your application is denied or your long-term care level is lower than expected.

What is a care level?

A care level is the official classification used to assess the extent to which a person in need of care is limited in their ability to perform daily activities and to determine whether this qualifies them for a care level and, consequently, entitlement to benefits. There are five care levels in total, and different benefits may be available depending on the care level. 

Applying for a Care Level – The Steps

1. Contact your long-term care insurance provider
2. Fill out the application
3. The Medical Service schedules an evaluation appointment
4. Preparing for the Medical Service's Evaluation
5. Schedule an appointment with the Medical Service
6. Review the decision and file an appeal if necessary 

Who can apply for a care level—and what are the requirements?

The following individuals may apply to the long-term care insurance program for a long-term care level: 

The requirement is that the individual must have been covered by social long-term care insurance for at least 2 years during the 10 years prior to filing the application—family coverage may also count toward this period.

In addition, the impairments are expected to last for at least 6 months. 

The diagnosis is rarely the deciding factor in determining a care level. What matters to the long-term care insurance provider is how the limitations affect the person in need of care in their daily life.

Where and how do I apply for a long-term care level?

Individuals with statutory health insurance must submit an application for a long-term care level to the long-term care insurance fund associated with their health insurance provider or that of their family member. They can submit the application by phone, in writing, or using a form provided by the long-term care insurance fund.

It is recommended that you submit the request in writing, as this will allow you to prove when it was submitted.

Important Information:

Make a note of the date you submitted the application and, if necessary, keep a copy of the letter.
After you contact them, you will receive the application form from the long-term care insurance fund. On this form, you should describe your need for assistance in daily life as specifically as possible. If you are acting on behalf of another person, clarify whether a power of attorney or other proof of authorization is required.
Privately insured individuals should submit the application to their private insurance company. 

As a general rule, a decision on an application for a long-term care level must be made within 25 business days, although exceptions provided for by law are possible.

How do I prepare for the medical examination by the Medical Service?

Next, the long-term care insurance fund sends a confirmation of receipt and schedules an assessment appointment with the Medical Service. 

During this appointment, which usually takes the form of a home visit, an assessment is made of how independently a person can manage their daily life and in what areas they need assistance.
The typical procedure: 

The Medical Service’s assessment serves as the basis for the long-term care insurance provider’s decision regarding whether the person in need of care will receive benefits and, if so, which ones. Family members and the person in need of care should prepare thoroughly for this appointment (which must be scheduled well in advance): 

To ensure that the Medical Service gains as complete a picture as possible of the person’s daily life during the visit, it is essential that the person have a trusted individual present. This person can serve as a reminder and provide specific examples of the support the person has already received in daily life prior to submitting the application.  

What does the Medical Service evaluate during the care level assessment?
 

The Medical Service assesses how independently the person in need of care can manage daily life and where they regularly require assistance. In other words, the decisive factor is always how independently the person in question can handle specific everyday situations.
The assessment focuses primarily on six areas where assistance is deemed necessary:

The areas are evaluated according to established criteria and then combined on a weighted basis. 

Was your care level denied or deemed too low? Here's how to file an appeal

Please read the decision and the information on legal remedies carefully. If you agree with the decision, the next step is to select and arrange the appropriate services.  

If the application is denied or if the care level is lower than expected, individuals in need of care and their family members may file an appeal against the decision within one month. 

Care Levels for Children and Adolescents: What Are the Specific Considerations?

A care level for children is granted not only for physical and mental disabilities, but also for chronic conditions such as diabetes, as well as rare or life-limiting illnesses. Developmental or behavioral disorders such as autism or ADHD can also be grounds for a care level.

For more information, read our article Children and Adolescents in Need of Care: What to Keep in Mind

FAQ: Frequently Asked Questions About Applying for a Long-Term Care Level

Can I submit the application on behalf of a family member?

Yes, family members and trusted individuals may also submit the application; a power of attorney may be required in some cases.

Where do I apply for a long-term care level?

Contact the affected person's long-term care insurance fund. Those with private insurance should contact their insurance company.

Do I have to submit all the documents when I file the application?

No. To submit the application, you only need to provide the most important personal information and indicate your need for long-term care services. You can submit the documents required for the assessment later.

How long will it take to reach a decision?

As a general rule, the long-term care insurance fund must make a decision within 25 business days. Exceptions are possible.

What does the Medical Service examine during the assessment?

The Medical Service assesses how independently the person functions in daily life and where they need assistance.

How do I prepare for the medical examination by the Medical Service?

Record the care needs in a care journal and describe the daily situation realistically.

What can I do if my application is denied or if my care level is too low?

You have one month to file an appeal. Please observe the deadline and follow the instructions in the notice.

What should I do if my health gets worse?

If your need for care has increased significantly, you can file a claim for a reassessment with the long-term care insurance fund.