What is a Pflegegrad-Bescheid?
A Pflegegrad-Bescheid is the formal decision from your Pflegekasse (long-term care fund, part of your Krankenkasse) after assessing how much help you need in daily life. It assigns a Pflegegrad from 1 (minor) to 5 (most severe) and states which benefits you can claim.
Almost everyone with statutory health insurance has a linked Pflegekasse. You apply when you or a relative need help with washing, dressing, mobility, eating, or household tasks because of illness or disability.
How you get here — the MDK assessment
After you submit a Pflegeantrag (care application), the Pflegekasse usually sends the Medizinischen Dienst (MDK) or a similar assessor for a home visit. They use the NPB (Neues Pflegebewertungssystem) questionnaire covering six modules:
- Mobilität — moving, stairs, transfers
- Kognitive und kommunikative Fähigkeiten — orientation, understanding
- Verhaltensweisen und psychische Problemlagen — dementia-related behaviour, anxiety
- Selbstversorgung — washing, dressing, eating, toilet
- Umgang mit krankheitsbedingten Anforderungen — medication, doctor visits
- Gestaltung des Alltagslebens — daily structure, social contact
The assessor scores points (Punkte); the total maps to your Pflegegrad. You can have someone present during the visit — strongly recommended.
The MDK also reviews work capacity for Krankengeld — that is a separate assessment with a different outcome letter.
Pflegegrad levels 1–5
- Pflegegrad 1 — slight impairment; mainly advice and prevention (Entlastungsbetrag €125/month)
- Pflegegrad 2 — considerable need for care
- Pflegegrad 3 — severe need for care
- Pflegegrad 4 — most severe need for care
- Pflegegrad 5 — hardest special cases with exceptional nursing needs
Higher grade means higher Pflegegeld (cash) and/or Pflegesachleistungen (professional care hours). Amounts are fixed by law and updated periodically.
What the Bescheid contains
- Assigned Pflegegrad and points total
- Start date of entitlement (Bewilligungszeitraum)
- Monthly Pflegegeld amount if you chose or receive cash benefits
- Budget for Pflegesachleistungen (home care services)
- Entlastungsbetrag and other add-ons (day care, respite care)
- Instructions for Widerspruch (objection) — one month from delivery
- Reference to the MDK Gutachten (expert report)
Request a copy of the Gutachten if the grade seems wrong — you need it to challenge the scoring.
Pflegegeld vs Pflegesachleistungen
Pflegegeld — monthly cash paid to the person in care, usually for help from relatives (informal carers). You must organise care yourself; the Pflegekasse may check plausibility.
Pflegesachleistungen — budget for certified home-care services (Ambulanter Pflegedienst). Often higher value than Pflegegeld alone — many families combine both (Kombinationsleistung) if a professional partly covers needs and family fills the rest.
Entlastungsbetrag (€125/month from Pflegegrad 1) and Verhinderungspflege (substitute carer when regular carer is unavailable) are separate pots — claim them even if you already receive Pflegegeld.
Common follow-up letters
- Bewilligung — approval with grade and amounts
- Teilbewilligung — partial approval pending more documents
- Ablehnung — no Pflegegrad assigned (Pflegegrad 0) — always appeal if care need exists
- Herabstufung — downgrade after reassessment
- Nachforderung — request for missing medical reports
Widerspruch — if the grade is too low
File Widerspruch within one month of receiving the Bescheid. It must be in writing (letter or fax; email only if the Pflegekasse accepts it).
- State clearly that you disagree with the Pflegegrad
- Request the full MDK Gutachten and assessment sheets
- Attach GP and specialist letters, hospital discharge summaries, care diaries
- Ask for a new assessment if circumstances worsened since the visit
Many successful appeals gain one or two grade levels. A Patientenfürsprecher (patient advocate) or Pflegeberatung (free care counselling) can help for free.
Reassessment and upgrades
Care needs can change. You can apply for Höherstufung (higher grade) when health deteriorates — no need to wait for the routine review. The Pflegekasse may also schedule periodic begutachtungsfreie Verlängerung (extension without new MDK visit) for stable cases.
If you receive Herabstufung, check whether the MDK actually saw worsening facts or relied on outdated information — Widerspruch applies here too.
Impact on other benefits
Pflegegeld counts as income for Wohngeld and Bürgergeld in some situations — but care-related amounts are often treated more favourably than wages. Report changes to those offices when your Pflegegrad starts.
Pflegegrad does not replace health insurance or sick pay — it is an additional long-term care benefit under SGB XI.
When to get help
- Pflegegrad 0 or much lower than your actual care hours
- MDK visit lasted only a few minutes or ignored key disabilities
- Dementia or psychiatric needs seem under-scored
- Deadline for Widerspruch is within days
- Herabstufung threatens your home care arrangement
Contact Pflegeberatung (§ 7a SGB XI), your Krankenkasse's care branch, or a lawyer specialising in social law (Sozialrecht).
Key terms glossary
| Pflegegrad | Care grade 1–5 based on care need |
| Pflegekasse | Long-term care insurance fund |
| MDK | Medical assessment service (Medizinischer Dienst) |
| Pflegeantrag | Application for care benefits |
| Pflegegeld | Monthly cash care benefit |
| Pflegesachleistungen | In-kind professional home care budget |
| Entlastungsbetrag | Monthly relief allowance (from grade 1) |
| Verhinderungspflege | Respite care when carer is unavailable |
| Gutachten | MDK expert report behind the decision |
| Widerspruch | Formal objection — one month |
| Höherstufung | Application for higher Pflegegrad |
| Herabstufung | Downgrade to lower Pflegegrad |
Still not sure what your letter wants?
- ✓ Plain English summary of your Pflegegrad and monthly amounts
- ✓ Check whether Pflegegeld vs Sachleistungen fits your situation
- ✓ One-month Widerspruch deadline highlighted
- ✓ Draft Widerspruch or Pflegeantrag follow-up in German
Last updated: June 2026