German statutory care insurance faces insolvency without federal loans, Medical Service warns

Germany's long-term care insurance is on track for insolvency without federal loans, the Medical Service of the Statutory Health Insurance Funds (MDK) warned on May 19, as the system absorbs a doubling of recipients in a decade. GKV-Spitzenverband chairman Oliver Blatt said reform was urgent and demanded "financial honesty" from the federal government on what care insurance is and is not supposed to fund.

Spending on care exceeded €70 billion in 2025, with 6 million people drawing benefits -- twice the number from ten years earlier. The MDK assessed 3 million applicants last year, and almost 80% were granted a care grade and the right to benefits in cash or in kind. About one in five recipients are in stationary care (Heim), the most expensive option at roughly €20 billion a year for the insurance fund.

The cost of Heim care has become a structural risk for residents themselves. The average co-payment in the first year of stationary care is €3,245 per month. Berlin briefly considered delaying Heim subsidies until residents had been in care for a longer period, but dropped the proposal after public protest. A DAK study projects that, on current trends, 46.2% of nursing-home residents in 2035 will be reliant on municipal social welfare to cover the gap.

Blatt called on the federal states to take over Heim investment costs, which residents currently pay out of pocket and which average roughly €500 per month -- a transfer he said would directly reduce co-pays without further loading the insurance fund. He criticised the federal government for using care insurance to fund items that should be borne by society as a whole, including COVID-era payments and pension contributions for family caregivers. Without federal loans, he said, the system was heading for the point where it could no longer meet obligations.

Carola Engler, MDK deputy chairwoman, said prevention should be treated as a core task for the service: fall prevention, work on risk factors such as obesity and isolation, and tighter coordination between the MDK, care funds and providers including physicians. Eighty per cent of all recipients are cared for at home, often by ageing spouses whose own health depends on whether respite and aids reach them in time.

The warning lands in a sequence: on May 12 a separate fact sheet on Care Day mapped 6 million current recipients rising to 6.8-7.6 million by 2055, and a Zweibrücken nursing-home case study showed residents on €3,233-per-month tariffs depleting savings into municipal welfare.