Spending your twilight years abroad – what if I need care?

A house by the sea, mild temperatures, a relaxed daily life: for many people, spending their retirement abroad is a long-cherished dream. But as appealing as this idea is, it also raises important questions. One of the key questions is: what actually happens if I need care whilst living abroad?

If you make sure you’re well-informed in good time, you’ll be well prepared should the need arise. This article provides an overview of the key aspects of health and long-term care insurance, benefits abroad and organisational challenges.

Health insurance abroad: You need the right cover

Regardless of whether you currently require care or not, health insurance is the most important foundation. The key factor here is whether you are living within or outside the EU.

Residence within the EU

For short, temporary stays, the European Health Insurance Card (EHIC) applies – this can be found on the back of your German health insurance card. This entitles you to medical treatment in the country concerned in the event of an emergency.

Important: The EHIC only covers necessary medical treatment during a temporary stay – but not long-term care.

Long-term residence in another EU country

Anyone who moves permanently to another EU country must bear a few things in mind:

• You are required to register in your new country of residence
• It is strongly recommended that you obtain an S1 certificate

This allows you to access the healthcare system in your country of residence, whilst the costs continue to be covered by your German health insurance. Without this arrangement, you may face gaps in care or financial burdens.

Staying outside the EU

The situation is quite different outside the EU:

• Coverage under German health insurance is generally suspended
• You often have to pay for treatment in full yourself

Therefore, private international health insurance is essential – and is also advisable within the EU, for example to cover repatriation, upfront costs for treatment, or additional services not covered locally.

The need for care abroad: What are the legal implications?

According to the Social Code (SGB XI), a person is considered to be in need of care if they are expected to require assistance for more than six months. The good news is that, in principle, you may still be entitled to benefits under the German long-term care insurance scheme whilst abroad – subject to certain conditions.

Application and assessment

• The application is still submitted to the German long-term care insurance fund
• The assessment is carried out by the Medical Service
  • either by assessors visiting the patient at home
  • or via partner organisations abroad
  • or alternatively by telephone, video call or on the basis of documentation

What benefits are available abroad?

Care allowance: The most common benefit

In practice, care allowance is usually the only benefit paid. This means that you organise the care yourself locally, for example through family members or private carers.

Respite budget

If your private carer is unable to provide care, a respite budget of up to €3,539 per year is available. This can be used to organise short-term support.

Important note: Hospital stays lasting more than four weeks must be reported. During this period, the care allowance will be suspended.

Care benefits abroad: only available to a limited extent

Services such as home care, residential care or the provision of medical aids are significantly restricted abroad. They can only be used if you have an S1 certificate and the services are available in the country in question. The regulations vary greatly from country to country. You must notify your German long-term care insurance provider if you wish to make use of these services. Be sure to check in advance!

The special case of the Netherlands

There is a special agreement between Germany and the Netherlands that simplifies certain procedures. Anyone planning to move there should definitely find out more, as different rules may apply.

When relatives stay in Germany: organising care from a distance

A particularly challenging situation: the person in need of care lives abroad, whilst their family lives in Germany.

Power of attorney for healthcare: Not valid everywhere

A lasting power of attorney issued in Germany is not automatically valid abroad. Within the EU, it may be recognised in certain cases, for example if it has been notarised and refers to international regulations. Our recommendation: clarify well in advance which regulations apply in the destination country.

Support for relatives in Germany

Even if the person requiring care lives abroad, certain rights apply to relatives in Germany.

Short-term leave from work in an emergency:

• Up to ten days’ leave per year
• Entitlement to a care allowance as a wage replacement

For longer periods of leave, options include:

• Care leave
• Family care leave
• End-of-life care

These are taken without continued pay, but with the option of an interest-free loan. Important: A medical certificate is required for this, even if issued abroad.

What you should consider before moving abroad

Living abroad requires careful planning, particularly when considering old age.

Organisational aspects

• Deregistering with the local registry office
• Notifying the authorities of your change of address
• Updating or transferring bank accounts

Medical and nursing care

Questions you should definitely ask yourself:

• How good is the local medical infrastructure?
• Where is the nearest hospital?
• How quickly is help available in an emergency?
• Is palliative care available?
• How easy is it to access medication and…

Social environment

• Is there a local network or community?
• Are there social contacts or opportunities to socialise?
• Isolation can be a major risk in old age.

Language and culture

• Are there any language barriers that could cause problems in an emergency?
• How do care and support work in the local community from a cultural perspective?

Emotional aspects

• Family and close friends are often far away
• Getting help with everyday tasks can become more difficult
• These factors are often underestimated, but they are crucial to quality of life.

Legal matters

• Wills and inheritance law abroad
• Different legal regulations

It is advisable to seek legal advice at an early stage.

Returning to Germany

A topic that is often overlooked, but very important: what happens if a return becomes necessary?

• Is there a realistic option for returning?
• How is care organised in Germany in that case?

Conclusion: Good preparation brings peace of mind

Spending your retirement abroad can be an excellent decision, provided the right conditions are in place.

The following are particularly important:

• comprehensive health insurance
• clarity regarding long-term care insurance benefits
• a realistic assessment of local care provision
• thorough preparation for emergencies

The need for care often arises unexpectedly. By finding out about the options and making arrangements in good time, you can ensure that you spend your later years safely and independently, even if you are living abroad.