With Swiss health insurance, you pay more than monthly premiums. When you see a doctor, need medication or receive hospital treatment, you usually also contribute to the treatment costs. This is where the deductible and co-payment come in. But what is the difference, and how much do you actually pay yourself?
The deductible is the amount you pay yourself first each year. Once you have reached it, your health insurer generally covers 90 % of further covered costs. You pay the remaining 10 % as a co-payment, but only up to a statutory limit.
This guide uses simple examples to explain how the deductible and co-payment work, which amounts apply in 2027 and how to calculate your healthcare costs.
What is the difference between a deductible and a co-payment?
The deductible and co-payment are two components of cost sharing under compulsory health insurance.
| Deductible | Co-payment | |
|---|---|---|
| What does it mean? | Amount you pay yourself first | Share of further costs |
| When does it apply? | At the start of covered healthcare costs in a calendar year | Once the deductible is reached |
| How much is it? | CHF 300 to CHF 2'500 for adults | Normally 10 % |
| Annual limit | Amount of the chosen deductible | CHF 700 for adults |
| Does it reset each year? | Yes | Yes |
| Can I choose it myself? | Yes, from the deductible levels offered | No |
Put simply: you pay the deductible first, then the co-payment. Your health insurer covers the remaining cost of insured services.
1. What is a health insurance deductible?
The deductible is a fixed annual amount up to which you pay covered treatment costs yourself.
For adults, the lowest deductible is CHF 300 and the highest is CHF 2'500 per calendar year.
You can choose from the following six deductibles:
| Deductible for adults | Meaning |
|---|---|
| CHF 300 | Lowest deductible, normally a higher premium |
| CHF 500 | Slightly lower premium |
| CHF 1'000 | Medium cost sharing |
| CHF 1'500 | Higher cost sharing |
| CHF 2'000 | High cost sharing |
| CHF 2'500 | Highest deductible, normally a lower premium |
Insurers are not required to offer every optional deductible.
Example: CHF 300 deductible
You have chosen a CHF 300 deductible.
In January, you see a doctor. The treatment costs CHF 200.
As you have not yet reached your deductible, you pay the full CHF 200 yourself.
In March, you receive another medical bill for CHF 400.
You first pay another CHF 100 of this bill to reach your full CHF 300 deductible.
A 10 % co-payment applies to the remaining CHF 300, which comes to CHF 30.
Your health insurer covers the remaining CHF 270.
The calculation therefore looks like this:
| Amount | |
|---|---|
| First medical bill | CHF 200 |
| Second medical bill | CHF 400 |
| Total treatment costs | CHF 600 |
| Your deductible | CHF 300 |
| Your co-payment | CHF 30 |
| You pay in total | CHF 330 |
| The health insurer pays | CHF 270 |
For all further covered treatment costs in the same year, you normally pay only the co-payment until its annual limit is also reached.
Do I have to pay the deductible every year?
No. The deductible is not an additional annual fee.
You pay it only to the extent that relevant healthcare costs actually arise.
If you have a CHF 2'500 deductible but do not need any medical services all year, you do not have to pay any deductible.
You pay only your regular health insurance premiums.
However, if you incur CHF 800 in healthcare costs with a CHF 2'500 deductible, you must pay that CHF 800 yourself.
2. What is the co-payment?
Once you have reached your full deductible, your health insurer contributes to further covered treatment costs.
You normally pay a 10 % co-payment, while your health insurer covers the remaining 90 %.
For adults, the standard co-payment is limited to CHF 700 per calendar year.
Example: calculating the co-payment
You have already paid your full CHF 300 deductible.
You now receive another medical bill for CHF 1'000.
The costs are split as follows:
| Amount | |
|---|---|
| Treatment costs | CHF 1'000 |
| 10 % co-payment | CHF 100 |
| Health insurer covers 90 % | CHF 900 |
You therefore pay only CHF 100 yourself.
When do I stop paying a co-payment?
Once you have reached the standard CHF 700 co-payment limit in the current calendar year, your health insurer generally covers further insured costs in full.
However, special rules on increased co-payments apply to certain medicines. A hospital contribution may also be payable.
3. What is the maximum annual cost sharing?
For adults, the standard maximum cost sharing is the chosen deductible plus an annual co-payment of no more than CHF 700.
| Deductible | Maximum standard co-payment | Maximum regular cost-sharing |
|---|---|---|
| CHF 300 | CHF 700 | CHF 1'000 |
| CHF 500 | CHF 700 | CHF 1'200 |
| CHF 1'000 | CHF 700 | CHF 1'700 |
| CHF 1'500 | CHF 700 | CHF 2'200 |
| CHF 2'000 | CHF 700 | CHF 2'700 |
| CHF 2'500 | CHF 700 | CHF 3'200 |
What does this mean in practice?
With the lowest deductible of CHF 300, you pay no more than CHF 1'000 per year for standard covered treatment costs.
With the highest deductible of CHF 2'500, the maximum is CHF 3'200.
Important: these limits apply to standard cost sharing. They do not include your monthly health insurance premiums, any hospital contributions or services not covered by basic insurance.
In addition, certain medicines with an increased co-payment of 40 % may result in higher actual cost sharing.
4. Calculation examples: who pays how much?
How much you pay yourself depends on your deductible and the amount of covered healthcare costs.
Let’s compare the CHF 300 and CHF 2'500 deductibles.
Example with CHF 2'000 in healthcare costs
| CHF 300 deductible | CHF 2,500 deductible | |
|---|---|---|
| Treatment costs | CHF 2'000 | CHF 2'000 |
| Deductible paid | CHF 300 | CHF 2'000 |
| Co-payment | CHF 170 | CHF 0 |
| You pay | CHF 470 | CHF 2'000 |
| Health insurer pays | CHF 1'530 | CHF 0 |
With a CHF 300 deductible, your health insurer already covers a large part of these treatment costs.
With a CHF 2'500 deductible, however, you must pay the entire CHF 2'000 yourself because you have not yet reached the deductible.
However, a higher deductible usually means lower monthly premiums.
Example with CHF 10'000 in healthcare costs
| CHF 300 deductible | CHF 2,500 deductible | |
|---|---|---|
| Treatment costs | CHF 10'000 | CHF 10'000 |
| Deductible paid | CHF 300 | CHF 2'500 |
| Co-payment | CHF 700 | CHF 700 |
| You pay | CHF 1'000 | CHF 3'200 |
| Health insurer pays | CHF 9'000 | CHF 6'800 |
With high healthcare costs, the standard maximum cost sharing is reached.
Your health insurer then covers further insured costs, subject to special statutory rules.
Comparison at different levels of healthcare costs
| Covered healthcare costs | Your share with a CHF 300 deductible | Your share with a CHF 2'500 deductible |
|---|---|---|
| CHF 0 | CHF 0 | CHF 0 |
| CHF 200 | CHF 200 | CHF 200 |
| CHF 500 | CHF 320 | CHF 500 |
| CHF 1'000 | CHF 370 | CHF 1'000 |
| CHF 2'000 | CHF 470 | CHF 2'000 |
| CHF 5'000 | CHF 770 | CHF 2'750 |
| CHF 10'000 | CHF 1'000 | CHF 3'200 |
The table considers only standard cost sharing for fully covered medical services. Premiums, hospital contributions and special rules are excluded.
5. What is the difference between a health insurance premium, deductible and co-payment?
In addition to the deductible and co-payment, you also pay a monthly health insurance premium.
These three amounts serve different purposes.
Health insurance premium: the fixed amount you pay each month for insurance cover, regardless of whether you need medical services.
Deductible: the annual amount up to which you initially pay your covered treatment costs in full yourself.
Co-payment: your share of further covered treatment costs after you have reached your deductible.
Example of your total annual costs
Suppose you pay CHF 400 per month for health insurance and have a CHF 300 deductible.
Over the whole year, you incur CHF 2'000 in covered healthcare costs.
| Cost type | Amount |
|---|---|
| Health insurance premiums (12 × CHF 400) | CHF 4'800 |
| Deductible | CHF 300 |
| Co-payment | CHF 170 |
| Your total annual costs | CHF 5'270 |
This example shows why you should look beyond the monthly premium when comparing health insurers.
A low premium may come with higher potential cost sharing.
6. When does the deductible reset?
Under Swiss basic insurance, the deductible and co-payment are calculated afresh each calendar year.
This means that annual cost sharing starts again on 1 January.
If you have already reached your full deductible and maximum co-payment in 2026, this does not automatically carry over to 2027.
From 1 January 2027, you must reach your chosen deductible again through relevant healthcare costs.
What happens to medical bills from December?
Generally, what matters is the date of medical treatment, rather than the date you receive the bill.
For example, if you receive treatment on 20 December 2026 but the bill arrives only in February 2027, the treatment counts towards cost sharing for 2026.
For longer treatments, services may be assigned to different calendar years according to the relevant treatment period.
Do I have to pay the deductible twice if I change health insurer?
No. If you are allowed to change basic insurance during the year, cost sharing you have already paid is taken into account.
You therefore do not have to pay the full annual deductible and maximum co-payment again solely because you change insurer.
Ask your previous health insurer to confirm which amounts have already been credited.
7. Deductible and co-payment for children
Children and adolescents have lower cost sharing than adults.
The standard deductible is CHF 0. Parents can voluntarily choose a higher deductible of up to CHF 600 to reduce premiums.
The standard co-payment for children is also 10 %, but no more than CHF 350 per calendar year.
| Adults | Children | |
|---|---|---|
| Standard deductible | CHF 300 | CHF 0 |
| Highest optional deductible | CHF 2'500 | CHF 600 |
| Maximum standard co-payment | CHF 700 | CHF 350 |
| Maximum standard cost sharing with the lowest deductible | CHF 1'000 | CHF 350 |
| Maximum standard cost sharing with the highest deductible | CHF 3'200 | CHF 950 |
Example: child with a CHF 0 deductible
Your child incurs CHF 1'000 in covered healthcare costs over the year.
As no deductible applies, the health insurer normally calculates the 10 % co-payment directly.
You therefore pay CHF 100, while the health insurer covers CHF 900.
With higher healthcare costs, the standard co-payment rises to a maximum of CHF 350 per calendar year.
Special rule for families
If several children from the same family are insured with the same insurer, additional limits apply to their combined cost sharing.
With the standard CHF 0 deductible for children, total standard cost sharing for all the children together is limited to CHF 1'000 per year.
Special calculation rules apply to higher optional child deductibles.
This family rule may be relevant when choosing health insurance for several children.
8. Do I have to pay extra in hospital?
Yes. For an inpatient hospital stay, a statutory hospital contribution of CHF 15 per day generally applies in addition to the deductible and co-payment.
This contribution helps cover food costs during the hospital stay.
It has no time limit and is not included in the standard co-payment cap.
The discharge day and days of leave are not counted as hospital days subject to the contribution.
Who does not have to pay the hospital contribution?
The following are exempt from the hospital contribution:
- Children and adolescents up to age 18
- Young adults up to age 25 who are in education or training
- Women receiving statutory maternity services
For other insured people, the hospital contribution can be an additional financial burden during a longer inpatient stay.
9. When do I pay neither a deductible nor a co-payment?
There are statutory exceptions to standard cost sharing.
Pregnancy and maternity
Certain maternity services are exempt from both the deductible and co-payment.
These include statutory pregnancy check-ups, childbirth and other specific maternity services.
In addition, from the 13th week of pregnancy until eight weeks after childbirth, women are also exempt from cost sharing for general medical services and nursing care in the event of illness.
During this period, this also applies to illnesses not directly related to the pregnancy.
Certain preventive examinations
Cost sharing is also waived fully or partly for certain statutory preventive measures.
Examples include certain examinations under recognised breast or colorectal cancer screening programmes.
The applicable exceptions depend on the examination and statutory conditions.
Accident insurance through your employer
If you are insured through your employer under the Accident Insurance Act (UVG), covered accident treatment is generally billed without a deductible or co-payment.
If accident treatment is handled through basic insurance, however, the same cost sharing rules as for illness normally apply.
10. Why do I have to pay a 40 % co-payment for certain medicines?
The health insurance co-payment is normally 10 %.
However, an increased co-payment of 40 % applies to certain medicines.
This affects medicines that exceed a certain price threshold compared with interchangeable products containing the same active ingredient.
This is intended to encourage insured people to choose cheaper, equivalent medicines.
Does this affect only original medicines?
No. The increased co-payment can apply to original products, generics and biosimilars.
What matters is the pricing rule for the medicine concerned.
If a doctor expressly prescribes a more expensive product for medical reasons, the increased co-payment may be waived.
Does the CHF 700 limit still apply?
A special rule applies here.
For medicines with a 40 % co-payment, not all of the amount actually paid counts towards the annual co-payment limit.
As a result, actual cost sharing may exceed the standard CHF 700, or CHF 350 for children.
Once the relevant annual co-payment limit is reached, no further co-payment is charged even for these medicines.
Our tip: ask your doctor’s practice or pharmacy whether a cheaper interchangeable product with the standard co-payment is available for a prescribed medicine.
11. Which healthcare costs count towards the deductible?
Generally, costs count towards your deductible if the services are covered by basic insurance under the Health Insurance Act and are subject to standard cost sharing.
These may include:
- Medical consultations
- Medically necessary examinations
- Covered medicines
- Prescribed and covered therapies
- Medically necessary hospital treatment
- Covered laboratory tests
However, not every health-related expense counts towards the deductible.
What is not credited?
For example, ordinary gym memberships, uncovered dental treatment or wholly private services do not automatically count towards your deductible.
Monthly health insurance premiums do not count towards the deductible either.
Services exempt from statutory cost sharing are not normally credited towards the deductible either.
Important: if you pay a medical bill yourself because you have a high deductible, still have your health insurer record it. This ensures that the amount you have already paid is correctly credited towards your annual deductible.
12. Who pays the medical bill: me or the health insurer?
Cost sharing is governed by law. However, billing can work in two different ways.
Tiers garant: you receive the bill
Under this system, the doctor’s practice sends the bill directly to you.
You submit it to your health insurer. The insurer checks which costs are covered and reimburses the relevant amount after deducting your cost sharing.
Tiers payant: the health insurer receives the bill
Under this system, the doctor’s practice, pharmacy or hospital bills your health insurer directly.
Your health insurer pays the bill and then charges you your deductible and co-payment.
In both cases, the same statutory rules generally apply to the deductible and co-payment. The main difference is the payment and billing process.
13. Which deductible is worthwhile for me?
The deductible affects both your cost sharing and your monthly health insurance premium.
As a general rule:
- A low deductible normally means higher monthly premiums but lower potential cost sharing.
- A high deductible normally means lower monthly premiums but greater financial risk when you need medical treatment.
The best deductible therefore depends on your expected healthcare costs and personal financial situation.
Example: CHF 300 or CHF 2'500 deductible?
Suppose you save CHF 1'400 in annual health insurance premiums with the CHF 2'500 deductible.
If you rarely see a doctor, the higher deductible can be financially advantageous.
However, if healthcare costs are high, you pay up to CHF 2'200 more in standard cost sharing with the CHF 2'500 deductible than with the CHF 300 deductible.
You should therefore consider both the premium savings and the potential additional cost risk.
Further reading: Which deductible is right for you? CHF 300 or 2,500?
Frequently asked questions about deductibles and co-payments
What is the difference between a deductible and a co-payment?
The deductible is the amount you pay yourself first each calendar year for covered healthcare costs. Once you have reached it, you normally pay 10 % of further covered costs as a co-payment.
How much is the health insurance co-payment in 2027?
The standard co-payment is 10 %, up to CHF 700 per calendar year for adults and CHF 350 for children. Certain medicines may have an increased co-payment of 40 %.
What is the maximum deductible in Switzerland?
For adults, the highest optional deductible is CHF 2'500. For children, the highest legally permitted optional deductible is CHF 600.
With a CHF 2'500 deductible, do I always have to pay CHF 2'500?
No. You pay the deductible only to the extent that relevant healthcare costs actually arise. If you have no such costs during the year, no deductible is payable.
What happens if my medical bill exceeds the deductible?
You first pay the outstanding part of your deductible. A 10 % co-payment normally applies to the covered amount above it. Your health insurer pays the rest.
When does the health insurer cover 100 % of costs?
Once you have reached your deductible and maximum standard co-payment, basic insurance generally covers further insured services in full. Exceptions and special contributions may still apply.
Does the deductible reset every January?
Yes. Annual cost sharing starts again on 1 January. It is generally the treatment date, rather than the billing date, that determines the year.
Do medicines count towards the deductible?
Yes, if the medicines are covered and subject to cost sharing. After the deductible is reached, a co-payment normally applies, with an increased rate of 40 % for certain medicines.
Do health insurance premiums count towards the deductible?
No. Monthly health insurance premiums are payable independently of the deductible and co-payment and do not count towards annual cost sharing.
Do I have to pay a deductible and co-payment for an accident?
This depends on which insurer is responsible. Covered treatment under compulsory accident insurance under the UVG generally has no deductible or co-payment. Accident treatment through basic insurance normally involves standard cost sharing.
Do children have a deductible?
The standard deductible for children is CHF 0. Parents can voluntarily choose a higher deductible of up to CHF 600 to reduce monthly premiums.
Do I have to pay a deductible and co-payment during pregnancy?
Statutory maternity services are exempt from cost sharing. From the 13th week of pregnancy until eight weeks after childbirth, general medical services and nursing care in the event of illness are also exempt.
Can I change my deductible during the year?
A regular change of deductible is possible only at the start of a new calendar year. The health insurer must comply with the statutory deadlines.
What happens to my co-payment if I change health insurer?
If you are allowed to switch during the year, amounts already reached are taken into account. You therefore do not have to pay a second full annual cost sharing amount solely because you change insurer.
Conclusion: the deductible and co-payment determine your additional health insurance costs
With Swiss health insurance, you pay a share of your medical treatment costs in addition to your monthly premium.
The deductible is the amount you pay yourself first each year. Once you have reached it, you normally pay a 10 % co-payment.
For adults, standard maximum cost sharing ranges from CHF 1'000 to CHF 3'200 per year, depending on the chosen deductible. Hospital contributions and special statutory rules may apply in addition.
Our tip: when choosing health insurance, compare the monthly premium and also consider your expected healthcare costs and potential cost sharing.
On K-Check, you can compare health insurance premiums for your place of residence and check which combination of deductible, insurance model and health insurer suits your situation.
Sources
- Federal Office of Public Health – Health insurance cost sharing
- Federal Office of Public Health – Optional deductibles
- Federal Office of Public Health – Differentiated co-payments for medicines
- Priminfo – Frequently asked questions about health insurance
- FOPH – Benefits and tariffs, tiers garant and tiers payant