Premiums, deductibles and co-payments: separating healthcare costs

The premium is payable regardless of treatment

In compulsory health insurance, premiums depend on factors including residence, age category, model and insurer. They are not proportional to income. Someone using few services still pays; someone who becomes ill faces more than treatment invoices alone. Similar premiums can therefore produce very different burdens.

Cantonal premium subsidies reduce eligible people’s insurance invoices. They do not automatically pay the deductible. The premium after subsidy must be distinguished from the amounts still payable when care is needed.

Following a covered treatment bill

The ordinary adult deductible is CHF300 per calendar year. Once it has been reached, the ordinary co-payment is 10%, subject to an annual CHF700 cap. Exceptions and special rules apply, so those figures are not a ceiling on every form of medical expenditure.

Consider a limited illustration: an adult with the ordinary deductible receives CHF2,000 in covered services during the year and has not previously used any deductible. In the ordinary case, they pay the first CHF300 and then CHF170 on the remaining CHF1,700. Their cost-sharing amounts to CHF470. Premiums remain payable separately. This example excludes hospital contributions, uncovered services and exempt situations.

A higher deductible shifts more expense to the individual before insurance pays, in exchange for a lower premium. Comparing options therefore requires considering both the regular saving and the amount that would need to be available if treatment became necessary. The smallest monthly figure does not adequately describe that risk.

The year of treatment matters

The deductible follows the treatment date rather than the date of the insurer’s statement. Treatment continuing across two calendar years can therefore encounter two successive deductibles. Medical need does not restart on 1 January. That rule matters when considering the cash required for prolonged care.

Other charges are separate. A hospital stay can carry a daily contribution, with exemptions. Services outside compulsory coverage do not become reimbursable because a deductible has been reached. Supplementary insurance follows its own contract. Any figure described as an annual maximum must therefore specify its scope.

Cash available at the time also matters

An annual burden differs from invoices concentrated within a few weeks. A household can balance spending over a year and still lack the cash needed when treatment becomes essential. Invoice, reimbursement and assistance-payment dates can aggravate that difficulty.

The PCP therefore includes liquidity in its assessment of access, without expecting people to predict their future health with certainty. Payment arrangements and support should be understandable before debts accumulate. Financial organisation is an additional question alongside the total amount; it does not establish that one insurance model suits every circumstance.

Financial comparison cannot replace access policy

Comparing premiums can reduce expenditure, but it does not resolve inadequate disposable income. A person can have formal coverage and lack cash when treatment is needed. The PCP supports considering the cumulative burden: net premiums, cost-sharing and essential uncovered expenditure.

Collective responsibility means preventing these layers of payment from obstructing necessary care. Relief measures should be assessed for their effects on households experiencing illness as well as those using few services. A solidarity-based system cannot be judged solely by the price available to someone able to bear the highest financial risk.