Choosing your Swiss deductible: the calculation behind the right franchise

How the deductible works – and what comes after it

The deductible is the amount of healthcare costs you carry entirely yourself per calendar year before basic insurance starts to pay. Adults choose between six tiers, children between seven – for children, a CHF 0 deductible is available. The higher the tier, the lower your premium; the discount is legally capped, however, at no more than 70 percent of the additional risk you take on.

The deductible is not the end of cost sharing. Above it, you pay a co-payment (Selbstbehalt) of 10 percent of further costs – limited to CHF 700 per year for adults and CHF 350 for children. For hospital stays, adults additionally contribute CHF 15 per day towards the cost of the stay; children and young adults in education are exempt. Your maximum annual cost risk is therefore clearly bounded: deductible plus the co-payment cap, plus any hospital days.

• Adults: deductible of CHF 300, 500, 1000, 1500, 2000 or 2500 per year.
• Children: deductible of CHF 0, 100, 200, 300, 400, 500 or 600 per year.
• Co-payment above the deductible: 10 percent, capped at CHF 700 (adults) or CHF 350 (children).
• Hospital contribution: CHF 15 per day for adults; waived for children and young adults in education.

The break-even calculation: premium savings versus cost risk

At its core, choosing a deductible is a total-cost comparison: annual premium plus the costs you carry yourself at your expected level of use. A higher deductible pays off exactly when the premium savings exceed the additional costs you take on when you do need care. The point where two tiers cost the same is the break-even – and it sits in a different place depending on your region and insurer, because premiums, and with them the savings, vary regionally.

A deliberately simplified example – the figure is invented: suppose moving from the CHF 300 to the CHF 2500 deductible cuts your premium by CHF 1500 per year. Your additional risk is the difference between the two deductibles, CHF 2200. In a year with hardly any medical costs, you keep the full CHF 1500. In a bad year you pay up to CHF 2200 more in deductible – a net CHF 700 worse than the low tier. Between those two poles lies the break-even: the level of annual healthcare costs above which the low deductible becomes the cheaper choice.

One thing the break-even can never do is disappear entirely: because the premium discount is legally capped at 70 percent of the additional risk you take on, the savings always stay below the difference between the deductibles – so above a certain level of costs, the low tier is always the cheaper choice. Where that point lies in your premium region is what our calculator works out for your profile, as a total-cost comparison across all deductible tiers using the official FOPH premiums.

Rules of thumb: which tier suits whom

Two profiles are clear-cut – everything in between is decided by the calculation:

• Healthy, rarely at the doctor, no regular medication: the highest deductible (CHF 2500) is often the cheapest choice – the premium savings recur every year, the risk only materialises in bad years.
• Regular medication, a chronic condition or treatments already planned: the lowest deductible (CHF 300) is usually the better choice – you will reach the cost-sharing threshold anyway, so it should be as low as possible.
• Pregnancy planned or expected: lean towards a low deductible – the details follow in the next section.
• Unsure or somewhere in between: calculate the break-even instead of guessing – your medical bills from the last two or three years give you a realistic cost base.

Special cases: pregnancy and children

An important exemption applies to expectant mothers: maternity services proper – check-ups, the birth and postpartum care – are exempt from the deductible and co-payment throughout the entire pregnancy. From the 13th week of pregnancy until eight weeks after the birth, treatments for illness are additionally exempt from cost sharing. Outside these windows, normal cost sharing applies. If you are planning a pregnancy, calculate conservatively – that often favours a low deductible, because costs beyond the exempt services can still arise.

For children the logic is the same, only the amounts are smaller: tiers run from CHF 0 to CHF 600, the co-payment is capped at CHF 350, and the hospital contribution does not apply. Because check-ups and paediatrician visits are frequent in early years, the break-even calculation more often comes out in favour of a low deductible for children – our calculator runs the numbers per person.

A second rule is often forgotten: only choose a deductible you could actually pay in a bad year. For healthy adults the top tier is a bet with a good expected value – but the deductible falls due when the costs arise, not conveniently spread across the year. If you do not hold a reserve of that size, a middle or low tier is the calmer choice.

Changing your deductible: deadlines and how it works

A change of deductible always takes effect on 1 January. If you want to lower your deductible, you must notify your insurer by 30 November; raising it is possible until the end of December. The change is not a switch of insurer: no termination is needed, a notice to your own health insurer is enough – best in writing, so receipt is documented.

Important for planning: the deductible counts per calendar year and resets to zero every 1 January, regardless of when in the year your costs arose. Scheduling a larger, movable treatment into the same calendar year as other costs is therefore often cheaper than spreading it across the year end. And if you are switching insurer anyway, you simply select the deductible directly on the application with the new insurer – the deadline for the switch itself (termination by 30 November) is unaffected.