An unexpected visit to A&E, a prolonged course of physiotherapy or regular treatment can completely change the actual cost of your insurance that year. That’s why knowing how to choose an insurance excess in Switzerland isn’t about looking for a figure that seems low or high: it’s about deciding what proportion of the risk you can and are willing to bear within your budget.
The excess is one of the factors that most influences the monthly premium for compulsory basic health insurance. A higher excess usually reduces the premium. However, if you need medical care, that saving can quickly cease to be worthwhile. The right choice depends on your health, your family situation, your savings and how much you value predictability.
What is the excess in Swiss basic health insurance?
The excess is the annual amount you pay yourself for covered services before the insurer starts to cover the costs. For adults, the usual options range from CHF 300 to CHF 2,500. For children, you can choose a deductible of between CHF 0 and CHF 600.
Once you have reached your excess, your contribution towards costs does not disappear completely. You usually also pay 10 per cent of subsequent costs, up to an annual limit set for basic health insurance. In certain cases, such as hospitalisation, additional co-payments may apply. Therefore, comparing only the monthly premium gives an incomplete picture.
The statutory cover provided by basic health insurance is the same, regardless of the excess you choose. The difference lies in how you split the cost between a fixed monthly premium and any out-of-pocket payments when you use medical services.
How to choose an insurance excess in Switzerland based on your profile
The useful question is not ‘which excess costs the least?’, but ‘which scenario can I manage without financial strain?’. To answer this, start by reviewing your last one or two years: consultations, medicines, specialists, therapies, tests or treatments that are likely to continue. It’s not about predicting everything, but about spotting patterns.
If you anticipate frequent medical expenses or already know you’ll need treatment, a low excess usually offers greater peace of mind. You’ll pay a higher premium, but you’ll reach the point at which the insurer starts to contribute towards the costs sooner. This option may be sensible for people with a chronic condition, planned treatments, a medically monitored pregnancy or recurring therapy needs.
If you rarely visit the doctor, do not take long-term medication and have sufficient financial reserves, a high excess may be a better fit. In exchange for a lower premium, you agree to cover a larger proportion of the costs should a problem arise that year. It is not a gamble on your health: it is a decision based on your financial capacity and risk tolerance.
Between these two extremes are those who only use medical services occasionally. An annual check-up, a preventive screening or an occasional infection do not necessarily determine the best excess. In these cases, it is worth comparing the annual saving on your premium with the extra cost you would incur if you had average or high medical expenses.
Work out the figures based on three scenarios, not just on a hunch
A clear choice stems from clear figures. For each excess you’re considering, work out the annual cost in three scenarios: a year with few medical expenses, a year with moderate expenses and a year with high expenses.
The basic formula is simple: monthly premium multiplied by twelve, plus the excess you’re likely to end up paying, plus your subsequent share of the costs where applicable. You don’t need to guess the exact amount of each bill. It’s enough to understand where the balance lies between a lower premium and greater exposure to out-of-pocket costs.
Consider two options. The first has a low excess and a higher monthly premium. The second reduces the premium, but significantly increases what you would pay if you need treatment. If the annual saving from the second option is small compared to the difference in excess, taking on more risk may not make sense. If the saving is considerable and you have sufficient funds available, the decision may be different.
This calculation is particularly relevant for households with several insured members. Each member has their own excess and their own healthcare usage. It is not advisable to automatically copy your partner’s choice or apply the same figure to all your children. An adult on regular medication and another who rarely uses healthcare services may require different arrangements.
The available funds are just as important as the premium
An excess of CHF 2,500 is only manageable if you can afford to pay that amount when the need arises. And, in practice, it is wise to also factor in the subsequent cost-sharing. Choosing a high excess without a savings buffer can turn an unexpected medical expense into a cash flow problem.
Think of that reserve as money set aside for healthcare, not as a theoretical figure. Could you pay several hundred or thousands of francs within a few months without taking out a loan, delaying other essential payments or foregoing a necessary medical appointment? If the answer is no, a lower excess may be a more reassuring choice, even if the monthly premium is higher.
Stability matters too. Someone who has just started a new job, moved to a different canton or is managing a tight household budget may prefer slightly higher monthly costs in exchange for reducing uncertainty. There is no one-size-fits-all answer.
Don’t confuse the excess, the insurance model and the cover
The excess is a cost lever, but it does not operate in isolation. The premium also varies depending on your canton and premium region, your age, the insurance model chosen and accident cover, where applicable. Models such as the GP scheme, telemedicine or HMO may determine the first point of contact for your care and affect the premium, but they do not alter the basic cover defined by law.
It is useful to review these decisions separately. First, choose a excess that is consistent with your risk exposure. Next, consider which model best suits the way you access healthcare. Finally, check that your details regarding residence, age and accident cover have been entered correctly. A reliable comparison should show which factor accounts for each price difference.
At Lamalux®, a visual experience based on verified data helps to break down these variables. With no sponsored rankings or opaque recommendations, you can see more clearly which part of a price difference stems from the excess, the model or your region of residence. You retain control over your data and any contact with a personal adviser.
When to review your decision
Your excess shouldn’t be a ‘set-and-forget’ decision. Review it every year before the relevant deadlines, especially if your medical, family or work situation has changed. A new diagnosis, a planned operation, the arrival of a child, a change in income or a move house can alter the balance.
It’s also a good idea to confirm the terms and dates directly with your insurer, as the deadlines for changing a excess may vary depending on the type of change. Waiting until you have a large bill on your desk usually leaves little room for manoeuvre.
Don’t choose the highest excess out of habit, nor the lowest out of fear. Choose the one you can explain in a single simple sentence: ‘This premium fits my budget, and I can cope with this level of unexpected expenditure.’ That clarity is worth more than a sales pitch and allows you to decide calmly when the next review period comes around.