Deductible and co-payment: the difference explained simply

Two terms, one form of cost sharing

Anyone who receives medical services in Switzerland pays part of the costs themselves — the so-called cost sharing of basic insurance. It consists of two elements that apply one after the other: first the deductible, then the co-payment.

The deductible is the fixed amount you pay in full yourself each calendar year before your insurer starts paying. The co-payment only comes into play after that: you bear 10% of the costs above the deductible — up to an annual cap.

The deductible: a fixed annual amount of your choice

Adults choose between the ordinary deductible of CHF 300 and the optional deductibles of 500, 1'000, 1'500, 2'000 and 2'500. Children have no ordinary deductible (CHF 0); levels up to CHF 600 can be chosen.

The deductible does not change the benefits — in basic insurance these are identical by law at every insurer. It only shifts who pays how much: a low deductible means a higher premium and little personal risk, a high deductible a lower premium and more personal risk. As a rule of thumb: if you rarely see a doctor, a high deductible often works out cheaper; if you have regular costs, a low deductible does.

The co-payment: 10% with a cap

Once the deductible has been used up, your insurer covers further costs — minus a 10% co-payment. The co-payment is capped: adults pay at most CHF 700 in co-payments per year, children at most CHF 350. Mathematically, the maximum is reached as soon as treatment costs of CHF 7'000 (CHF 3'500 for children) have accumulated after the deductible — beyond that, no further co-payment is due.

Two special cases: for original medicines for which a generic is available, the co-payment can be higher. And in hospital, adults additionally pay a contribution of CHF 15 per day towards the costs of the stay — this does not apply to children or to young adults in education.

Worked example: from doctor's visit to statement

Suppose your treatment costs covered by basic insurance total CHF 2'500 in one calendar year — outpatient, without a hospital stay.

For context, the maximum annual risk: with a CHF 300 deductible, cost sharing is at most CHF 1'000 per year (deductible plus the full co-payment), with a CHF 2'500 deductible at most CHF 3'200 — in each case excluding the hospital contribution of CHF 15 per day. This is how the calculation looks for an adult:

• With a CHF 300 deductible: you pay the first CHF 300 in full yourself. On the remaining CHF 2'200 you bear a 10% co-payment, i.e. CHF 220. Your cost sharing: CHF 520 — the insurer covers CHF 1'980.
• With a CHF 2'500 deductible: the entire costs fall within the deductible. You pay the full CHF 2'500 yourself; no co-payment is due.

When cost sharing does not apply or is credited

An important exception applies to maternity: from the 13th week of pregnancy until 8 weeks after the birth, neither deductible nor co-payment is charged for general benefits and nursing care in the event of illness (Art. 64 para. 7 KVG).

If you switch insurer during the year (for example as of 1 July), cost sharing does not start again from scratch: the new insurer credits the deductible and co-payment already invoiced in the same calendar year (KVV Art. 103 para. 4). Keep your previous insurer's cost-sharing statement as proof.

Conclusion: submit your invoices, review your deductible every year

Submit all invoices to your insurer — including those below the deductible. This is the only way your deductible balance is recorded correctly and your annual statement is accurate. For outpatient treatment, you usually pay the invoice yourself first and submit it to your insurer (“tiers garant”); in hospitals and pharmacies, the provider usually bills the insurer directly (“tiers payant”). Reimbursement is usually made within 2 to 4 weeks, minus cost sharing.

If your deductible no longer suits your situation, you can change it with your own insurer as of 1 January each year: report a lower deductible by the end of November; most insurers accept a higher one until the end of December. In the easyall calculator you can work through different deductibles and models directly — and easy, our AI guide, answers detailed questions about cost sharing right in the comparison.