Swiss Health Insurance Franchise Explained: A Guide for Americans

If you moved to Switzerland from the US, you've probably looked at your health insurance policy, seen the word "Franchise," and assumed it works like the deductible you had back home. It doesn't — not exactly. The mechanics are different, the math is different, and the decision you make once a year (or once and then forget about) can quietly cost or save you over a thousand francs annually. This isn't a scary topic. It's a solvable one, once you understand how the pieces fit together.

How the Swiss Franchise Actually Works

Under Switzerland's mandatory health insurance system (LAMal in French, KVG in German), every resident chooses an annual franchise — the amount you pay entirely out of your own pocket before your insurer starts contributing to medical costs. Think of it as a pre-set spending threshold you select each year, not something imposed on you after the fact. For adults, six standard tiers are available: CHF 300 (the legal minimum), 500, 1,000, 1,500, 2,000, and 2,500 (the legal maximum). Children and adolescents under 18 are exempt from the franchise entirely — they pay only coinsurance, capped at CHF 350 per year.

• CHF 300 — the baseline, mandatory minimum for adults
• CHF 500 — roughly CHF 14/month cheaper than the CHF 300 baseline
• CHF 1,000 — roughly CHF 47/month cheaper
• CHF 1,500 — roughly CHF 80/month cheaper
• CHF 2,000 — roughly CHF 113/month cheaper
• CHF 2,500 — the maximum, roughly CHF 147/month cheaper than the CHF 300 baseline

Swiss Franchise vs. US Deductible: The Critical Difference

In the US, a typical plan works like this: you pay your deductible, then insurance covers a percentage of costs (say 80/20), and eventually you hit an out-of-pocket maximum. Swiss coverage flips the order and simplifies the ceiling. You pay 100% of costs until you reach your chosen franchise. Once you cross that line, you don't jump straight to full coverage — you enter a coinsurance phase where you pay 10% of further costs, and your insurer covers 90%. That 10% coinsurance is capped at CHF 700 per year for adults (CHF 350 for children), which means your total annual exposure is mathematically fixed: your franchise plus a maximum of CHF 700. Choose CHF 300 and your worst-case year costs CHF 1,000. Choose CHF 2,500 and your worst-case year costs CHF 3,200. There's no ambiguity, no network to navigate, and no surprise bill beyond that number — one of the genuine advantages of the Swiss system compared to the complexity many Americans are used to.

The Real Math: Premium Discounts and Out-of-Pocket Maximums

Here's the part that trips people up: a higher franchise doesn't just change what you pay when you get sick — it changes your monthly premium every single month, whether you use the insurance or not. Moving from CHF 300 to CHF 2,500 saves roughly CHF 147 per month, or about CHF 1,764 per year, in premium alone. That's real money banked automatically, before you've spent a franc on care. The trade-off is that if you do need significant treatment, you're covering more of it yourself before coinsurance and the CHF 700 cap step in.

The average adult premium in Switzerland for 2026 sits around CHF 393.30 per month, though this varies significantly by canton, age bracket, insurer, and insurance model. Premiums have also been rising — roughly 4.4% in 2026 — which is part of why the franchise decision deserves an actual look each year rather than a one-time guess when you first arrived.

When a Higher Franchise Saves You Money (and When It Doesn't)

If you're generally healthy and your annual medical spending tends to stay low — say, under CHF 500 a year in routine visits — a higher franchise like CHF 2,000 or CHF 2,500 usually works in your favor. You bank the premium discount every year, and even in a year where something unexpected happens and you hit your full out-of-pocket maximum, you've likely still come out ahead over a multi-year average, because the discount accumulates whether or not that bad year ever arrives.

If you have ongoing conditions, regular specialist visits, planned procedures, or a family with predictable annual costs above roughly CHF 3,000, the calculation flips. A low franchise like CHF 300 means you reach the coinsurance phase — and your fixed CHF 700 cap — much sooner in the year. The premium difference between tiers stops looking like free money and starts looking like the price of avoiding a much larger out-of-pocket swing. This is genuinely a case-by-case calculation, and it depends on your situation — if you're unsure which side of that line you're on, that's worth working through with someone who can look at your actual usage pattern rather than guessing.

Common Mistakes Americans Make With the Franchise Decision

• The "highest-franchise reflex": picking CHF 2,500 automatically because it looks like the biggest discount, without checking whether your actual usage supports it — this can cost CHF 500–1,500 net in a heavy-use year.
• The "lowest-franchise reflex": picking CHF 300 purely out of caution, even with genuinely low usage, forfeiting a premium discount that would have outweighed the risk in most years.
• "Set-and-forget": choosing a franchise once when you land in Switzerland and never revisiting it, even as your health, family situation, or income changes.
• Confusing the Swiss franchise (you pay 100% first, then 10% coinsurance) with the US deductible-then-percentage model, which leads to miscalculating your real annual exposure.

Coinsurance, the Family Picture, and the Fine Print

A few details matter beyond the headline numbers. The 10% coinsurance applies only after your franchise is met, and only up to its CHF 700 (or CHF 350 for children) annual cap — after that, your insurer covers 100% of further covered costs for the rest of the calendar year. If you have a family, each household member selects their own franchise, and costs can compound across a household faster than you'd expect if choices aren't coordinated. It's also worth knowing that if you're newly navigating Swiss coverage as an American — including questions about whether and how you qualify — our guide to health insurance eligibility for US expats in Switzerland covers the basics of getting set up in the mandatory system before you even reach the franchise decision.

Choosing (and Changing) Your Franchise

Your franchise isn't locked in forever. Under Article 7 of the KVG, you can request a change for the following calendar year by notifying your insurer by November 30, effective January 1. That gives you an annual checkpoint — a natural moment to look back at how much you actually spent on care this year and ask whether your current tier still fits. Many people set their franchise once during a stressful relocation month and never touch it again; a five-minute annual review is a small habit that can meaningfully change your yearly cost.

The mandatory franchise decision also sits alongside other choices, like whether to add supplementary coverage beyond the basic mandatory plan. If you're weighing private or semi-private hospital options, dental, or coverage abroad, our overview of Swiss supplementary insurance for Americans walks through how that layer interacts with your basic policy and franchise.

Where This Fits Into Your Bigger Financial Picture

The franchise decision is a small line item compared to your overall financial picture as an American in Switzerland — but it's a good example of how the two systems you're straddling don't map onto each other cleanly, even in places that seem simple on the surface. Getting comfortable with the small decisions, like this one, is part of building the kind of quiet confidence that comes from actually understanding your situation rather than guessing. This article is educational information, not individual insurance, tax, or legal advice — for a recommendation on your specific franchise level or how it fits your broader planning, a conversation with a specialist who understands both the Swiss and US sides is the right next step.