The Two-System Problem: Why Split Time Creates a Coverage Gap
When you divide your year between Switzerland and the US, you are standing in the middle of two health systems that do not talk to each other. Swiss mandatory basic insurance, known as KVG or LAMal, covers medically necessary care inside Switzerland. It does not cover treatment in the US except in very limited situations. On the other side, Medicare Parts A, B, and D pay essentially nothing outside the United States. For Americans who still file US taxes every year, this is not just a travel inconvenience; it is a structural gap that can leave a six-month US stay without meaningful coverage if you plan around the wrong assumptions.
Your Swiss Baseline: KVG Is Mandatory and It Does Not Follow You
Because you are a Swiss resident, you must enroll in KVG within three months of arrival. An international private medical plan generally does not satisfy that mandate except in narrow, time-limited exemption cases. KVG gives you access to Swiss doctors, hospitals, and the annual deductible and cost-sharing structure every resident knows. It is not an optional add-on, and it is not replaced by a global plan.
- KVG covers medically necessary outpatient, inpatient, and pharmaceutical care in Switzerland.
- KVG generally provides no coverage for care in the United States.
- Some Swiss insurers sell supplementary travel or international cover, but only while you remain a Swiss resident.
Practical takeaway
Think of KVG as your Switzerland-only base layer. It solves the Swiss legal requirement, but it does not solve the US side of your split time.
Medicare in Switzerland: What Actually Works and What Doesn't
$202.90
Standard Medicare Part B monthly premium in 2026
If you are eligible for Medicare, it is tempting to think of it as a US safety net. In reality, Medicare Parts A, B, and D pay essentially nothing outside the US, apart from three narrow exceptions. That means a hospital visit in Zurich or a specialist consultation in Lausanne will not be billed to Medicare. If you have a Medicare Advantage plan, the situation is even more fragile: after roughly six months outside the country, the plan can auto-disenroll you, often without you noticing until a claim is denied.
The Practical Fix: Layer a Cross-Border International Health Plan
Because neither KVG nor Medicare covers the other country, many Americans who split time use a two-layer approach: keep mandatory KVG for Switzerland and add an international private medical insurance plan for the US portion and other non-Swiss travel. For shorter gaps, a well-designed Swiss travel insurance policy can help, but it does not replace ongoing cross-border health coverage.
The key design choice is whether that international plan includes or excludes US coverage.
- Worldwide excluding US: the default choice for many US citizens fully relocated abroad. It costs meaningfully less and covers care in most countries outside the US. For US visits, you add short-term travel medical cover.
- Worldwide including US: usually two to three times more expensive, but worth comparing if you spend 90 or more days per year in the US or want direct billing through US hospital networks.
$300–$800
Typical monthly cost range for international health insurance for people 65 and older
30–50%
Approximate premium reduction when a plan excludes the US
Which structure fits split time?
If you spend most of the year in Switzerland and only a few weeks in the US, a worldwide excluding US plan plus travel cover for US trips is often the more cost-effective structure. If your US time regularly exceeds 90 days, including US coverage becomes the relevant comparison.
Keep or Drop Medicare Part B? The Decision That Creates a 7-Month Gap
Part B is the part of Medicare with a standard monthly premium — $202.90 in 2026. The keep-or-drop decision is not simply about saving that premium while you live abroad. If you drop Part B and re-enroll later, you generally face a permanent late-enrollment penalty and can only sign up during the General Enrollment Period from January 1 to March 31, with coverage starting July 1. That creates an unavoidable seven-month gap in US Medicare coverage exactly when you may be planning a longer US stay.
Three Things to Check in Any International Plan
International health plans are not standardized the way KVG is. When comparing policies, focus on three areas that cause the most expensive surprises.
- Pre-existing condition coverage: some plans exclude them, some include them after a waiting period, and the difference can be enormous.
- Medical evacuation and repatriation: especially if you want transport back to Switzerland or the US for treatment.
- Renewal age limits: some plans become expensive or unavailable after a certain age, which matters if you plan to keep coverage for decades.
Don't choose on premium alone
The cheapest plan is often the one that quietly excludes the event you need it for.
How the Tax Side Works Without Overcomplicating It
Health insurance premiums for Swiss KVG are generally not the same as US health insurance for tax purposes, and certain Swiss insurance policies can trigger separate US reporting obligations such as the foreign insurance premium excise tax on Form 720. That is a distinct issue from choosing your coverage. If you are also carrying Swiss VVG supplementary insurance, it adds another layer to your coverage but does not change the basic split-time gap. It can, however, create US tax reporting considerations you will want to review with a cross-border advisor.