Medical and Accident Expenses and Insurance Premiums: Which Costs Are Deductible?

Healthcare costs and insurance premiums constitute a significant portion of annual expenses in many Swiss households. Fortunately, certain expenses can be claimed in the tax return. However, it is important to distinguish: While medical and accident costs are only deductible under certain conditions, insurance premiums can be considered within maximum deduction limits.

In this article, you will learn which costs are tax-recognized, what proof you need, and what limits must be observed.

Medical and Accident Costs

Basic Principle

Costs that are medically necessary and not covered by health or accident insurance are deductible.

Deductible Expenses

• Doctor and hospital costs
• Dental costs (treatments, but not purely aesthetic procedures)
• Medications that are medically prescribed
• Aids such as glasses, hearing aids, or prostheses
• Care costs (e.g., Spitex, nursing or retirement home – only care costs, not hotel costs)
• Therapy costs (physiotherapy, occupational therapy, speech therapy, psychotherapy), if medically prescribed
• Costs for alternative and complementary medicine, if performed by certified professionals
• Additional costs for medically ordered, life-essential diets (e.g., for celiac disease, diabetes)
• Medically necessary transport, rescue, and recovery costs (e.g., Rega)

Special Case: Celiac Disease

Persons with medically certified celiac disease can deduct a flat rate of CHF 2,500 per year without proof of actual costs.

Self-Deductible and Threshold

Medical and accident costs can only be deducted if they exceed a certain self-deductible amount.

• At federal level: 5% of net income (gross income minus expenses and general deductions)
• Cantonal: Different regulations possible – some cantons have lower thresholds (2–5%)

Important: Only the amount above this self-deductible is deductible.

Non-Deductible Costs

• Purely aesthetic or cosmetic procedures without medical necessity
• Preventive measures such as vaccinations (unless medically necessary)
• Transport costs to the doctor (except for medically necessary rescue transport)
• General living costs arising from illness
• Health insurance premiums (these are considered separately under insurance premiums)

Insurance Premiums

Basic Principle

Insurance premiums can be deducted up to a maximum amount. This is a limited deduction – not all paid premiums are deductible, only up to the legal maximum limit.

Deductible Insurance

• Health insurance premiums (basic and supplementary insurance)
• Life insurance (savings or term insurance, Pillar 3b)
• Accident insurance
• Interest from savings capital

Maximum Amounts Federal Tax

The deduction amount depends on whether contributions to occupational pension schemes (Pillar 2) or tied pension schemes (Pillar 3a) have been made:

With contributions to Pillar 2 or 3a:

• Singles: maximum CHF 1,700 per year
• Married couples: maximum CHF 3,500 per year
• Plus CHF 700 per child for whom a child deduction is allowed
• Plus CHF 700 per dependent person (federal tax only)

Without contributions to Pillar 2 or 3a:

The deductions increase by half:

• Singles: maximum CHF 2,550 per year
• Married couples: maximum CHF 5,250 per year
• Plus CHF 700 per child/dependent person

Maximum Amounts Cantons

Cantons often have significantly higher maximum deductions than federal tax. In addition, many cantons have a minimum amount (flat rate) granted regardless of the premiums actually paid.

Examples:

• Zurich: up to CHF 5,800 for married couples (with Pillar 2)
• Bern: minimum CHF 1,800 for singles, CHF 3,700 for married couples
• Cantonal deductions can differ significantly from federal tax

Consider Premium Reductions

Important: Those who receive premium reductions must subtract them from the declared premiums. Only self-paid premiums are deductible.

Combination of Costs and Premiums

Many taxpayers confuse medical costs with insurance premiums. Clear separation is important:

• Insurance premiums: Only deductible within maximum deduction limits
• Medical and accident costs: Only deductible above the self-deductible threshold
• Declare both separately – they cannot be mixed

Practical Examples

Example 1: Dental Bill

A family pays CHF 4,000 for dental treatment, of which CHF 2,000 is not covered by insurance. With a net income of CHF 80,000, the self-deductible is CHF 4,000 (5%). These costs do not exceed the self-deductible and are therefore not deductible.

Example 2: High Medical Costs

A person with net income of CHF 60,000 has CHF 8,000 in self-paid medical costs. The self-deductible is CHF 3,000 (5% of 60,000). Therefore, CHF 5,000 (8,000 – 3,000) is deductible.

Example 3: Health Insurance Premiums

A married couple without children pays CHF 10,000 in health insurance premiums and has made contributions to Pillar 2. However, only CHF 3,500 (maximum for married couples with Pillar 2) is deductible for federal tax.

Example 4: Premiums Without Pillar 2

A self-employed person without Pillar 2 pays CHF 6,000 in health insurance premiums. As a single person without Pillar 2, they can deduct up to CHF 2,550 (increased amount).

Example 5: Nursing Home Care Costs

A retiree pays CHF 20,000 annually in care costs not covered by insurance (excluding hotel costs). With a net income of CHF 40,000, the self-deductible is CHF 2,000. CHF 18,000 is deductible.

Example 6: Celiac Disease

A person with medically certified celiac disease can deduct a flat rate of CHF 2,500 without submitting individual receipts for diet costs.

Common Mistakes and Tips

Common Mistakes

• Deducting aesthetic procedures without medical necessity
• Mixing or confusing insurance premiums and medical costs
• Not submitting or keeping receipts (invoices, insurance statements, health insurance statements)
• Not deducting premium reductions from declared premiums
• Declaring higher premiums than the maximum amount allows
• Not considering the self-deductible for medical costs
• Declaring hotel costs in nursing homes as medical costs

Tips

• Always keep all receipts: Medical certificates, invoices, health insurance statements, payment receipts
• Only declare medically necessary costs – no wellness or purely preventive measures
• Consider different cantonal deduction limits – cantons often have higher limits
• Correctly deduct premium reductions – only declare self-paid premiums
• Calculate self-deductible in advance: With low medical costs, the deduction is often not worthwhile
• Check whether care costs can be considered within supplementary benefits
• Use celiac disease flat rate: Easier than individual receipts
• Utilize cantonal differences: Some cantons have much more generous regulations

Disability-Related Costs

Important: Disability-related costs are a separate deduction without self-deductible. They apply to persons with permanent physical, mental, or psychological impairment and include, for example:

• Costs for aids and care
• Costs for residential stays (minus living expenses)
• Costs for therapeutic pedagogy therapies

These are deducted fully and without the 5% threshold.

Conclusion

Medical and accident costs as well as insurance premiums offer important opportunities for tax optimization – however, clear limits and differences between federal and cantonal levels apply.

Insurance premiums are only deductible up to a maximum amount, which depends on whether contributions are made to Pillar 2 or 3a. Cantons often have significantly higher limits than the federal level.

Medical and accident costs can only be claimed if they exceed the legally defined self-deductible (usually 5% of net income). Therefore, the deduction is often not worthwhile with low healthcare costs.

Proper documentation, correct separation of costs, and attention to cantonal differences are crucial to fully and correctly utilize the deductions.