Published on 05/09/2026 · Sources last reviewed: 05/09/2026 · Our method

A spouse with no income and two children cost zero euros in extra health contributions in Germany, Austria, Belgium and France. In Switzerland they have a price, and each of them their own. This is not a nuance in a rate table: it is the factor that decides everything, and it stays invisible for as long as you compare percentages.

This article costs a household’s health cover in eleven countries, from each country’s official texts. It does not say which system is better. It says where the line falls, and why it falls there.

The question nobody asks at the right moment

Health systems get compared on their rate, their number of insurers, the quality of their hospitals. Those are good questions. They are not the ones that change the end of the month.

The question that changes the end of the month is blunter: when one more person joins your household, how much does that cost?

In eight of the eleven countries in the panel the answer is stable. It is zero.

Two families, one single difference

Take two employees with the same profile: one salary, a spouse not in work, two children. One works in Germany, the other in Switzerland.

The German pays 8.75 % of gross salary — half of the 17.5 % made up of the general rate of 14.6 % (§ 241 SGB V) and the average supplementary rate of 2.9 % for 2026, the other half falling to the employer. The base is capped at €5,812.50 a month. § 10 SGB V covers “der Ehegatte, der Lebenspartner und die Kinder” with no extra contribution: children up to 18, up to 25 in education.

The spouse and the two children cost nothing.

The cross-border worker in Switzerland pays a per-head premium, independent of income. The FOPH’s EU/EFTA cross-border scale for 2026 runs from CHF 200 to CHF 823.10 per adult, depending on the insurer and the country of residence. Each member of the household pays their own, children included.

The spouse and the two children each carry a price.

Income changes nothing here. It only opens a possible right to a cantonal premium reduction — which is a benefit to apply for, not a tariff.

The table, and what to read in it

Three readings stand out, and the third matters most.

France shows 0 %, and that is not a mistake. The employee health contribution was abolished for the general scheme; funding runs through the CSG levy and the employer. A French employee sees no “health insurance” line withheld on their payslip.

Austria has an exception, and it deserves to be named honestly. A co-insured spouse owes a supplementary contribution of 3.4 % of the insured person’s base. But they are exempt if they are raising a child living in the household, or have raised one for at least four years. A household with children is therefore not affected — which covers almost every household this question interests.

Three countries have no figure, and that is a choice. Italy, Spain and Portugal fund health from general taxation. No health contribution line exists on the payslip. Writing “0 %” would suggest it is free; reconstructing an amount from income tax would be an invention. We write “not applicable”, and that is the only true thing to write.

The proof by Liechtenstein

The easy explanation would be: “it is the flat-premium model that produces this result.” It is false, and Liechtenstein demonstrates it.

The same model as Switzerland: flat premium, a market of private insurers, three funds. The same border, the same currency, the same order of magnitude in salaries. And yet:

• children up to their sixteenth birthday are exempt from the premium;
• 16 to 20-year-olds pay half the premium;
• the employer contributes CHF 180.50 a month per adult.

So the model does not dictate the result. Two neighbouring countries, the same system, two opposite treatments of childhood. What decides is the design choices — and a design choice, by definition, could have been made differently.

That is the only political conclusion in this article, and it is a factual one.

Set against the median salary, the map redraws itself

A premium of CHF 400 means nothing on its own. It has to be set against what people in the country earn. Here are the full-time median salaries, on a single basis:

The Swiss median is 1.5 times Luxembourg’s and 2.5 times France’s. The Portuguese one is a fifth of it.

Why this table says “full-time”, and why that matters

This detail is worth a paragraph, because it changes the figures twofold.

The first extraction of this data used Eurostat’s harmonised median across all employees. It gave €5,930 a month for Switzerland — well below the median published by the Federal Statistical Office. The gap was not an error: that column includes part-time workers at their actual pay, with no standardisation. Yet the part-time rate varies sixfold across this panel.

The demonstration sits in the Netherlands: €2,582 a month across all employees, €4,176 a month full-time. The first figure does not say the Dutch are badly paid. It says they work part-time on a large scale.

Publishing the first column and calling it “the median salary” would have compared part-time rates while believing it was comparing salaries. The table above is therefore full-time, on the Eurostat earn_ses_annual dataset, median indicator in euros, excluding public administration.

Liechtenstein has no row, and that is deliberate

Liechtenstein does not take part in the European Structure of Earnings Survey. This is not a missing value: it is a non-participation. Its statistical office does publish a national median, on a different basis and for a different year — adding it would manufacture a row that does not belong in this table.

We prefer an honestly empty cell to a figure that looks comparable and is not.

If you are a cross-border worker, your country of residence changes two things

Everything above compares countries where you both work and live. The cross-border worker straddles the two — and the bill then depends as much on where you sleep as on who employs you.

Your Swiss premium is not the same depending on where you live. The FOPH does not publish one cross-border scale, but one scale per country of residence. The CHF 200 to 823.10 range therefore hides different sub-ranges depending on whether you live in France, Germany, Italy or Austria. Comparing your premium with a colleague who lives across a different border makes no sense.

And your right to leave the LAMal scheme does not exist everywhere in the same form. If you live in France, a right of option gives you three months from starting work to choose between LAMal and the cross-border CMU — the first a per-head premium, the second a percentage of income. That is exactly the trade-off in this article, and you can settle it yourself.

If you live in Germany, Austria or Italy, the question does not arise in that form: each of those countries has its own rules for exemption from compulsory Swiss cover. The choice exists, but it does not go by the same name and is not exercised the same way.

One practical consequence, and it surprises people: for a large family living in France, the right of option is the heaviest financial decision of the whole move. Switching from a per-head premium to a percentage of income removes, with one form, the factor this entire article describes. Doing nothing is also a decision — with no form inside three months, you are enrolled in LAMal by default.

What this changes for you in practice

If you are single and well paid, the Swiss system is often in your favour. Your premium is fixed while your German contribution climbs with your salary, up to the cap.

If you have a spouse not in work and children, the trade-off flips, sometimes sharply. Five heads in Switzerland means five premiums. Five heads in Germany, Austria, Belgium or France means the same amount as for one.

If you are weighing up two countries, do not compare the rates against each other. A percentage and a per-head premium are not comparable: they do not measure the same thing. What is comparable is the amount your specific household would pay on each side.

Key points

• In contribution-based countries, a spouse without income and children are covered at no extra cost. A family of five pays exactly what a single person on the same salary pays.
• Switzerland is the only country in the panel where a child has a price. Every head pays a premium, regardless of household income.
• Liechtenstein proves that the model does not impose this: the same flat premium, but children exempt up to their sixteenth birthday and CHF 180.50 a month from the employer.
• Three countries have no comparable figure — Italy, Spain, Portugal — because their health cover is funded from general taxation and is not separable from the rest.
• The Swiss median salary is the highest in the panel, €84,109 gross full-time, but it is set against a cost that grows with the household when elsewhere it does not depend on it at all.

Practical advice

Count the heads before you compare the rates. That is the only operation that separates the two families of system. A single person and a family of five do not live in the same country, even when it is the same one.

Look at the ages of your children, not only how many. In Switzerland the tariff band changes at 19: the shift to “young adult” is the most expensive and the most overlooked. In Liechtenstein the line falls at the sixteenth birthday, then at 20.

Check the contribution cap if you are well paid. In Germany, above €5,812.50 a month, your contribution stops rising. In Austria the ceiling is €6,930. In Belgium and France there is none — the percentage follows the whole salary.

Apply for the cantonal premium reduction if you live in Switzerland. It exists, it depends on income, and it is only granted on application. Nobody will offer it to you.

Common mistakes

“The German rate is higher, so it costs more.” Not for a household. 8.75 % of a salary is a single amount whatever the size of the family. Four Swiss premiums is four times an amount. The highest rate can produce the lowest bill.

“France shows 0 %, so health cover there is free.” No. The employee health contribution was abolished for the general scheme, but funding runs through the CSG levy and the employer. The line disappeared from the payslip, not from the economy.

“The Swiss median salary makes up for everything.” It makes up for a great deal, not always for everything. A salary 2.5 times higher than in France sits against a health cost that is multiplied by the number of people in the household. The result depends on your family make-up, and it flips somewhere.

“I will compare health systems on quality of care.” A legitimate question, but a different one. This one is about what leaves your account each month, and the two do not have the same answer.

What to check in your own situation

If you work in Switzerland, add up the premiums of every member of the household, not just your own. Then check your entitlement to the cantonal premium reduction: it depends on income and canton of residence, and it changes the trade-off for modest incomes.

If you are comparing two countries, run the numbers on your real household — spouse, ages of children, salary. National averages describe nobody, and a family least of all.

If your family situation is about to change, run the numbers again. A birth costs nothing extra in Germany. In Switzerland it adds a premium.

The contribution rates, caps and dependant rules in this article come from the texts and authorities of each country — SGB V and the German Federal Ministry of Health, Austria’s ASVG and ÖGK, Belgium’s INAMI/RIZIV, Switzerland’s FOPH, and the CLEISS country files. The median salaries come from a single basis, the European Structure of Earnings Survey, full-time. Every source is dated and listed below.

Frequently asked questions

Official sources

• FOPH — 2026 premiums for insured persons resident in the EU/EFTA, by country of residence (accessed on 31/08/2026)
• German Federal Ministry of Health — 2026 statutory health insurance rates; § 10 and § 241 SGB V (accessed on 31/08/2026)
• Sozialversicherung — 2026 contribution values; ÖGK — co-insurance of family members (accessed on 31/08/2026)
• Eurostat — Structure of Earnings Survey, earn_ses_annual (MED_E_EUR, full-time, NACE B-S excluding public administration) (accessed on 31/08/2026)
• CLEISS — Liechtenstein scheme for employees (accessed on 31/08/2026)
• INAMI/RIZIV — Belgian insurance bodies and contributions (accessed on 31/08/2026)

Related guides: the hub · caisses assurance maladie europe · reste a charge urgences · lamal ou cmu · allocations familiales comparatif europe