What to Do When You Can't Afford Healthcare Costs

Prämienverbilligung (premium reduction)

Every canton in Switzerland is legally required to offer Prämienverbilligung (IPV — individuelle Prämienverbilligung) to residents whose health insurance premiums represent a disproportionate burden relative to their income. This is the single most important tool for managing healthcare costs.

• Who qualifies: Eligibility and the amount of the subsidy vary by canton. Generally, individuals and families with low to moderate income qualify. The threshold depends on your canton — in some cantons, families earning up to CHF 80,000-100,000 may still qualify for partial subsidies.
• How to apply: Contact your cantonal social insurance office (Sozialversicherungsamt / service des assurances sociales) or apply online through your canton's website. In some cantons (e.g., Zurich), the subsidy is calculated automatically from your tax return.
• What it covers: The subsidy is paid directly to your health insurer, reducing your monthly premium. It can cover part or all of your KVG premium.
• Children and young adults: Premiums for children and young adults (up to 25 in education) from low-income families must be reduced by at least 80% by law (since 2024).

Ergänzungsleistungen (supplementary benefits)

Ergänzungsleistungen (EL) are supplementary benefits for people receiving AHV (old-age) or IV (disability) pensions whose pension is not sufficient to cover basic living costs. EL can cover:

• Health insurance premiums in full (up to a cantonal maximum)
• Medical and dental costs not covered by KVG (up to certain limits)
• Costs of assistive devices, home care, and nursing home costs
• General living expenses to reach the minimum subsistence level

EL is not a loan — it does not need to be repaid (with limited exceptions related to inheritance). Apply at your cantonal AHV compensation office (Ausgleichskasse).

Sozialhilfe (social assistance / welfare)

If you are not eligible for EL but cannot cover basic living costs including health insurance, Sozialhilfe (social assistance) is the last-resort safety net. It is administered at the municipal (Gemeinde) level.

• Sozialhilfe covers health insurance premiums and essential medical costs.
• To apply, contact the Sozialdienst (social services) of your Gemeinde.
• Sozialhilfe is means-tested — you must disclose your full financial situation, including savings, assets, and income.
• Unlike EL, Sozialhilfe must generally be repaid if your financial situation improves significantly.

What happens if you don't pay premiums (Betreibung)

If you fail to pay your health insurance premiums, the following escalation process occurs:

• Reminders: Your insurer sends payment reminders (Mahnung). After 2-3 reminders, they may charge late fees.
• Betreibung (debt enforcement): If premiums remain unpaid, the insurer initiates a Betreibung — a formal debt enforcement proceeding through the cantonal Betreibungsamt. This is recorded in the debt register and affects your creditworthiness.
• Verlustschein: If the Betreibung confirms you cannot pay, a Verlustschein (certificate of shortfall) is issued. The canton then covers the unpaid premiums and adds the debt to your record.
• Coverage continues: Your KVG coverage is never terminated for non-payment. Basic insurance is mandatory and cannot be cancelled by the insurer.

Cantonal blacklists (Leistungssperren)

Some cantons maintain a controversial system called Leistungssperren (benefit restrictions) or informally "blacklists" for people with unpaid premiums and outstanding Verlustscheine:

• In cantons with this system, non-emergency medical treatments may be restricted until outstanding debts are settled or a payment plan is agreed.
• Emergency care is always provided regardless of blacklist status — this is a legal requirement.
• As of recent reforms, several cantons have abolished or limited the blacklist system. Zurich, Basel-Stadt, and others no longer apply benefit restrictions.
• The federal parliament has debated abolishing blacklists entirely, but the decision remains with individual cantons.

Schuldenberatung (debt counselling)

If you are overwhelmed by healthcare debts or general financial difficulties, free or low-cost debt counselling services can help:

• Schuldenberatung Schweiz (schulden.ch): The national umbrella organisation for debt counselling. Their website lists cantonal debt counselling services.
• Caritas Schweiz (caritas.ch): Offers free Schuldenberatung in many cantons. Also provides direct financial support through its KulturLegi programme (discounts on health-related services) and emergency aid.
• Pro Infirmis (proinfirmis.ch): Provides social counselling and financial support for people with disabilities, including help with insurance-related costs.
• Budgetberatung Schweiz (budgetberatung.ch): Free budget counselling to help you plan your finances and avoid future debt.

Other support options

Several other organisations and programmes can help with healthcare costs:

• Winterhilfe Schweiz: Provides financial support for heating, healthcare, and basic needs for people in financial difficulty.
• HEKS/EPER: Offers legal and social counselling, particularly for refugees and migrants facing financial barriers to healthcare.
• Cantonal patient ombudsman (Ombudsstelle): Can mediate between you and your insurer or healthcare provider if you are being unfairly billed or denied access.
• Switching to a cheaper insurer: If you are paying more than necessary, switching your KVG insurer during the annual switching period (by November 30) can save several hundred francs per year. Benefits are identical across all KVG insurers.
• Raising your franchise: If you are healthy and rarely need medical care, choosing a higher franchise (up to CHF 2,500) lowers your monthly premium significantly. But be aware of the risk if unexpected medical needs arise.