Thursday, November 15, 2012

Dear Frau: Compare U.S. and Swiss Health Insurance

Welcome to another edition of Dear Frau. It’s kind of like Dear Abby, except with an international twist. Remember, if you have a question about moving to Switzerland or living in Switzerland, don’t hesitate to contact the Frau.

Dear Frau,

Did you visit Switzerland often before moving there? And how does health insurance in Switzerland compare to the U.S.?

Interested in Switzerland

Dear Interested in Switzerland,

Whew. Short questions. Long answers…

Visiting Switzerland

The Frau had been to Switzerland three times before she moved there. She did the whirlwind, “Everything you need to know about Switzerland is in Lucerne” Globus bus tour of Europe in 2001. She never imagined living in Switzerland at that point. All she did during that trip was swim with the swans in Lake Lucerne and run around the Alpine meadows singing, “The hills are alive…” (Never mind that The Sound of Music takes place in Austria. To the Frau at that point, Switzerland and Austria were one in the same).

The Frau did another tour of Switzerland in 2005 when Mr. Frau came to Switzerland for a business trip. This visit was slightly more serious, since at that point the Frau and Mr. Frau knew a couple that had moved to Switzerland with the company Mr. Frau worked for. Mr. and Mrs. Frau met this couple for dinner. It got them thinking.

Finally, in May 2006, the Frau sealed her Swiss fate with a trip to Switzerland to (gulp) find an apartment. The Frau was really going to move there. And she was really going to become a (gulp, gulp, gulp) trailing spouse for the next three years.

Anyway, let’s fast-forward six + years (yes, the Frau has greatly overstayed her welcome) and answer the next part of the question. The answer, as you can imagine when dealing with health insurance, is somewhat complicated. The Frau is no expert, but she’ll try her best to explain the main differences.

Health Insurance in Switzerland

First of all, healthcare costs in Switzerland are typically less than in the United States. When traveling outside of Switzerland, regular Swiss insurers will pay up to two times the cost that the same procedure would have cost in Switzerland. BUT…and here’s the amazing thing…the United States as seen as so extreme when it comes to healthcare costs, that unbelievably, two times the Swiss cost is not seen as adequate. So the Frau and her family also have “World insurance” in addition to their regular Swiss insurance so they are fully covered in the United States since they do visit home at least once a year.

Here are some basic differences between the two systems:

One: Swiss health insurance is not tied to employment. This means you must take on all costs of health insurance yourself. The employer pays nothing (except usually they pay for accident insurance, which is also a mandatory part of Swiss health insurance). Regular health insurance costs can vary widely depending on your plan. You are free to choose both your insurer and your plan. In general, basic health insurance in Switzerland with a CHF 2,500 deductible will probably cost between CHF 150-225 per adult, per month. Swiss salaries are typically higher than U.S. salaries though, so in this sense, they help you pay for things like health insurance. The good part about having insurance not tied to a job is that when you lose a job or want to work part-time, you always have your health insurance. It allows employees much more freedom and flexibility, even though paying it from your own pocket can feel much more painful.

Two: Swiss health insurance is mandatory. You can’t decide you don’t want it. If you don’t sign yourself up for Swiss insurance within three months of moving here (or prove you have international insurance through an expatriate company program), the Swiss government will sign you up. Now before you scream socialism, think about it: it’s actually a good thing for health insurance to be mandatory. Everyone needs healthcare. And if everyone has it, then the insured won’t also be paying for the uninsured.

Three: Dental and eye insurance is pretty non-existent in Switzerland. You can pay extra to have it, but most plans are really, really bad. This is one area the Frau thinks Switzerland could do better in. Because in the U.S., she always had good dental and eye care which at least covered yearly or bi-yearly check-ups. In Switzerland, these kinds of visits are paid completely out of pocket.

Four: Standards of healthcare are as high or higher than in the United States. Appointments are typically easy to obtain in Switzerland. During visits, patients sit at a desk with their doctors and discuss problems before anyone undresses. It feels like a more human approach to the Frau and she also finds that Swiss doctors listen more than American doctors and order fewer pointless medical tests as a result.

Five: Like in the United States, healthcare costs are rising fast in Switzerland. The Frau’s premiums will go up by about 10% next year…and there’s nothing she can do about it.

How much will you pay for Swiss insurance? In general, you should expect to pay at least CHF 5,000 per person per year on healthcare in Switzerland. (Note that costs for children are much lower).

Anyone else want to chime in on healthcare differences/similarities between the U.S. and Switzerland? 

Readers in Switzerland: Has the Frau given a good estimate of healthcare costs in Switzerland?


JuanitaTortilla said...

We've opted for the most affordable plan and insurer there is available here, so I think your estimates may be right.
I'm with you on the eye and dental care -- there is now every reason to be afraid to see the dentist or get an eye check.

Chantal said...

Thanks for your input. We also tried to find the most affordable option since with basic insurance you have the same coverage anyway.

No kidding! I hate not having eye and dental.

Sam said...

Wouldnt Rega "repatriate" you anyway if you got sick while in the US?

Chantal said...

Hi Sam,
I'm not sure about Rega, but I doubt it. Otherwise this wouldn't be an issue.

Anonymous said...

One important aspect often neglected or unknown by expats is that tariffs are fixed by insurer and age group.

I had the rather unfortunate luck of getting HIV while living here and my mandatory healthcare costs will not go to exorbitant prices next year. Complimentary insurance, which convert hospital costs, however is impossible to change now. Insurers may charge whatever they want and even refuse complimentary coverage to people with chronic diseases.

On the other hand they can't refuse basic coverage or charge more than anyone else my age. If I were in US, they could refuse to cover me for preexisting conditions and raise my costs over time, that's why I won't be moving back. That, plus chocolate :-)

Chantal said...

Yes that is one great thing about insurance here--every adult pays the same price--whether you are 30 or 90.

I had the same issue with a pre-existing condition. In my case, I had to switch from expatriate insurance to Swiss insurance mid-pregnancy. Great thing: the Swiss couldn't refuse me! But I was only allowed to sign up for the basic insurance. This turned out to be just fine. Most other costs (like private hospital room) can be paid for out of pocket if you want those things. Swiss insurance has very good coverage for pregnant women--you pay nothing out of your deductible for normal procedures.

Ice Charades said...

Hi Chantal - Swiss coverage sounds a similar to the German coverage. We pay a lot for it in our taxes, but then many things don't cost after that. For example, we've had to get many vaccines for an upcoming trip to Africa and most of that was covered. When my daughter broke her wrist, ALL of that was covered.

But, if we want our teeth cleaned we have to pay for that ourselves (our daughter is free though) and it costs about $170.

I haven't checked into eye care yet. But I need to!

Chantal said...

Thanks for chiming in on the German side of things. It does sound pretty similar to the Swiss system.

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