Europe's Hidden Health Gap: Why Expats Pay More and How to Get the Best Coverage in 2025

Arriving in a new European country does not put you on the same track as long-term residents. Three mechanisms explain most of the extra costs:

• Later access to the national system because registration takes time and documents are incomplete.
• Mandatory private cover at the start, sometimes required by employers or schools.
• "Tourist" or private pricing while your residency and social security status are still unclear.

In practice this leads to very concrete situations:

• In France, an expat who has not yet registered with CPAM often pays full price upfront with no third-party payment.
• In Germany, clinics may bill you as a private patient until your Krankenkasse is clearly identified.
• In Spain, without a Seguridad Social registration, most care goes through private clinics.
• In Switzerland, basic insurance under the LAMal law is mandatory within three months; late registration can mean retroactive premiums.

On top of this, many expats delay care because they are unsure how reimbursement works, or they use travel-style coverage long after becoming residents, which rarely matches real life needs.

Not all European systems feel the same when you arrive as a newcomer. Some are generous but costly, others more affordable but with higher deductibles or longer waits.

• Switzerland (LAMal): for adults, entry level premiums of roughly 350 to 450 Swiss francs per month are common, plus a yearly deductible. Official information in English and German is available via the Federal Office of Public Health at bag.admin.ch.
• France: the base system via CPAM covers many essentials, but a top-up policy is now almost unavoidable for everyday care, dental and eyewear. For families with several children, cumulative premiums are significant.
• Netherlands: mandatory basic insurance for all residents with a local contract includes a substantial monthly premium and a yearly excess. Official portals and comparison tools help, but the first year still comes as a shock for many newcomers.
• Cross-border workers between France and Switzerland: choosing between LAMal and French coverage has a direct impact on net salary and tax planning. The dedicated cross-border guide on this site details the trade-offs.

Which system is "best" depends on income, family size, health history and how long you plan to stay. A system that looks expensive can be efficient if you understand how to use it and how to combine it with private cover.

A few recurring mistakes explain a large share of the extra money expats spend on healthcare:

• Letting the European Health Insurance Card expire, then being billed at full private rates while travelling. The article on EHIC renewal published on 2 November shows how to check dates before each trip.
• Submitting an incomplete registration file to CPAM or another national system: missing proof of address, unclear work contract, or no evidence of stable residence. This often leads to months without a health card or assigned family doctor.
• Relying on low cost international insurance with long exclusion lists for pregnancy, pre-existing conditions or mental health.
• Choosing very high deductibles in Switzerland or on international policies to save on monthly premiums, then paying everything out of pocket during the first part of the year.
• Staying in "visitor" status even though you already live, work or study in the country, which confuses reimbursement rules and the right institution in charge of you.

If you read this article together with the broader 2025 healthcare guide and the practical guide on finding doctors and dentists abroad, you will recognise many of these traps and be able to avoid them.

The starting point is to clarify your status: resident, detached worker, cross-border commuter, student, or self-employed. Each category maps to specific rights and forms such as S1 or S2 in some cases.

Concrete levers include:

• Registering with the local system (CPAM, Krankenkasse, Seguridad Social, LAMal) as soon as you meet the criteria, even if you keep an international policy in parallel during the transition.
• Using third-party payment and preferred provider networks whenever available so you do not advance large sums.
• Comparing top-up policies in France or deductibles in Switzerland based on your real usage instead of a generic profile.
• Favouring strong public hospitals for heavy procedures, and specialists located outside the most expensive city centres for follow-up care.
• Planning an annual check-up in your home country or a nearby lower-cost country, after checking reimbursement rules and any required pre-authorisation.
• In France, reviewing your eligibility for support schemes such as the complementary health solidarity via the family benefits office. The official site caf.fr provides simulators and conditions.

The goal is not to chase every last euro but to move from random, reactive care to a clear structure that matches your life stage: everyday care, pregnancy, chronic disease follow-up, dental work or mental health support.

Profile 1: employee from the United States in France

He moves to Paris with an international policy paid by his employer. For six months he never registers with CPAM, pays full price at every GP visit and never declares a family doctor. By combining fast registration, a conventioned GP and a simple top-up, his annual bill could have been roughly halved.

Profile 2: France–Switzerland cross-border commuter

She works in Lausanne and lives in Haute-Savoie. Unsure between LAMal and French cover, she picks a cheap option with a very high deductible without modelling the impact of regular exams she needs. A simple calculation, like those shown in the France–Switzerland cross-border guide, would have revealed the true yearly cost.

Profile 3: student in Italy

He enrols at an Italian university but keeps only his initial travel insurance, without understanding the regional health system. He later discovers that some exams are only fully covered when ordered by a registered family doctor inside the regional network. The guide on finding doctors and specialists abroad explains how to avoid this type of dead end.

To turn these principles into practical decisions, use this guide together with other articles already published on the site:

• Understand the overall 2025 healthcare landscape: European Healthcare 2025.
• Renew and use your European Health Insurance Card correctly: EHIC Renewal Made Simple.
• Find reliable doctors, dentists and specialists abroad: Doctors and dentists abroad guide.
• Keep energy and housing costs under control, which weigh as much on your overall budget as health: Energy supplier and housing charges.
• Build a long term healthcare strategy for your family: Healthcare for European expats.