The Eigen Risico: How the Dutch Health Insurance Deductible Actually Works
Every adult (18 and over) with Dutch health insurance pays the first 385 EUR of most healthcare costs themselves each year before the insurer covers the rest. This mandatory eigen risico has been frozen at 385 EUR since 2016, but a 2024 coalition agreement proposes raising it to 460 EUR in 2027 and 520 EUR by 2030, a plan that is not yet law and depends on a minority coalition finding more seats in parliament. You can voluntarily raise it further, in steps of 100 EUR up to 500 EUR extra (885 EUR total), for a lower monthly premium, worth up to roughly 282 EUR a year in 2026 depending on the insurer. GP visits, maternity and midwife care, district nursing, and all care for children under 18 are exempt and never count toward it. If your insurance starts partway through the year, which is the normal situation for most newcomers, the amount is prorated by the months you're actually covered, not the full 385 EUR.
The Official Rule
Every adult with Dutch health insurance has a mandatory deductible, known as the eigen risico, on their basic package (basisverzekering). According to Rijksoverheid.nl, the government’s own portal, you pay the first 385 EUR of most healthcare costs yourself each calendar year before your insurer starts covering the rest. It resets every January 1, regardless of how much of it you used the year before.
This isn’t a new or unusual number. The mandatory deductible has been frozen at 385 EUR since 2016, making 2026 the eleventh consecutive year at the same level. That freeze is politically significant, and, as covered further down this page, it’s also about to end.
What Counts, and What’s Exempt
Not all healthcare spending touches your deductible. Zorginstituut Nederland, the official body that defines what’s covered under the basisverzekering, lists a specific set of exemptions that never count toward the 385 EUR, no matter how much you use them:
- GP (huisarts) visits and consultations
- Maternity and midwife care (verloskundige zorg, kraamzorg)
- District nursing (wijkverpleging)
- Chain care programs for chronic conditions like type 2 diabetes, COPD, and cardiovascular risk (ketenzorg)
- Smoking cessation programs
- Combined lifestyle interventions
- Psychiatric intake consultations
- Organ donation follow-up care and related travel costs
- All care for children under 18, across the board, not just specific services
Everything else in the basic package, hospital stays, specialist appointments, prescription medication, ambulance transport, and most diagnostic tests, does count. If you’re budgeting for your first year in the Netherlands, the practical takeaway is that seeing a GP costs you nothing toward the deductible, but a referral from that GP to a specialist likely does.
The 2026 Numbers, and Why 2027 Looks Different
| Deductible level | Total amount | Typical annual premium discount |
|---|---|---|
| Mandatory only (default) | 385 EUR | None, this is the baseline |
| Mandatory + 100 EUR voluntary | 485 EUR | Varies by insurer, a fraction of the maximum |
| Mandatory + 300 EUR voluntary | 685 EUR | Varies by insurer |
| Mandatory + 500 EUR voluntary (maximum) | 885 EUR | Up to about 282 EUR/year with some insurers, as low as 60 EUR/year with others |
You can raise your deductible voluntarily in steps of 100 EUR, up to a maximum of 500 EUR extra, bringing the ceiling to 885 EUR total. According to Overstappen.nl’s 2026 comparison of insurer discounts, the premium discount for taking the full 500 EUR increase is not standardized across insurers: it ranges from as little as 60 EUR a year with some providers up to roughly 282 EUR a year (about 23.50 EUR a month) with others, a gap of over 200 EUR a year for choosing the same deductible level with a different company.
The 385 EUR freeze is ending. According to Zorgwijzer’s coverage of the 2027 changes, the 2024 coalition agreement between D66, CDA, and VVD proposes raising the mandatory deductible to 460 EUR in 2027, with a further planned rise to 520 EUR by 2030. A companion proposal would cap what you pay per individual treatment at 150 EUR from 2028 onward, so a single expensive procedure couldn’t wipe out your entire deductible in one visit. None of this is law yet: the three coalition parties hold a minority in parliament and need roughly 10 more seats to pass it, so treat the 460 EUR and 520 EUR figures as a real but unconfirmed direction rather than a settled fact.
Mandatory eigen risico by year, EUR (2027 and 2030 are coalition proposals, not yet law)
Photo by Kindel Media on Pexels
If You Arrive Partway Through the Year
This is the detail that matters most for newcomers, and it’s genuinely good news: you don’t pay the full 385 EUR if your Dutch health insurance only starts partway through the calendar year. Zorginstituut Nederland’s own guidance confirms the deductible is calculated pro rata, based on the number of months you’re actually insured, the same rule that applies to Dutch residents who turn 18 mid-year. Someone whose coverage starts in October, for example, is looking at roughly a quarter of the full amount for that first partial year, not the whole 385 EUR.
This matters because most of SettledIn’s readers fall into exactly this situation: you’re required to arrange Dutch health insurance within 4 months of registering in the BRP, and for most newcomers that registration happens well after January 1. Don’t assume you owe the full annual figure when you sign up mid-year, and don’t let an insurer’s estimate go unquestioned if it looks like they’ve charged you the full 385 EUR for a partial year.
What Real People Flag
Expat-focused resources describe two recurring points of confusion that are worth knowing before your first bill arrives. First, per Healthcare for Internationals’ explainer, insurers don’t always proactively itemize which portion of a bill is deductible versus insurer-covered, so it’s worth requesting a detailed breakdown if a bill looks larger than expected rather than assuming the full amount is correct. Second, unplanned care like an ambulance callout or an emergency room visit still counts toward the deductible even though it wasn’t a choice you made in advance, which catches people off guard if they were mentally budgeting only for planned appointments.
The broader, low-stress version of this advice from Dutch comparison sites and insurers alike: track your own healthcare spending loosely across the year, because once you’ve hit 385 EUR (or your voluntary ceiling), everything else covered by the basisverzekering is free until January 1 resets the count.
Step by Step
- Check your current deductible level when you sign up for or review your zorgverzekering. The default is the mandatory 385 EUR unless you’ve actively opted into a higher voluntary amount.
- If you’re arriving mid-year, ask your insurer to confirm your prorated amount rather than assuming you owe the full 385 EUR for a partial first year.
- Decide whether raising it voluntarily makes sense for you, weighing your expected healthcare use against the premium discount, which varies meaningfully between insurers for the same 500 EUR increase.
- Remember GP visits, maternity care, district nursing, and all under-18 care are exempt when you’re estimating what you’ll actually pay out of pocket in a typical year.
- If you switch insurers mid-year, settle any deductible balance you still owe with your previous insurer rather than assuming it disappears.
- Watch the 2027 proposal if you’re planning multi-year budgeting, the 460 EUR figure isn’t law yet, but it’s a real possibility worth tracking.
What You’ll Need
- A BSN and an active Dutch basisverzekering policy, since the eigen risico only applies once you’re enrolled.
- Your insurer’s app or online portal (most major insurers offer one) to track how much of your deductible you’ve used during the year.
- Documentation of your arrival or BRP registration date, useful if you need to confirm a prorated first-year amount with your insurer.
Compliance Note
This page explains the general eigen risico framework, 2026 figures, and the proposed 2027-2030 changes as published by Dutch government sources and reported by insurance advisory sites, current as of 2026. It is not personal financial or medical advice, and the 2027 and 2030 figures described here are coalition proposals, not enacted law, and may change or be dropped entirely depending on the outcome of parliamentary negotiations. Confirm your own deductible level, prorated amount, and any bill you’re questioning directly with your health insurer or the Zorginstituut Nederland before relying on any figure here.
FAQ & Common Pitfalls
Does the eigen risico apply to dental care or physiotherapy?
Not directly, because those aren't part of the standard basisverzekering for adults in the first place. Adult dental care and physiotherapy are only covered if you've bought optional supplementary insurance (aanvullende verzekering), and that supplementary coverage has its own separate terms, it isn't subject to the Zvw eigen risico at all. What the eigen risico does apply to is most basic-package care: hospital treatment, specialist visits, prescription medication, and ambulance transport are common examples.
If I only use 100 EUR of care this year, do I get the rest of the 385 EUR back?
No. The eigen risico isn't a deposit you get refunded, it's simply the ceiling on what you pay yourself. If your actual eligible healthcare costs for the year come to 100 EUR, you pay that 100 EUR and nothing more, the insurer covers everything after that point for the rest of the year. You only "use" as much of the 385 EUR as your actual costs require.
I'm arriving in the Netherlands in October. Do I really only pay part of the 385 EUR?
Yes, according to Zorginstituut Nederland's own rules on pro-rata calculation, people who become newly insured partway through the calendar year pay a reduced amount based on the months remaining, not the full annual figure. The same rule applies to Dutch residents turning 18 mid-year. In practice this means an October arrival is looking at roughly a quarter of the 385 EUR figure for that partial first year, though you should confirm the exact amount with your chosen insurer when you sign up.
Can I switch insurers to avoid paying a deductible I already owe?
No. If you've used part of your deductible with your current insurer and still owe money for it, switching to a new insurer doesn't erase that debt, your old insurer still collects what you owe, usually with a payment plan available if needed. What does happen automatically is the reverse case: if it turns out you paid more eigen risico than your actual care required, you get the overpaid amount refunded.
Is raising my voluntary deductible actually worth it?
It depends entirely on how much healthcare you expect to use. If you're healthy, rarely see a specialist, and have savings to cover an unexpected 885 EUR bill, the premium discount, worth up to roughly 282 EUR a year with some insurers in 2026, can be a straightforward win. If you have a chronic condition, take regular prescription medication, or would struggle to cover an 885 EUR bill in a bad year, the lower monthly premium usually isn't worth the risk. Comparison sites note the discount itself varies significantly between insurers for the same 500 EUR increase, so it's worth checking your specific insurer's offer rather than assuming a flat rate.