Health insurance in retirement: what becomes of the right of option between LAMal and the insurance of the country of residence?

During their career, the cross-border worker made a choice of health insurance that was presented to them as irrevocable. It is, as long as nothing changes. Retirement changes everything: it is no longer the place of work that determines the insurance, but the pensions received and the country that pays them. Depending on the combination, the choice comes round again for three months, or disappears. This guide is for everyone who will receive a Swiss pension while living in the European Union: former cross-border workers, but also former residents of Switzerland who have moved abroad for their retirement.

1. Which country insures a retiree who receives a Swiss pension?

The one that pays the pensions, according to an order of priority laid down by European Regulation No 883/2004, which Switzerland applies with the European Union under the Agreement on the Free Movement of Persons. There are three possible scenarios.

An example of the third case: a retired woman who lives in Annemasse, worked twelve years in Germany and then twenty-five years in Geneva, and receives no French pension. She was insured for longer in Switzerland: it is Switzerland that covers her, as if she received only Swiss pensions; whether she can then apply for exemption from LAMal should be confirmed with the Common Institution under the Health Insurance Act (LAMal/KVG). With twenty-five years in Germany and twelve in Geneva, it would be Germany that covered her.

What Switzerland counts as a pension

The Common Institution under the Health Insurance Act (LAMal/KVG), the insurers' foundation entrusted by law with managing the insurance obligation of pensioners living in the European Union, takes into account statutory benefits from the AVS (old-age and survivors' insurance), the AI (invalidity insurance), military insurance, accident insurance and occupational pensions. An LPP lump sum also counts, if it is paid at the ordinary retirement age set by the pension fund's regulations, and at 58 at the earliest. Private pension provision, such as life insurance, does not count. In practice, if their pension fund's regulations set the ordinary retirement age at 62, a former cross-border worker who takes their LPP lump sum at that age becomes the recipient of a Swiss pension for health insurance purposes, even before their first AVS pension. A lump sum taken on early retirement does not count.

2. In which countries can you choose your health insurance?

The principle, for a person receiving Swiss pensions only, is LAMal insurance. Annex II to the Agreement on the Free Movement of Persons allows residents of a few countries to depart from it: the person can, on application, be exempted from LAMal if they prove that they are covered in their country of residence. This is what is known as the right of option.

Two points matter. In Spain, the exemption requires membership of the Spanish social security system: a contract with a private insurer does not allow you to leave LAMal, the Federal Social Insurance Office points out. And the Federal Office of Public Health describes this right of option for retirees who are nationals of Switzerland or of a European Union country: a national of another country who receives a Swiss pension would do well to have their situation confirmed by the Common Institution under the Health Insurance Act (LAMal/KVG) before acting.

For a resident of Spain or Portugal, our guide to Swiss retirement in Portugal and Spain also covers the taxation of pensions and the export of AVS and LPP benefits.

3. Former cross-border worker: do you have to make your choice again on retirement?

Yes, if you receive only Swiss pensions. The Franco-Swiss agreement of 7 July 2016 sets out the closed list of events that reopen the right of option: taking up work in Switzerland, resuming work after a period of unemployment, settling in France, and the move from worker status to pensioner status. The official form draws the consequence for a cross-border worker who had chosen French insurance: on moving to an exclusively Swiss pension, the option for French health insurance must, where applicable, be exercised again.

In other words, the choice made at 30 does not automatically carry over at 65. A cross-border worker who was affiliated with French Social Security and does nothing on retirement is automatically assigned to a Swiss insurer. Conversely, one who was under LAMal can take advantage of this moment to join French insurance. Our guide on changing a cross-border worker's health insurance details the other events that reopen the choice during working life.

Deadlines and pitfalls

• 3 months: this is the deadline set by the Agreement on the Free Movement of Persons. The Federal Office of Public Health and the CLEISS, the French liaison body for European and international social security, run it from the first payment of the Swiss pension, or from settling in the country of residence if that comes later.
• A written application, and nothing else. The Federal Supreme Court ruled in March 2015 that a right of option exercised tacitly, without a formal application, is not valid.
• A late application is admitted only in justified cases. If it is, the exemption takes effect from the start of the obligation to be insured in Switzerland.
• The S1 certificate counts as a choice. Having the S1 certificate issued by a Swiss insurer registered with the health insurance fund of your country of residence amounts, according to the Common Institution under the Health Insurance Act (LAMal/KVG), to exercising your right of option in favour of Switzerland. Exemption is no longer possible afterwards.
• Marriage, divorce, a birth or a death do not reopen the choice, the CLEISS specifies.

The procedure for a resident of France

It goes through the joint form “Choix du système d'assurance-maladie” (choice of health insurance system), published by the Common Institution under the Health Insurance Act (LAMal/KVG) and by the Assurance Maladie, the French national health insurance. The retiree fills in the parts that concern them, ticking the box for the move from worker status to pensioner status, has their caisse primaire d'assurance maladie (the local French health insurance fund) complete the section reserved for it, then sends the whole form to the Common Institution, within 3 months. The application covers the non-working family members listed on the form. For Germany, Austria and Italy, the deadline in principle runs in the same way from the first pension, but no text there is as explicit as the Franco-Swiss form: have your situation confirmed by the Common Institution, which offers an online application.

4. When does the right of option disappear?

As soon as you receive a pension from your country of residence. Article 23 of the European regulation then assigns your health insurance to that country, as if you had only that pension. The Common Institution under the Health Insurance Act (LAMal/KVG) states it without qualification: the amount of the pension plays no role. A French pension, even of a few dozen euros a month, makes the retiree an insured person under the French scheme.

The right of option exists only for people receiving Swiss pensions only. A retiree who also receives a French pension no longer chooses, and their contribution regime changes: they leave, as the case may be, LAMal or the specific contribution for cross-border workers and, according to the prefecture of Haute-Savoie, their Swiss-source pensions become part of the base for the CSG, the CRDS and, where applicable, the CASA, to be declared in box 8 of the 2042-C return, with no cap. Our guide on the CSG, the CRDS and the cross-border worker's health contribution details these levies.

5. How much does each solution cost?

The two approaches have nothing in common: LAMal charges a fixed premium per person, regardless of income; French insurance takes a percentage of income. The right choice therefore depends first and foremost on the level of your pensions.

LAMal: one premium per insurer and per country

There is no single premium for a country. Each insurer sets its own according to healthcare costs in the country of residence, and the Federal Office of Public Health publishes them all. For a retiree, who is no longer covered by the employer's compulsory accident insurance (LAA), it is the premium with accident cover that applies.

These ranges go from the cheapest insurer to the most expensive, accident cover included. Yet the benefits reimbursed are the same everywhere: those of statutory basic insurance. Three rules specific to insured persons living in the European Union are added: they can choose neither an optional deductible nor an alternative model such as the family doctor or telemedicine model; the insurer collects the premium in francs or in euros, and can bill it quarterly; a retiree of modest means can obtain a premium reduction, granted by the Confederation through the Common Institution under the Health Insurance Act (LAMal/KVG), provided that the family's annual premiums exceed 6% of its gross income (pensions, maintenance payments and investment income) and that its assets do not exceed 100,000 francs, or 150,000 francs for a household with children. Our guide on LAMal coverage and the S1 form explains how reimbursements work in France.

French insurance: 8% of income after an allowance

A retiree receiving Swiss pensions only who chooses French insurance is affiliated with the general scheme. They pay neither CSG nor CRDS on their Swiss pension, but a contribution of 8% of their income, less an allowance equal to 25% of the annual Social Security ceiling, i.e. 12,015 euros for the 2026 contribution, calculated on 2024 income. It is recalculated each year on the income of the year before last, and collected by the Urssaf department (the Urssaf being the French social contributions collector) dedicated to cross-border workers in Switzerland. The contribution is individual: it is calculated on each insured person's own income.

Compare these amounts, taking the exchange rate into account, with the annual premium of the LAMal insurer you would choose: 225 francs a month comes to 2,700 francs a year, 500 francs a month to 6,000. The higher the pensions, the more attractive the fixed premium becomes; the more modest they are, the more attractive the proportional contribution. But cost is not the only criterion: section 7 shows that the choice also determines access to treatment in Switzerland. Our guide LAMal or CMU details the comparison during working life; in retirement, the family picture changes, since a spouse who receives their own French pension falls under the French scheme in any case.

Staying under LAMal while living in France: no French contribution

A retiree who stays under LAMal pays neither the 8% contribution, nor the CSG, nor the CRDS on their Swiss pension. The European regulation prohibits a country from levying a health contribution on a pension if it does not bear the cost of treatment, and tax notice 2041-GG subjects foreign-source pensions to the CSG and the CRDS only if their recipient is covered by a compulsory French health insurance scheme.

6. Spouse, moving house, returning to Switzerland: what happens?

The spouse and children

Family members with no gainful activity and no pension of their own follow the retiree: the same scheme and, if the retiree is under LAMal, the same insurer. The application for exemption covers the whole family living in the same country. The exceptions are those in the table in section 2: in Portugal, Denmark and Sweden, the family is insured in the country of residence; in Finland, it can opt for Finnish insurance while the retiree stays under LAMal. A spouse who works or receives their own pension has a right of their own, which takes precedence: they are insured where they work, or according to their own pensions. The circle of family members is the one defined by the country of residence; in France, it mainly covers the spouse, the PACS civil partner or the cohabiting partner, and children up to a certain age.

Leaving Switzerland to spend your retirement in the European Union

A recipient of a Swiss pension who settles in a European Union country in principle remains subject to LAMal, the Federal Office of Public Health points out. They must inform their insurer of their change of address; if the insurer does not offer insurance in the new country, they must switch. The insurer issues them the S1 certificate, to be presented to the health insurance fund of the country of residence. The right of option is exercised within 3 months of settling there, and before having the S1 certificate registered: that registration counts as choosing Switzerland. For a move to France, the copy of the form stamped by the caisse primaire must be sent without delay to the Swiss insurer to end the insurance in Switzerland.

Returning to live in Switzerland

Anyone who takes up residence in Switzerland must take out ordinary LAMal insurance within 3 months. A retiree who returns with a Swiss pension and a pension from a European Union country is insured in Switzerland, whatever the amount of the Swiss pension. By contrast, one who receives only a pension from a European Union country, with no Swiss pension, remains insured in the country that pays that pension.

7. Where can you receive treatment once retired?

This is the most tangible consequence of the choice, and often the least anticipated.

For a retiree who has had their doctor, specialist or hospital in Geneva or Lausanne for twenty years, the difference is real: staying under LAMal keeps the door to Swiss healthcare open, opting for the insurance of the country of residence largely closes it. The French Assurance Maladie allows consultations in Switzerland without prior authorisation for the cross-border workers it insures; a retiree who intends to rely on this should have their caisse primaire confirm that the arrangement also applies to them.

8. Pension in francs, premium in francs, spending in euros: how to organise yourself?

A retiree who has stayed under LAMal ends up with income in francs, a health insurance premium in francs or in euros as their insurer chooses, and everyday spending in euros. Receiving the pension in euros into a French account means each payment is converted automatically, at the rate of the bank or the fund that pays it, and then part of it is converted back into francs to pay the premium if the insurer bills it in francs.

A personal Swiss IBAN lets you fix where the pensions arrive in francs, settle locally whatever is still denominated in francs, LAMal premium included, and then convert the rest to the euro account, for the amount and at the time you choose. ibani is a Swiss financial intermediary based in Geneva, not a bank: it converts at the real market rate, plus a margin of 0.40% to 0.15% depending on the amount. Our guide to the life certificate covers the annual procedure on which the payment of pensions abroad depends; the day's rate can be followed on our CHF-EUR converter, and our cross-border worker service page presents the offer.

9. Frequently asked questions