Belgium Healthcare and Medical Expenses Tax Guide

the Belgian tax treatment of healthcare and medical expenses — Belgium has a universal healthcare system (the "verplichte ziekteverzekering" / "assurance maladie obligatoire") funded through social security contributions. The guide covers: the medical expenses deduction (the "aftrek van gezondheidsuitgaven" / "déduction des frais médicaux" — the deduction of medical expenses that are NOT reimbursed by the health insurance: the out-of-pocket costs for doctor visits, hospital stays, prescription medication, dental care, physiotherapy, glasses and contact lenses, hearing aids, and other medical devices; the deduction is limited to the amount exceeding €210 per person per year (the "drempel" / "seuil" — the threshold); the expenses above €210 are deductible at the progressive tax rate; the deduction is available to the taxpayer, the spouse/partner, and the dependent children), the hospitalisation insurance (the "hospitalisatieverzekering" / "assurance hospitalisation" — the employer-paid hospitalisation insurance is a taxable benefit in kind for the employee (the VAA — voordeel alle aard — calculated as the actual insurance premium paid by the employer, aged-based, ranging from €200 to €1,500 per year); the employee-paid hospitalisation insurance premium is deductible as a medical expense if the premium is not reimbursed by the employer or the social security), the social security health insurance (the "ziekenfonds" / "mutuelle" — the mandatory health insurance fund: the employee contributes 13.07% of gross salary to social security (of which approximately 2–3% is for health insurance); the employer contributes approximately 27%; the health insurance reimburses approximately 70–85% of the standard medical costs; the patient pays the "remgeld" / "ticket modérateur" — the co-payment — which is partially deductible as a medical expense), the disability and incapacity tax rules (the "arbeidsongeschiktheid" / "incapacité de travail" — the sick pay (the "gewaarborgd loon" / "salaire garanti") paid by the employer is fully taxable as professional income; the disability benefit (the "invaliditeitsuitkering" / "prestation d'invalidité") paid by the health insurance fund is taxable as replacement income, subject to a reduced withholding rate of 10–15%), and the long-term care (the "zorgverzekering" / "assurance dépendance" — the Flemish care insurance and the Walloon/Brussels disability allowance; the contributions to the Flemish care insurance are deductible as a health expense).

Belgium's healthcare system is comprehensive but complex — the tax treatment of medical expenses and health insurance depends on whether the costs are reimbursed by the mandatory health insurance. All amounts in Euros (EUR). For related reading, see our Personal Tax Guide →, Employment Benefits Guide →, and Payroll Tax Guide →.

Medical Expenses Deduction

Deductible medical expenses: The following unreimbursed medical expenses are deductible (Article 105 WIB/92): (a) doctor and specialist fees (the "erelonen" / "honoraires" — GP, specialist, surgeon, anaesthetist), (b) hospitalisation costs (the "ziekenhuiskosten" / "frais d'hospitalisation" — the room, the nursing care, the surgery, the medication), (c) prescription medication (the "geneesmiddelen" / "médicaments" — only the portion not reimbursed by the health insurance), (d) dental care (the "tandheelkundige zorgen" / "soins dentaires" — including fillings, crowns, bridges, implants, orthodontics), (e) physiotherapy and rehabilitation (the "kinesitherapie" / "kinésithérapie"), (f) glasses and contact lenses (the "brillen en contactlenzen" / "lunettes et lentilles de contact"), (g) hearing aids, (h) wheelchairs, crutches, and other medical devices, (i) ambulance transport (the "ziekenwagen" / "ambulance"), (j) the cost of a hospital stay (including the "supplementen" / "suppléments" — the extra fees for a single room or for a specialist outside the insurance agreement). The deduction is available for the taxpayer, their spouse/partner, and their dependent children (including children under 18 and students under 25).
The threshold (drempel / seuil): Medical expenses are deductible only to the extent that they exceed €210 per household member per year (2026 — indexed annually). The threshold is applied per person — if a couple has unreimbursed medical expenses of €500 for one partner and €100 for the other, the deductible amount is €500 – €210 = €290 (the €100 is below the threshold and is not deductible). The threshold is increased to €420 for each dependent child (the total medical expenses for all children are aggregated, and the threshold of €420 applies to the aggregate). The deductible amount is the net medical expenses minus the threshold, multiplied by the taxpayer's marginal tax rate (25–50%).
Non-deductible expenses: The following are NOT deductible as medical expenses: (a) cosmetic surgery (unless it is medically necessary — e.g., reconstructive surgery after an accident), (b) over-the-counter medication (the "zelfzorgmedicatie" / "médicaments en vente libre" — vitamins, supplements, herbal remedies), (c) health club memberships, (d) fitness equipment, (e) alternative medicine (acupuncture, homeopathy — unless prescribed by a doctor and provided by a registered practitioner), (f) travel costs to the doctor's office (except ambulance).

Hospitalisation Insurance

Employer-paid hospitalisation insurance (VAA): If the employer pays the hospitalisation insurance premium for the employee and the employee's family, the premium is a taxable benefit in kind (VAA) for the employee. The VAA is calculated as the actual insurance premium paid by the employer (the premium is reported on the employee's annual tax statement — the fiche 281.10). The VAA is: (a) subject to employee social security (13.07%), (b) subject to payroll withholding tax (bedrijfsvoorheffing / précompte professionnel), (c) included in the employee's taxable income. The employee can deduct the hospitalisation insurance premium as a medical expense (if the premium is not reimbursed by the employer — but since the employer pays the premium, there is no additional deduction). The employer can deduct the premium as a professional expense (Article 49 WIB/92).
Individual hospitalisation insurance: If the employee pays the hospitalisation insurance premium directly (without the employer), the premium is deductible as a medical expense under Article 105 WIB/92. The deduction is subject to the €210 threshold. The insurance benefit (the payout from the insurance when the employee is hospitalised) is tax-free — the payout is not considered taxable income.

Disability and Sick Pay

Sick pay (gewaarborgd loon / salaire garanti): When an employee is unable to work due to illness or accident, the employer must continue to pay the salary for a guaranteed period (the "gewaarborgd loon" / "salaire garanti"): (a) 30 days for a blue-collar worker (arbeider / ouvrier), (b) 30 days for a white-collar worker (bediende / employé) — extended to 90 days for certain long-term illnesses (cancer, stroke, mental health). The sick pay is fully taxable as professional income (subject to payroll tax and social security). After the guaranteed period, the health insurance fund (ziekenfonds / mutuelle) pays a disability benefit (the "invaliditeitsuitkering" / "prestation d'invalidité").
Disability benefit: The disability benefit (paid by the health insurance fund after the guaranteed sick period) is taxable as replacement income (the "vervangingsinkomen" / "revenu de remplacement"). The benefit is subject to a reduced withholding tax rate of 10–15% (the "bedrijfsvoorheffing op vervangingsinkomens" / "précompte professionnel sur revenus de remplacement"). The benefit is reported in the annual tax return and taxed at the progressive rates. The first €4,260 of the disability benefit per year is tax-exempt (the "belastingvrije som voor invaliditeit" / "quotité exonérée pour invalidité").

For the full personal income tax framework and the deduction thresholds, see our Personal Tax Guide →. For the employment benefits and the hospitalisation insurance, see our Employment Benefits Guide →. For the social security rules, see our Payroll Tax Guide →.