Netherlands Healthcare Costs and Medical Expenses Tax Guide

Dutch healthcare costs and medical expenses tax treatment — the Netherlands has a mixed public-private healthcare system under the Zorgverzekeringswet (Zvw — Health Insurance Act). Every resident must purchase basic health insurance (basisverzekering) from a private insurer (CZ, VGZ, Zilveren Kruis, Menzis, etc.). The system is funded through: (a) the inkomensafhankelijke bijdrage Zvw (income-related contribution — 6.7% of taxable income up to the maximum premium income level of €71,628 in 2026), paid by the employer (the employer reimburses the employee for the contribution — the werkgeversheffing Zvw — the employer's contribution is not taxable for the employee), (b) the nominal premium (nominale premie — the flat-rate premium of ~€1,600–1,800 per year paid directly to the health insurer), and (c) the zorgtoeslag (healthcare benefit — an income-tested subsidy paid by the Belastingdienst/Toeslagen to low and middle-income adults). The specifieke zorgkosten (specific medical expenses) are deductible in box 1 if they exceed the drempel (threshold) — the threshold is 1% of the adjusted income (verzamelinkomen) plus €150 (2026). Deductible costs include: doctor and specialist fees (not covered by insurance), hospital costs (not covered), prescription medicines (not covered by the basisverzekering), dental costs (for adults — basic dental costs are not covered by the basisverzekering), physiotherapy (for the first 20 sessions — not covered), acupuncture, homeopathic treatment, and medical aids (glasses, contact lenses, hearing aids — if prescribed by a doctor). The herstelkosten (curative medical treatment costs) such as the eigen risico (the compulsory deductible of €385 — the deductible paid by the patient before insurance coverage starts) are not deductible separately (the eigen risico is not a tax-deductible expense). The aanvullende verzekering (supplementary insurance) premium is not deductible — only the basic insurance costs are eligible through the income-related contribution system.

Zorgverzekeringswet — Three Funding Pillars

Income-related contribution (inkomensafhankelijke bijdrage — 6.7%): The employer pays 6.7% of the employee's gross salary (up to the maximum premium income — €71,628 in 2026) as the werkgeversheffing Zvw. The employee does not pay this contribution directly — it is an employer cost. The employer can claim a deduction for corporate tax purposes (the contribution is a deductible business expense). For self-employed (ZZP'er), the income-related contribution is 5.43% of the taxable profit (2026) — the ZZP'er pays the contribution directly via the income tax assessment. The maximum contribution for a ZZP'er is 5.43% × €71,628 = ~€3,889.
Nominal premium (nominale premie — ~€1,600/year): The nominal premium is the flat-rate insurance premium paid to the health insurer. The premium varies by insurer (the overheid sets the basic premium — the basispremie — which insurers must charge for the basisverzekering). The premium is ~€1,600–1,800 per year in 2026. The nominal premium is not tax-deductible (the taxpayer cannot deduct the premium from their personal income tax). The premium is paid monthly or annually to the insurer. The insurer is not allowed to refuse an applicant for the basisverzekering (the acceptatieplicht — the open enrolment obligation).
Eigen risico — €385 compulsory deductible: Every adult (18+) has a compulsory deductible (eigen risico) of €385 per year (2026). The patient must pay the first €385 of medical costs each year before the insurance covers the remaining costs. The eigen risico applies to most medical services (GP visits are exempt — the huisarts is not subject to the eigen risico). The voluntary deductible (vrijwillig eigen risico) can be increased to €885 per year (an extra €500 voluntary deductible) in exchange for a lower nominal premium. The eigen risico is not tax-deductible.

Zorgtoeslag — Healthcare Benefit

Income-tested subsidy up to €2,000/year: The zorgtoeslag is an income-tested subsidy paid by the Belastingdienst/Toeslagen to adults with a household income below the threshold. The maximum zorgtoeslag is approximately €2,000 per year for singles (2026). The subsidy is reduced by 5–10% for each euro of income above the central government's reference income level. The zorgtoeslag is paid monthly (the voorschot — the advance payment) or annually. The recipient must apply for the zorgtoeslag at Toeslagen (via Mijn Toeslagen). The eligibility test: (a) the applicant must have Dutch health insurance (basisverzekering), (b) the household income must be below the threshold (~€35,000 for singles, ~€45,000 for couples in 2026), and (c) the applicant must be 18+ and legally resident in the Netherlands.

Specifieke Zorgkosten — Medical Expenses Deduction

Drempel — 1% of income + €150: The specifieke zorgkosten (specific medical expenses) are deductible in box 1 as persoonsgebonden aftrek (personal deduction). The deductible amount is the total qualifying medical expenses minus the drempel (threshold). The threshold is: 1% of the verzamelinkomen (total income from boxes 1, 2, and 3) + €150. For a taxpayer with an income of €50,000: the threshold is €500 + €150 = €650. If the qualifying medical expenses are €2,500, the deductible amount is €2,500 − €650 = €1,850. The deduction is at the progressive box 1 rate (up to 49.5%).
Qualifying medical expenses: The following are deductible (if not reimbursed by the basisverzekering or the aanvullende verzekering): (a) doctor and specialist fees (including hospital fees for clinical treatment not covered by the basisverzekering), (b) prescription medicines (if prescribed by a doctor), (c) dental costs (for adults — fillings, crowns, bridges, dentures, implants — root canal treatment and extractions are deductible, but routine check-ups and cleanings are not), (d) physiotherapy and manual therapy (beyond the first 20 sessions), (e) acupuncture, homeopathy, and alternative medicine (if prescribed by a doctor), (f) hearing aids (if prescribed by an audiologist), (g) glasses and contact lenses (if prescribed by an ophthalmologist or optometrist), (h) travel costs for medical treatment (€0.23 per km for car travel, or actual costs for taxi/public transport), and (i) dietary supplements (if prescribed by a doctor or dietitian — the dieetkosten — the prescribed diet costs). The deductible amount is reduced by any reimbursement from the health insurer or the aanvullende verzekering.

Additional Insurance — Aanvullende Verzekering

Premium not deductible: The premium for the aanvullende verzekering (supplementary insurance — covering dental, physiotherapy, alternative medicine, and other services not covered by the basisverzekering) is not tax-deductible. The premium is paid with after-tax income. The supplementary insurance typically costs €200–600 per year depending on the coverage level. The benefits from the supplementary insurance (reimbursement of medical costs) are not taxable — the payout is a tax-free reimbursement.

For the full personal income tax system and the box 1 rates, see our Personal Tax Guide →. For the employer's payroll tax obligations (including the werkgeversheffing Zvw), see our Payroll Tax Guide →. For the ZZP'er health insurance rules (the Zvw contribution and the zorgtoeslag), see our Starting a Business Guide →.