Person Receiving Care
The insured person is responsible for the deductible and copayment, as well as—depending on cantonal regulations—a patient contribution.
Check who covers the costs:
Who Pays for Spitex Care Services?
People who need care at home often wonder who covers the costs. The answer depends on what services are needed and whether they qualify as recognized care services. Here, we explain step by step what portion is covered by the person receiving care, the health insurance provider, and the municipality or canton.
Who helps cover the cost of long-term care?
Health Insurance
Basic insurance covers the legally mandated contributions toward recognized Spitex care services.
Municipality / Canton
The municipality or canton covers the remaining costs of approved long-term care within the framework of statutory requirements.
How much does basic insurance cover?
Basic insurance covers a portion of the costs for nursing care services defined by law under the Health Insurance Act (KVG), provided that the need for care has been professionally assessed.
These include:
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Assessment, counseling, and coordination
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Examination and treatment
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Basic care
A doctor’s order is required for therapeutic care services. These include, for example, wound care, injections, preparing medications, or measuring blood sugar.
Basic Insurance Contributions per Hour of Care
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CHF 76.90/hour
Assessment, counseling, and coordination provided by a nurse
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CHF 63.00/h
Examinations and treatments ordered by a doctor
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CHF 52.60/hour
Assistance with basic daily care tasks
What costs are covered by the municipality or canton?
After the basic insurance coverage has been applied, additional long-term care costs remain for approved long-term care services. These are covered through what is known as “residual financing.”
Which costs are covered and how much the municipality or canton contributes depends on the legal requirements of the respective canton.
How is residual financing calculated?
SpitexCare lists the care services actually provided in a cost statement. The respective canton determines which of these costs are eligible for residual financing.
The legally mandated contributions and copayments are deducted from the recognized care costs. The municipality or canton covers the remaining recognized amount as part of residual financing.
SpitexCare cannot determine the amount of the remaining funding on its own.
Which services do patients pay for out of pocket?
Not all Spitex services are considered KVG nursing care services. Services such as housekeeping assistance, grocery shopping, accompaniment, or general care are generally not covered by mandatory health insurance and are billed separately.
These may include, for example:
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Household help and cleaning services
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Shopping and meal preparation
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Accompaniment to appointments
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Companionship and general care
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Other services not covered by insurance
Depending on your insurance coverage and personal situation, it may be worth checking whether supplemental insurance covers part of these costs.