Dutch health insurance: the basic plan, the eigen risico and your four-month clock

Forget the open-enrollment maze back home. In the Netherlands, one government-defined basic plan covers everybody, and you have four months from arrival to buy it.

The short version

• It's mandatory. Everyone who lives or works in the Netherlands must take out Dutch standard health insurance (basisverzekering), even if you already have a US or international policy [1][2].
• Four months, max. Buy it no later than four months after you arrive, with cover from your arrival date. Wait longer and you're not covered for the gap [2].
• The deductible is €385 in 2026 and 2027 (about USD 430). GP visits don't count toward it [3].
• Premiums are set by each insurer but are the same for everyone on a given policy. The CAK put the average 2026 premium at €157 a month (about USD 175) [4].
• Low and middle earners can get zorgtoeslag, a monthly healthcare allowance of up to €129 (about USD 144) for a single person in 2026 [5].

USD conversions use the Federal Reserve H.10 rate of October 30, 2026 (EUR 1 = USD 1.1163) [8].

Who has to buy a Dutch basic plan

The rule from the Dutch government is blunt: "Everyone who lives or works in the Netherlands is legally obliged to take out standard health insurance" [1]. That includes Americans on a highly skilled migrant permit, a DAFT self-employment permit or a partner permit. Your Blue Cross card from back home doesn't get you out of it [2].

There are a few exceptions [2]:

• You work for an employer based outside the Netherlands. Then your insurance from home can be enough, under rules the Social Insurance Bank (SVB) explains.
• You work only for an EU institution. You're covered by the EU's own sickness scheme instead.
• You're a student. Depending on what else you do besides studying, you may or may not need a Dutch policy. Nuffic's Study in Holland site walks through it.
• You don't have a residence permit yet. You can't take out Dutch health insurance until the IND has decided on your application. Once your permit comes into force, the four-month clock runs, and the policy must start on the date the permit took effect [1].

Kids under 18 must be insured too, but they pay no premium for the basic plan. Parents must register a newborn with an insurer within four months of the birth [1].

The four-month rule, and what happens if you miss it

You must register with the municipality (in Amsterdam, that's your BRP registration and BSN) even before you have insurance [2]. Then:

1. Within four months: take out a policy that starts on your arrival date. You'll pay premiums back to that date, and claims from those first weeks are covered [2].
2. After four months: you're no longer insured retroactively. You don't owe back premiums, but you won't be reimbursed for any care between arrival and the date the policy starts [2].
3. The CAK letter: once you're registered, the CAK (the agency that checks everyone is insured) writes to you if it sees no Dutch policy. Don't ignore it [2].
4. The fine: if you haven't taken out a policy within three months of that letter, the CAK fines you. In 2026 the fine is €529.74 (about USD 591), three months of the average premium plus deductible [4].
5. More fines: you can avoid a second fine by insuring yourself before the date in the CAK's letter [4].

Heads-up for new arrivals: the IND and the city don't sign you up for insurance. It's on you.

What the basic plan covers, and what it costs

The government decides what's in the standard package, and every insurer offers the same one. Insurers must accept anyone who applies for it and must charge everyone on a policy the same premium regardless of age or health [1]. It covers things like GP visits, hospital treatment and prescription medicine [1]. Physical therapy and adult dental care mostly need optional extra cover (aanvullende verzekering), and insurers can turn you down or ask health questions for those [1].

The eigen risico (your deductible)

Sources: Rijksoverheid [3], CAK [4].

The €385 was frozen by law for 2026 [6], and Rijksoverheid says it stays at €385 in 2027 too [3]. It works like a US deductible: you pay the first €385 of covered care each calendar year, then your insurer pays.

What doesn't count toward the deductible [3]:

• GP care, including the after-hours GP post (huisartsenpost)
• Midwife and maternity care (kraamzorg)
• Certain chronic-care programs for type 2 diabetes, COPD and cardiovascular risk
• Community nursing (wijkverpleging)
• Everything for kids under 18, including most dental checkups and fillings

You can raise your deductible voluntarily in steps of €100 up to €500 in exchange for a lower monthly premium [3]. That's a bet you're healthy, and the fine print matters: one hospital visit and you could owe €885.

Premium plus payroll contribution

There are two charges, and Americans often only notice one [1]:

• The nominal premium you pay your insurer each month. It varies by insurer and policy type.
• The income-related contribution (the ZVW contribution), a percentage of your income set by law. Your employer sends it straight to the Health Insurance Fund, so it shows up on your payslip.

Choosing a policy

Insurers sell three main policy types [7]:

• Naturapolis (in-kind policy): the insurer contracts with selected providers. Go outside the network and you may be reimbursed less.
• Budget policy: an in-kind policy with fewer contracted providers or lower reimbursements.
• Combination policy: a mix of the two.

Many employers offer a group (collectief) policy with a discount [7]. Ask HR before you shop. Policies run on the calendar year. Insurers send next year's terms in November; switch by December 31, or cancel by December 31 and buy a new policy by February 1 [9].

Zorgtoeslag: the healthcare allowance

If your income is modest, the Tax Administration's benefits office (Dienst Toeslagen) pays a monthly allowance toward your premium and deductible [3][5]. You must be 18 or older, have Dutch health insurance, have a residence permit (or Dutch nationality), and stay under the income and asset limits [10].

Source: Belastingdienst/Dienst Toeslagen [5]. The amount tapers between those points; the Belastingdienst's proefberekening gives your exact number. There's also a limit on savings and investments; we couldn't open the page with the 2026 figure, so check it on the Toeslagen site before applying.

You apply once through Mijn toeslagen with your DigiD, and it renews automatically. Report income changes quickly, or you may have to pay some back. You can apply for a year until September 1 of the following year [10]. Many expats on a 30% ruling salary won't qualify, but a trailing spouse starting a new job mid-year might.

Your GP is the front door

The Dutch system runs through the GP (huisarts). You generally need a GP referral to see a specialist, and GP visits cost you nothing out of pocket because they sit outside the deductible [3]. In practice:

1. Register early, with a practice near your home, ideally in your first weeks. Ask whether the practice covers your address and is taking new patients; don't wait until you're sick to find out.
2. Ask at your first call whether the doctors are comfortable consulting in English. Many are.
3. Find your nearest huisartsenpost for evenings and weekends. Use 112 only for emergencies.
4. Keep your pharmacy consistent; Dutch pharmacies keep your medication record.

Don't expect American-style "let's run every test" medicine. Dutch GPs are known for watchful waiting, which can feel like sticker shock in reverse.

The US side

Uncle Sam doesn't care which Dutch insurer you pick, but a few things still follow you:

• Medicare works differently once you live abroad, and late-enrollment penalties can bite if you plan to retire stateside. See our Medicare guide below.
• US marketplace plans aren't designed for people living abroad, and a Dutch resident must hold the Dutch plan regardless.
• Your Dutch premiums are generally personal expenses on a US return. A US expat tax preparer can check your case.

Got questions about which insurer other Americans picked, or which Amsterdam GPs take new patients? Ask in our community group for Americans in the Netherlands.

Sources

1. Government.nl: Standard health insurance and Health insurance and residence permit
2. Government.nl: When do I need to take out health insurance if I come to live in the Netherlands?
3. Rijksoverheid: Eigen risico zorgverzekering
4. CAK: Waarom is de boete zo hoog? and Waarom heb ik een boete gekregen?
5. Belastingdienst/Dienst Toeslagen: Hoeveel zorgtoeslag krijg ik?
6. Eerste Kamer: Bill 36679, keeping the mandatory deductible unchanged in 2026
7. Rijksoverheid: Welke polissen biedt de zorgverzekeraar?
8. Federal Reserve: H.10 foreign exchange rates
9. Government.nl: When and how can I change my health insurance?
10. Rijksoverheid: Kan ik zorgtoeslag krijgen?

Keep reading

• Healthcare and health insurance in Amsterdam
• BSN and registering in Amsterdam
• The 30% ruling for Americans
• Medicare when you live abroad