CMU vs LAMal: which insurance scheme should you choose in 2025?

As a cross-border worker in Switzerland, your choice of health insurance is not just a matter of healthcare cover; it is also a financial decision that directly affects your purchasing power and that of your family.

What many people don’t realise is that you only have three months from the start of your business to join a health insurance scheme. After this period, you will be automatically enrolled in a health insurance scheme.

Whether you opt for the Swiss KVG or the French CMU, you will need to make regular payments, which often involve costly currency conversions and cross-border transfers.

At b-sharpe, we help thousands of cross-border workers every year to optimise their cross-border finances. In this article, discover our comprehensive comparison of the CMU and LAMal systems in 2025, learn how to assess your personal situation, and find out how to maximise your savings whatever decision you make.

A comparison of CMU and LAMal: pros and cons

The basics: CMU vs LAMal for cross-border workers in 2025

Health insurance is compulsory in Switzerland, and as a cross-border worker, you automatically lose your French cover from your first day of work in Switzerland. You then have the right to choose between two separate schemes:

• Universal Health Cover for cross-border workers: the French Universal Health Cover scheme
• The LAMal for cross-border workers: the Swiss health insurance system

Key point to remember: You have only three months from the start of your employment in Switzerland to make your choice. Once this period has expired, you will automatically be enrolled in the LAMal scheme. This choice is irrevocable for as long as you work in Switzerland.

To help you make the best choice between French and Swiss insurance policies, you need to take a number of factors into account, including:

• taxation…
• the cost of insurance;
• your income;
• your family situation;
• the place where your treatment is carried out;

The KVG: a closer look at Swiss health insurance for cross-border workers

Under the Swiss health insurance scheme (LAMal), you must pay a monthly premium, plus a deductible and a co-payment. For cross-border workers, the deductible is set at CHF 300 per year for adults. This means that you are responsible for the first CHF 300 of covered medical costs. Children, however, do not have a deductible.

The excess amounts to 10% of the costs covered by the insurance. It is capped at CHF 700 per calendar year for adults and CHF 350 for children.

If you wish to receive medical treatment in France, you can present your Carte Vitale and you will be reimbursed in accordance with French legislation. However, if you use your Swiss health insurance card (European Health Insurance Card), Swiss rules (excess and co-payment) will apply.

Please note: To ensure you are properly covered, particularly for expensive treatments such as hospitalisation, dental care or optical care, we strongly recommend taking out supplementary health insurance. We advise you to contact a broker for assistance with this! the period of unemployment in Switzerland, during which you would be receiving unemployment benefits or would have a paid job in France.

CMU, the French health insurance scheme for cross-border workers

The CMU (Universal Health Cover) is the French health insurance scheme available to cross-border workers. It allows you to receive healthcare in France with costs covered in accordance with Social Security rules. Cross-border workers enrolled in the CMU pay contributions based on their taxable income. This is often an attractive option at the start of a career or for those who live mainly in France.
With the CMU, you are part of the French healthcare system, which makes it easier to access healthcare, use the Vitale card and receive reimbursements in line with agreed rates.

Under the French social security system, contributions are calculated based on the Reference Taxable Income (RFR) declared in France and amount to 8% after deductions. All your declared income is taxed, and the more you earn, the higher your contribution will be.

If your spouse does not receive any income in France, please note that your children are automatically considered beneficiaries, without you having to pay a single penny. 

Key takeaways

If you opt for the LAMal, you will be able to receive medical treatment in both Switzerland and France, without restriction.
However, under the CMU, access to healthcare in Switzerland is limited. To ensure you receive a higher level of reimbursement, particularly for expensive treatments, it is advisable to take out supplementary health insurance. It is therefore important to compare the two schemes carefully before making your decision.

In any case, bear in mind that your choice of insurance is final. You will not be able to change it whilst you are working in Switzerland or are a cross-border worker. The only situation in which you would be able to change your insurance would be if you were to take a break from work in Switzerland, during which you were receiving unemployment benefits or were in paid employment in France.

How much will the CMU and LAMal cost in 2025?

Cost of the CMU in 2025

The CMU contribution for cross-border workers is calculated each year on the basis of income received in the year before last (N-2). For the 2025 contribution, therefore, income from 2023 is taken into account, according to the following formula:

Annual contribution = (2023 taxable income − 25% allowance on the 2024 income threshold) × 8%

• Standard allowance: For the 2025 contribution, the allowance is €11,592 (i.e. 25% of the 2024 income threshold, set at €46,368)
• Contribution rate: 8% for the year 2025

Practical example: For an RFR of €60,000 in 2023:

That is approximately €322.72 per month

Calculation: (€60,000 − €11,592) × 8% = €3,872.64 per year

Cost of the KVG in 2025

The new 2025 rates for cross-border workers’ health insurance are now official: 

Adults living in France and working in Switzerland will have to pay a monthly premium of CHF 200 for the most affordable health insurance provider (Helsana), compared with CHF 189.80 in 2024. Although this increase is significant, it is expected to rise further in 2026. As a guide, the highest premium offered to cross-border workers in France, by the KPT health insurance provider, is CHF 785.90 per month.

In addition to these bonuses:

• A compulsory annual excess of CHF 300 (equivalent to a ‘deductible’ – the amount you must pay yourself before the insurance starts to cover your medical expenses)
• A 10% co-payment on covered costs (cost-sharing after the excess, capped at CHF 700 per year for adults and CHF 350 for children)

Note: In 2023, the Swiss National Council adopted a key measure affecting the health insurance premiums of cross-border workers insured in Switzerland.  This change will result in a significant increase in their premiums, estimated at nearly 65%, or an average rise of around 129 francs. Despite this notable increase, the additional cost remains below the monthly average applied to Swiss residents.

How do you make the right choice? And what is the financial impact based on your circumstances? 

It can be difficult to make such an important decision, especially when you know it’s final. Indeed, your choice of health insurance is largely irrevocable, unless there is a major change in your circumstances (unemployment, moving house, retirement, etc.). It therefore warrants careful consideration, taking into account your personal circumstances and your medium- or long-term plans.

To help you decide, ask yourself the following questions:– Are you working in Switzerland for a short period, or are you planning a long-term career?
– Is your income likely to change?
– Do you have dependants?

If you plan to stay in Switzerland for several years and advance your career, the LAMal may prove to be more advantageous in the long term. Unlike the CMU, where contributions are based on a percentage of your reference taxable income (RTI), the LAMal applies a fixed premium that is not affected by salary increases or annual bonuses.

In short: A rise in income often means a sharp increase in CMU contributions, whereas with the LAMal, there is no risk of your healthcare costs spiralling out of control without warning.

For high earners

• Under the CMU: The higher your income, the higher your contribution (proportional system)
• Under the LAMal: A fixed premium that is not dependent on your income

At what income level does the LAMal become more cost-effective? For a single person, the ‘break-even point’ (the point at which one option becomes more economical than the other) is around €42,000 in RFR (2023). In practical terms:

• If your RFR is less than €42,000: CMU will cost you less, as the calculation—based on a percentage of your income—remains favourable
• If your disposable income exceeds €42,000: The LAMal becomes more cost-effective as its fixed price does not depend on your income

Example with figures:

• RFR of €50,000:
  • CMU = (€50,000 – €11,592) × 8% = €3,072.64 per year
  • LAMal = ~200 CHF × 12 = ~2,400 CHF/year (~2,280 €)
  • Savings with LAMal: nearly €800 a year

For families

• CMU: If your spouse has no income in France, your children are automatically covered at no extra cost
• LAMal: This is an individual scheme: a separate monthly premium is payable for each child (approximately CHF 60 to 80 per child).

For young workers

• CMU: A good option if your annual income is low early in your career.
• LAMal: Offers good cover in Switzerland, particularly suitable if you spend a lot of time there or are planning to pursue your career there.

b-sharpe tip: As a new cross-border worker, don’t make life difficult for yourself by opening a Swiss bank account to receive your salary. With b-sharpe, you can convert your earnings into euros simply, quickly, and without the fees associated with a Swiss bank account.

Key takeaways

Your income: the key determining factor

The amount of the CMU contribution is calculated based on your taxable income from the previous year, after a deduction of 25% of the Social Security ceiling. The contribution rate remains at around 8%, which means that a higher income results in a higher contribution.

Conversely, under the Swiss system, the KVG premium is not linked to income, but depends primarily on age, the canton of residence and the chosen health insurance provider. Each insurer is free to set its own rates, which explains the price differences between the various providers.

Your family situation and place of residence: other factors to consider

The Swiss health insurance system operates on an individual basis, which means you have to pay a separate premium for each child. Although KVG contributions are generally lower for children and young people, this is a cost you will need to factor into your healthcare budget for 2025.

Important point: Although the CMU may be a beneficial option for households with dependent children, the spouse’s circumstances also play an important role.

If your spouse works in France or is a cross-border worker in Switzerland who has opted for the CMU, your children may already be covered by their French health insurance. In this case, you can opt for the LAMal without having to pay any additional contributions for your children.

What steps do I need to take to register for CMU and/or LAMal?

How do I register for LAMal?

You can take out cover directly with an approved insurer. You will then need to sign a health insurance policy and submit the “choice of health insurance scheme” form to the relevant cantonal authority (for example, in the canton of Geneva, this is the Health Insurance Office).

Membership takes effect on the date you start work, and contributions are also payable from that date. You can calculate an estimate of the membership cost and compare the benefits of the LAMal, particularly its reimbursement limits and health cover. Please note that the LAMal only covers basic cover, but it is possible to take out supplementary insurance.

How do I register for the CMU?

If you opt for the CMU (now known as PUMA, although the term CMU is still commonly used), you must register with the Caisse Primaire d’Assurance Maladie (CPAM) in France. You must contact the CPAM in your department, complete the relevant form, and provide the necessary supporting documents: place of work, country of residence, proof of income for the calculation of the CMU contribution, etc.

Membership also takes effect on the date of commencement of employment, and the contribution is subject to French tax, calculated on the basis of an income ceiling.

Please note: You can access the forms and details of all the procedures required for cross-border health insurance on the CPAM website or the cantonal authorities’ website.

Our recommendation for 2025

The best choice depends on your personal circumstances, but here are our general recommendations:

The LAMal may be more advantageous if:

• Your RFR is over €42,000
• You regularly receive medical treatment in Switzerland
• You do not have any dependent children

The CMU may be the better option if:

• You are on a moderate income
• You have several dependent children
• You mainly receive medical treatment in France

Additional services from b-sharpe

Whether you opt for CMU or LAMal, effective management of your cross-border finances remains essential to maximise your purchasing power as a cross-border worker.

If you’re looking to make a smart choice and save money on other types of expenditure, b-sharpe can help you do just that, allowing you to pay up to five times less to transfer your wages or savings between CHF and EUR (and over 30 other currencies). It’s very simple to take advantage of this:

• Create your account for free in under 10 minutes
• Save on every transfer 
• Simplify your cross-border financial affairs

Calculate your savings with our simulator →

Why is health insurance compulsory for cross-border workers?

Health insurance is compulsory in Switzerland. All workers must be insured for medical care in the event of illness or accident, but with so many different schemes and options available, it can be difficult to know where to start…

Please be aware that, as a cross-border worker, your first day of work in Switzerland has the unfortunate consequence of causing you to lose your health insurance altogether!

Choosing the right insurance quickly and wisely is therefore a crucial step. Furthermore, bear in mind that you alone must take the necessary steps, as your employer will not assist you in any way.
You therefore have no choice: you must find out the necessary information and insure yourself and your family independently, without relying on any external parties (employer, local authority, etc.) to assist you in your search.

Should you take out supplementary health insurance to maximise your cover?

Yes, it is often recommended that you take out supplementary health insurance, whether you are covered under the LAMal or the CMU. These schemes only cover part of your medical expenses, based on a set reimbursement rate.

Supplementary health insurance helps to top up these reimbursements, particularly in the event of expensive treatment, medical care in France, or emergency hospitalisation. It can be tailored to your personal circumstances (unemployment, pensioner, resident in a border area, etc.). 

What is the cost of living in Switzerland, and how does it affect your choice of insurance?

The cost of living in Switzerland is very high, which has a direct impact on your healthcare budget. It is crucial to assess your monthly income, your potential medical expenses, and your personal circumstances (resident, pensioner, unemployed, etc.). The LAMal scheme for cross-border workers has a fixed membership fee (in CHF per month), whilst the CMU for cross-border workers applies a rate based on your RFR. Each scheme has its advantages: the LAMal offers Swiss healthcare coverage, whilst the CMU is integrated into the French system (CPAM, GP, mutual insurance). There are online calculators that can help you get more precise recommendations on whether to choose LAMal or CMU based on your income bracket, country of residence, and medical needs.

Still can’t decide between LAMal and CMU? Have you considered using a broker?

At b-sharpe, we recommend that you seek advice from a specialist who can guide you in making the right choice, based on your personal circumstances. A health insurance expert will be able to help you find the solution that best suits your needs.

To help you get a clearer picture, some professionals offer comparison tools that allow you to assess the policies offered by the leading insurance companies. This could save you a significant amount – up to 60% on your current basic premium!

As you can see, choosing health insurance as a cross-border worker is a complex process. And yet, this decision is both crucial and final. The information you need is often hard to come by, and your employer may not necessarily be able to help you… That is why consulting an expert in the field can prove particularly useful.

With b-sharpe, always make the smart choice for your cross-border finances

Whether you opt for CMU or LAMal, effective management of your cross-border finances remains essential to maximise your purchasing power as a cross-border worker.

If you’re looking to make a smart choice and save money on your expenses, b-sharpe can help you do just that, allowing you to pay up to five times less when transferring your wages or savings between CHF and EUR (and over 30 other currencies). It’s very simple to take advantage of this:

• Create your account for free in under 10 minutes
• Save on every transfer 
• Simplify your cross-border financial affairs

Calculate your savings with our simulator →