Health insurance premiums: full reform by 2029, first phase in 2027

Context

TL;DR

• Ticino approves two health insurance initiatives: limit premiums to 10% income and full tax deductibility.
• Reform starts in 2027 if Parliament approves; full implementation by 2029.
• Total cost: CHF 61.4 million, split between canton and municipalities.
• Cross-border workers benefit from increased tax deductions starting 2027.

Key facts

• Iniziative: Due iniziative popolari approvate il 28 settembre: limite del 10% sul reddito disponibile e deducibilità fiscale completa.
• Fase iniziale: La prima fase della riforma entrerà in vigore nel 2027, se il Parlamento cantonale approva il piano entro i termini.
• Costo totale: Il costo annuale totale è di CHF 61,4 milioni, di cui CHF 51 milioni coperti dal cantone e CHF 10,4 milioni dai comuni.
• Finanziamento: Il cantone propone di coprire i CHF 25 milioni attraverso risparmi e nuovi introiti, senza aumentare il deficit.
• Deducibilità fiscale: Deducibilità fiscale aumentata a CHF 6.500 per single e CHF 13.000 per coppie sposate dal 2027.
• Sussidi: I sussidi RIPAM aumenteranno significativamente dal 2027, con un costo aggiuntivo di CHF 38 milioni all'anno per il cantone.
• Beneficiari: Il numero di beneficiari passerà da 115.000 a circa 123.000 persone, con un aumento di 7.200 a 8.000 persone.
• Scadenza: La riforma deve essere approvata dal Gran Consiglio ticinese entro il 2026 per entrare in vigore nel 2027.

Bellinzona, 15 April 2026 — The Ticino State Council today unveiled, during a press conference held at the Government Palace, the government programme for implementing the two popular initiatives approved last 28 September: one promoted by the Socialist Party (SP) calling for a limit on premiums to 10% of disposable income, and the other by the League proposing full tax deductibility of premiums.

The first phase of the reform will come into force in 2027, but only if the cantonal Parliament approves the plan within the set deadlines. The total annual cost amounts to CHF 61.4 million, of which CHF 51 million will be covered by the canton and CHF 10.4 million by the municipalities. To finance the canton’s share, the State Council proposes an equal split: CHF 25 million through annual expenditure savings and CHF 25 million through new revenue, without increasing the deficit.

The two initiatives in brief

• SP initiative: maximum limit of 10% of disposable income for health insurance premiums. The government intends to adjust the calculation parameters of subsidies (RIPAM), intervening on the constants that determine the maximum disposable incomes (RDM). The goal is to significantly increase the amount of subsidies already from 2027, with an additional estimated cost of CHF 38 million per year for the canton. This will lead to an increase in beneficiaries from 115,000 to around 123,000 people (between 7,200 and 8,000 more), with an increase in subsidies already envisaged in the automatic system (PMR), which in 2025 reached CHF 426 million.
• League initiative: full tax deductibility of premiums. From the 2027 tax period, the maximum deductions would be increased by 20%, rising from CHF 5,500 to CHF 6,500 for single individuals and from CHF 10,900 to CHF 13,000 for married couples. The net financial impact is estimated at CHF 13 million for the canton and CHF 10.4 million for the municipalities, for a total of CHF 23.4 million.

Government reactions

The President of the State Council, Claudio Zali, highlighted the complexity of the challenge: «In a society that demands everything now and in a canton that has been living beyond its means for years, the feeling is that the dissatisfaction of the promoters of the two initiatives prevails». Zali emphasised that the reform will require at least three years to be completed, with the first step in 2027 and full implementation by 2029, according to modalities that will be defined in a second government message.

The State Council also recalled that the two initiatives were approved by a popular majority, but their implementation requires a balance between financial resources and the sustainability of the Ticino healthcare system.

Operational details

What changes concretely for cross-border workers in Ticino?

Cross-border workers residing in Ticino but working in Lombardy are among the most affected by this reform, particularly concerning the deductibility of health insurance premiums from taxes. Currently, Ticino’s tax regulations allow deductions of up to 5,500 francs for single individuals and 10,900 francs for married couples. Starting in 2027, these amounts will increase to 6,500 and 13,000 francs respectively, providing an immediate tax saving when filing annual returns.

Practical case: a single cross-border worker in Mendrisio

• Annual income: 80,000 francs
• Current health insurance premiums: approximately 5,000 francs per year
• Current deductibility: 5,500 francs (so the premium is fully deductible)
• Deductibility from 2027: 6,500 francs (additional saving of 1,000 francs)

For married couples with children, the increase in deductibility could reach an extra 2,100 francs per year, depending on the amount of premiums paid. This translates into a lower tax burden and greater liquidity available for everyday expenses.

📊 Comparison with the previous situation

• Before 2026: no limits on premiums, deductibility up to 5,500/10,900 francs.
• From 2027: 10% income limit on premiums (only for the SP initiative) and increased deductibility (for the Lega initiative).
• From 2029: full implementation of both initiatives, with methods still to be defined.

💡 Possible scenarios for cross-border workers 1. If income is low: the increase in deductibility can almost entirely cover premiums, making healthcare access less burdensome. 2. If income is medium-high: the 10% premium limit can provide significant relief, especially for those with dependents. 3. If already in financial difficulty: the reform introduces an increase in subsidies (RIPAM), which could reach up to 38 million francs more for the Canton, benefiting around 8,000 additional people compared to today.

⚠️ Deadlines to watch The first phase of the reform will only come into effect if the Ticino Parliament approves the plan by 2026. If delayed, implementation will automatically be postponed to 2028 or later. The State Council has already begun work to define technical details, but the ball is now in the court of the cantonal deputies.

What remains unchanged

• Health insurance premiums will stay the same until 2027. The reform does not reduce insurance costs but introduces support mechanisms for lower incomes.
• Healthcare coverage remains unchanged: all cross-border workers must still take out valid Swiss health insurance as required by federal law.
• Procedures for cross-border workers will not change: health insurance remains mandatory and must be demonstrated to obtain or renew a work permit in Ticino.

Useful tools to protect your net income

To reduce FX leakage, compare CHF-EUR exchange options and banks for cross-border workers.

Key points

What cross-border workers in Ticino need to do to benefit from the reform

The reform will only come into force if approved by the Ticino Parliament by 2026, but it is worth preparing now to maximize benefits. Here are the concrete steps to take:

1. Check your tax situation

From 2027, deductions for health insurance premiums will automatically increase. However, you should check your 2026 tax return (to be submitted in 2027) to ensure the amount of premiums paid is correctly reported. If you already have a policy, you won’t need to do anything: the reform will automatically update the deductibility limits.

2. Update documents for subsidies (RIPAM)

If you are among the estimated 123,000 beneficiaries of subsidies (an increase of 8,000), you will need to apply for RIPAM (Reddito di Integrazione per l’Accesso alle Cure). The Ticino government has announced that parameters will be adjusted as early as 2027, but the access procedures have not yet been published. Keep an eye on updates on the DSS (Dipartimento della Sanità e Socialità) website of the Canton of Ticino.

3. Monitor parliamentary deadlines

The reform must pass the Ticino Grand Council by 2026. To stay informed in real time, subscribe to the official newsletters of the State Council or follow parliamentary work on the Grand Council website.

4. Use calculation tools

To estimate the tax savings from the increased deductions, you can use the cross-border worker tax calculator. Simply enter your annual income and the amount of premiums paid to get an estimate of the tax benefit.

5. Contact the relevant services if you have questions

• For subsidies (RIPAM): DSS Ticino
• For tax deductions: Agenzia delle Entrate Ticino
• For work permits: DFE Ticino

Key deadlines to remember

Frequently asked questions

• Does the reform also apply to cross-border workers who work in Italy but live in Ticino?

Yes, the reform applies to all residents of Ticino, regardless of where they work. Cross-border workers must still have valid Swiss health insurance.

• What happens if premiums exceed 10% of income?

From 2027, RIPAM subsidies will cover the difference for low incomes. For medium-high incomes, the increase in tax deductions will reduce the burden.

• Can I already apply for RIPAM subsidies?

No, the DSS Ticino will publish the details of the procedure only after the plan is approved by the Grand Council.

• Does the reform reduce health insurance premiums?

No, the reform introduces support mechanisms for low incomes and increases tax deductibility, but it does not lower health insurance premiums.

• What happens if the Ticino Parliament does not approve the reform?

The first phase will automatically be postponed to 2028 or later. The State Council has already begun work to define the technical details, but without parliamentary approval, the reform cannot proceed.

For more information

• Cross-border worker tax calculator
• Guide to health subsidies in Ticino
• Updates on the Ticino Grand Council

Source: tio.ch