Healthcare costs by country: what a family of four pays to stay covered

By Skyler Bissell · Updated October 2026 · computed from cityparity's engine data

A US family of four on $150,000 pays about $13,500 a year to stay covered, premiums and out-of-pocket costs together. The table puts the same family, two working parents with children aged 3 and 6, in all 71 countries we cover, and 68 of the other 70 come in under that figure. What a government spends on health per person is a different number, which the World Bank and the OECD publish.

In the 27 countries marked optional private cover, a public system already covers everyone and the premium is cover a professional there usually holds anyway, so those totals are an upper bound. That is why Costa Rica sits above the US: without the elective premium the family in Costa Rica pays $5,811.

Two working parents on $150,000 between them, children aged 3 and 6. Each figure is the median across the metros we cover in that country, converted to dollars at 2026-10-21 rates. Premium is what the household pays to hold cover; in the US that is the worker's share of an employer plan. The next column is realized annual spending on co-pays, prescriptions and adult dental, net of reimbursement, so it is a typical year and never a statutory maximum.

A low row can also mean the money is collected somewhere else. In the 15 countries marked payroll levy (Cyprus, Japan and Czechia among them), cover is paid for by a health contribution taken from gross pay. That money is already counted on the income tax rates ranking, so this table leaves it out and shows only what the family pays on top.

Universal coverage still bills a premium in 28 countries

28 of the 53 countries our data marks as having universal healthcare still bill this family a premium. In 25 of them the premium is elective private cover on top of a public system that already covers everyone, and in the other 3 the law or the tax code makes it unavoidable. Who the law sends the invoice to is what moves a country up or down the table, and the 6 answers our data uses are below.

The UK is the plainest case of the first row. The NHS is paid for out of general taxation, so this family pays $0 in premiums and about $2,166 a year in prescriptions, dental and other costs at the point of use. Switzerland sits at the other end of the universal group: every resident, children included, must buy a basic policy, and this family's premiums come to about $17,455 a year.

What the US figure covers

The US total is $8,280 of premiums plus $5,260 of out-of-pocket costs and dental at the median metro, and it runs from $12,885 in Atlanta to $15,104 in San Francisco. For scale, KFF's 2025 Employer Health Benefits Survey puts the average worker's share of a family premium at $6,850 a year before any deductible, on a total family premium of $26,993. The employer pays the rest, which is salary you never see, and the cover is tied to the job. How much of that the employer spends on you is worked through in how much your employer pays for health insurance, and what it does to the "Europe taxes more" argument is in the true tax burden once healthcare is counted.

Healthcare is one of the costs that decide a family move, alongside childcare and leave. The full family picture is in what it costs to raise kids, paid leave around a birth is ranked in parental leave by country, and the calculator runs this family from Detroit to London with tax, rent and childcare priced together.

FAQ: healthcare costs by country

Which country has the cheapest healthcare for a family?

Sweden, on our numbers: a family of four pays about $848 a year there, with no premium at all, against $13,540 in the US. Cyprus ($1,055) and Norway ($1,149) come next. Every figure is for two working parents on $150,000 with children aged 3 and 6.

How much does healthcare cost a family of four in the US?

About $13,540 a year at the median of the 28 US metros we cover: $8,280 in premiums, the worker's share of an employer plan, plus $5,260 in out-of-pocket costs and dental. It runs from $12,885 in Atlanta to $15,104 in San Francisco. The employer pays the larger part of the premium on top, and the cover ends with the job.

Is healthcare free for children in Europe?

For the premium, mostly yes. In 20 of the 26 European countries we cover, two children add nothing to what the family pays for cover: they ride on public cover or on a parent's policy. Switzerland, Ireland, France and Belgium charge for the children as part of cover we count as required (about $3,491 a year for two in Switzerland). In Greece and Bulgaria the extra premium is optional private cover. Co-pays and prescriptions can still cost something, so free cover is not always a free bill.

Is healthcare more expensive in Switzerland than in the US?

Yes, for this family. Switzerland comes to about $20,776 a year, $17,455 of it in compulsory basic-insurance premiums, against $13,540 in the US. Swiss premiums are paid in full by the household, where a US employer pays most of the premium on top of the worker share.

Figures come from cityparity's per-city engine, computed from official sources with a per-value audit trail; currency conversions use rates from 2026-10-21 and drift daily. Treat any single number as a strong estimate and run your own. See the methodology.