Healthcare in Austria: e-card, contract doctor or Wahlarzt, and which route is yours

Yes, you are insured quickly in Austria, but not automatically and not through one office. Which route you take depends on one question: are you coming to work, with a Dutch pension, or with neither. The first two routes are cheap and largely automatic. The third is the pitfall: anyone with no work and no pension who can't be co-insured with a partner pays € 565.25 a month in 2026 for the Selbstversicherung and in principle is only entitled to a doctor, medicines and hospital after six months.

Which route applies to me?

Route 1: you're going to work. Your employer is obliged to register you with the health insurer before your first working day, and has to give you a copy of that registration as soon as possible. With your first Austrian job the employer also requests your Versicherungsnummer. How pay and contributions work beyond that is in working in Austria.

Route 2: you come with a Dutch statutory pension or benefit. Then your healthcare runs through the CAK. The CAK advises starting three months before your move and processes your registration within four weeks. You receive an S1 or 121 document, with which you register with the designated insurer in Austria. You pay a treaty contribution to the Netherlands, and the country-of-residence factor that goes with it is high for Austria: 0.9177 in 2026. What that means alongside the tax treaty is in AOW and pension in Austria; if you come with early retirement, first read about the narrowing CAK route.

Route 3: no work and no pension. If your partner has Austrian insurance, you can be co-insured as spouse, registered partner or Lebensgefährte. The insured person pays a Zusatzbeitrag of 3.40% of their contribution base for this, unless you are raising children or their net income does not exceed € 2,064.12 a month. For a Lebensgefährte there is an extra threshold that hits newcomers: you must have shared a household for at least ten months. If there is no partner with insurance, the Selbstversicherung is what's left.

What does it cost in 2026?

Item	Amount or rule	Who pays
Serviceentgelt e-card	€ 25 for the year 2026, collected via the employer	the insured person, not co-insured family
Rezeptgebühr	€ 7.55 per pack	everyone, up to the annual cap
Wahlarzt	80% of what the ÖGK would have paid a contract doctor	the difference with the bill is yours
Zusatzbeitrag partner	3.40% of the insured person's contribution base	not with children or on a low income
Selbstversicherung	€ 565.25 a month	whoever is not otherwise insured
CAK treaty contribution	Dutch contribution × country-of-residence factor 0.9177	pensioners via the CAK

The Rezeptgebühr has an annual cap: once you have paid at least 2% of your net annual income in a calendar year, and in any case at least € 314.01, in prescription charges, you pay nothing more for the rest of that year. On 1 January the counter starts again.

Contract doctor or Wahlarzt: where's the difference?

With a Vertragsarzt (contract doctor) the e-card settles the bill. A Wahlarzt has no contract with the fund, sets their own rate and has you pay first yourself. The ÖGK then refunds 80% of the amount it would have paid a contract doctor for the same treatment, and never more than the actual costs. The ÖGK says it itself: you rarely get 80% of the bill back, because Wahlarzt rates are usually higher than those of the fund.

Two rules to know. You can submit a bill up to 42 months after the treatment. And anyone who sees a Wahlarzt and a contract doctor of the same specialism in the same quarter gets nothing refunded. Since 1 July 2024, Wahlärzte with at least 300 patients a year must submit the claim for you.

What do I do with the e-card?

The e-card is your proof of insurance and your key to the electronic health record ELGA; no medical data is stored on the card itself. On the back is the European Health Insurance Card, so you are covered when travelling within the EU. Pensioners under the ASVG, through a transitional rule, only pay the Serviceentgelt on 15 November 2026, for the year 2027.

A small hurdle that is often overlooked: an e-card can only be made once a photo of you is available. Co-insured family members, and also anyone with only a small side job, register with the insurer themselves after the move for a Versicherungsnummer and an e-card. For that the ÖGK asks for a birth certificate or passport, and if needed your marriage certificate.

The Selbstversicherung is an emergency brake, not a plan. If you insure yourself, in principle you are only entitled to a doctor, medicines and hospital after six months. That waiting period only lapses if immediately before you were co-insured, or insured under the ASVG or B-KUVG, for six weeks, or for 26 weeks in the last twelve months. Anyone coming without a job and without a pension therefore arranges before departure how the first months are covered.

Why does my residence document depend on this?

For the Anmeldebescheinigung, the document you apply for within four months of entry, anyone who doesn't work must show full health insurance alongside sufficient means. Which route fits your situation is in staying in Austria. And don't forget the Dutch side: your basic insurance ends when you leave, and cancelling without a gap is your own job.

In Vertrekklaar this is phase 5 of 5 of the journey, step 5.3: the same steps, but for your situation — in your order, tickable, and with the deadlines watched. See the whole journey to Austria or go straight to step 5.3 in the open plan.