VAT exemption in healthcare: who is exempt and who is not?

Care is exempt from VAT if the treatment has a therapeutic purpose and you have the right qualification for it. That can be through a BIG profession, an equivalent level of training, or through the law under which the client receives care: the Wlz, the Wmo or the Youth Act. If one of those conditions is missing, you simply charge 21% VAT.

VAT exemption means that you do not put VAT on your invoice. It also means that you do not get back the VAT on your own purchases. For a care business this makes a treatment table, a car or software more expensive.

In this article

1. Which care is exempt from VAT?
2. When are you exempt with a BIG profession?
3. What if your profession is not in the BIG Act?
4. Which services of a care provider are still taxed?
5. When is care exempt because of the client's needs assessment or decision?
6. Can a care company make a profit and still be exempt?
7. What does the exemption do to your costs and your accounts?

Which care is exempt from VAT?

Care is exempt when it consists of medical acts for the personal healthcare of a human being. The Belastingdienst lists medical professions, dentists, care in institutions, social support, long-term care and day activities (Belastingdienst, Exemption in healthcare).

The rules are in article 11 of the 1968 Turnover Tax Act. Part g lists the services of medical and paramedical professions with training regulated by or under the BIG Act, insofar as those services belong to their expertise and training. The same part lists care for clients with a Wlz needs assessment, Wmo support for clients who are entitled to it and day activities (Turnover Tax Act 1968, article 11(1)(g), version 1 January 2026).

The purpose of the treatment always counts. According to the Belastingdienst it concerns treatments intended to protect, maintain or restore a patient's health (Belastingdienst, Medical practitioners). A treatment that only improves appearance is therefore taxed, even if a doctor carries it out.

When are you exempt with a BIG profession?

If you practise a profession under the BIG Act and the treatment belongs to your expertise. The BIG Act (Individual Healthcare Professions Act) regulates which care professions have a protected title or registration. For VAT it matters in which article of that act your profession is listed (Belastingdienst, Professions regulated by the BIG Act).

• Article 3 profession, such as doctor, nurse, physiotherapist or healthcare psychologist: you must be on the BIG register (BIG Act, article 3). If you are not, you cannot apply the exemption.
• Article 34 profession: there is no registration requirement. You apply the exemption if you meet the other conditions.
• Article 36a profession, an experimental profession: exempt for as long as the pilot runs.

For doctors the rule is wider. According to the Belastingdienst they are exempt for all treatments that protect the patient's health, including alternative treatments. It also does not matter whether you work under the direction and supervision of another care provider (Belastingdienst, Medical practitioners).

If you stand in for a colleague, the service remains exempt. The Belastingdienst says so explicitly, as it does for evening, night and weekend shifts at a GP out-of-hours service (Belastingdienst, Examples of exempt medical services).

What if your profession is not in the BIG Act?

Then you can still be exempt, if your care has a quality level equivalent to that of a BIG profession. The Belastingdienst names three ways to show this. A completed 240 ECTS higher professional bachelor aimed at the profession. Or a healthcare training combined with an additional training, or with relevant knowledge and experience, at the same level (Belastingdienst, Medical professions at a quality level equivalent to the BIG Act).

In all cases you must also have basic medical or psychosocial knowledge. The Decree on the medical VAT exemption lists as evidence, among other things, a registration with a professional association recognised by health insurers which shows that you have that knowledge (Decree on the medical VAT exemption, section 4.1, version 27 April 2023).

For a few professions the Belastingdienst has already established the equivalent level, such as the NIP child and youth psychologist and the medical pedicurist (Belastingdienst, equivalent quality level). For other professions you assess yourself whether you meet the requirements, and you must be able to prove it.

The care must also be given personally and directly to an individual patient. That may be in the consulting room, by phone or online. General information on a website about illnesses or treatments does not qualify (Decree on the medical VAT exemption, section 5).

Which services of a care provider are still taxed?

Everything without a therapeutic purpose, and any form of agency work. The Belastingdienst gives a list of examples of medical services that are taxed at 21% VAT (Belastingdienst, Examples of taxable medical services):

• medical statements and reports on liability, damage or professional errors
• driving licence examinations and medical examinations for pilots
• group treatments, unless everyone in the group is treated for their own disorder or limitation
• work by a psychologist for employers to improve employees' performance, and relationship therapy
• fall prevention training by physiotherapists, because it has no therapeutic purpose

Employment agencies that supply care staff always charge 21% VAT. That also applies if the staff have a BIG registration (Belastingdienst, Exemption in healthcare).

A doctor's assistant or practice nurse working as a freelancer in a GP practice charges VAT. Only if that person meets the conditions for the exemption themselves is the work exempt. If the assistant is an employee, VAT plays no role (Belastingdienst, Medical practitioners).

Do you also provide taxed services alongside exempt care, such as examinations, training or product sales? Then you must record them separately in your accounts. The Decree on the medical VAT exemption says that taxed and exempt supplies are recorded separately (Decree on the medical VAT exemption, section 5).

When is care exempt because of the client's needs assessment or decision?

For long-term care and Wmo support the exemption does not depend on your diploma, but on the client. Wlz care is exempt if a needs assessment under the Long-term Care Act states that the client is entitled to that care. This also covers personal care, support, nursing and domestic help at home (Belastingdienst, Exemption for social support and long-term care).

Wmo support is exempt if the client is entitled to it under the Wmo. For a customised provision this is shown by the municipality's decision. For a general provision the exemption only applies if the support fits the municipality's policy plan and by-law. Exempt are cleaning the home, cleaning clothes, help with personal care and activities for participation and self-reliance (Belastingdienst, Wmo and Wlz).

Not exempt within the Wmo are home adaptations, maintenance, garden work and transport (Implementing Decree on turnover tax 1968, article 7a(3)). A domestic helper who cleans for a private client without a Wmo decision or Wlz needs assessment therefore does not fall under this exemption.

Youth care has its own route. Youth care providers and certified institutions under the Youth Act are listed in annex B of the Implementing Decree, and the requirement that the institution does not aim for profit does not apply to them. The same goes for district nursing and for day centres for disabled people with a needs assessment (Implementing Decree on turnover tax 1968, annex B, items 9, 12 and 30 and the note to it).

Can a care company make a profit and still be exempt?

For the exemption for medical professions, yes. That exemption depends on the profession, the training and the purpose of the treatment. Article 11(1)(g) contains no profit requirement (Turnover Tax Act 1968, article 11). A physiotherapy practice run as a company therefore charges no VAT on treatments by its BIG-registered physiotherapists.

For care and nursing in an institution it is different. That exemption only applies if the institution has no profit motive. For commercial institutions it applies partly (Belastingdienst, Exemption for care and nursing in an institution). A profit-seeking institution with accommodation must therefore check for each service which other route it can rely on.

What does the exemption do to your costs and your accounts?

You do not put VAT on your invoices and you may not deduct the VAT on your costs. If you have both exempt and taxed turnover, you may deduct the VAT on costs for your taxed turnover, and part of it for mixed costs (Belastingdienst, What should you do if you supply exempt goods or services?).

That non-deductible VAT is a real cost. An exempt practice investing € 10,000 pays € 2,100 VAT that it does not get back. So include that VAT in your rate and in your investment budget.

Legal research shows why this is so strict. The European Court of Justice interprets the healthcare exemptions strictly, because they are an exception to the main rule that every service for consideration is taxed. Care providers often experience the exemption as a disadvantage, because they cannot deduct the VAT on their purchases (Påhlsson, 2015). That research is about Sweden, but the European rules are the same.

Will you provide taxed services alongside exempt care while you are registered with the Belastingdienst as having only exempt supplies? Then you must start filing periodic VAT returns. You send a letter to your tax office with the date from which you provide taxed services (Belastingdienst, Exemption in healthcare). How the return itself works is explained in a separate article (Filing a VAT return).

Sources

• Turnover Tax Act 1968 (Wet op de omzetbelasting 1968), article 11, version 1 January 2026, read via the BWB repository. wetten.overheid.nl
• Implementing Decree on turnover tax 1968, article 7a and annex B, version 1 January 2026 (in Dutch). wetten.overheid.nl
• Decree on the medical VAT exemption, BLKB2016/433M, amended 19 April 2023, version 27 April 2023 (in Dutch). wetten.overheid.nl
• Individual Healthcare Professions Act (Wet BIG), article 3, version 5 July 2025 (in Dutch). wetten.overheid.nl
• Belastingdienst, Exemption in healthcare (in Dutch), accessed 1 November 2026. belastingdienst.nl
• Belastingdienst, Medical practitioners (in Dutch), accessed 1 November 2026. belastingdienst.nl
• Belastingdienst, Professions regulated by the BIG Act (in Dutch), accessed 1 November 2026. belastingdienst.nl
• Belastingdienst, Medical professions at a level equivalent to the BIG Act (in Dutch), accessed 1 November 2026. belastingdienst.nl
• Belastingdienst, Examples of taxable medical services (in Dutch), accessed 1 November 2026. belastingdienst.nl
• Belastingdienst, Examples of exempt medical services (in Dutch), accessed 1 November 2026. belastingdienst.nl
• Belastingdienst, Exemption for social support and long-term care (in Dutch), accessed 1 November 2026. belastingdienst.nl
• Belastingdienst, Exemption for care and nursing in an institution (in Dutch), accessed 1 November 2026. belastingdienst.nl
• Belastingdienst, What should you do if you supply exempt goods or services? (in Dutch), accessed 1 November 2026. belastingdienst.nl
• Påhlsson, R. (2015). The VAT exemption for health care: EU law and its impact on Swedish law. Nordic Tax Journal, 2015(2), 18-35. doi.org