VAT-exempt work: healthcare, education and more

Some services in the Netherlands are VAT-exempt by law, not because of a choice you make. If you're a healthcare provider, educator, insurance agent, or childcare worker, your invoices don't carry VAT—but there's a catch: you cannot reclaim the VAT you pay on your business costs. This article explains how VAT exemptions work, how they differ from the small business scheme (KOR), and what to do if your work spans both taxable and exempt activities.

What is a VAT exemption?#

A VAT exemption is different from charging zero VAT. When you're exempt:

• You do not charge VAT to your customers
• You cannot reclaim VAT on your business purchases
• You do not file a VAT return (unless you're partly taxable—more below)
• The rule is mandatory: you cannot opt into or out of it

This is enshrined in EU VAT law and applies across all member states, though the list of exempt services varies slightly.

The main VAT-exempt services#

Healthcare and medical care#

If you're a doctor, nurse, physiotherapist, or other licensed healthcare provider:

• All medical services are exempt, including diagnosis, treatment, rehabilitation, and preventive care
• This includes dentists, psychologists, and complementary therapists (if licensed)
• Medical devices supplied as part of a service are exempt (e.g., a bandage applied during a dressing change)
• But selling a medical device alone (hearing aids, crutches, prescription glasses) is usually not exempt—you charge 9% VAT on most, or 21% on some

Education and training#

If you provide education:

• Full-time educational courses run by a school, college, or university are exempt
• Vocational training and craft instruction are typically exempt
• But commercial training courses, webinars, or "skills workshops" for professionals are often not exempt—they're usually 21% VAT

The distinction is whether it's formal education (established curriculum, recognized qualifications) or commercial service (workshops, coaching, one-off courses).

Insurance#

If you work in insurance:

• Insurance brokerage and agent services are exempt
• This covers helping customers find and arrange insurance policies
• But financial advice, investment services, or bundled consulting (where insurance is just one element) may not be fully exempt

Childcare and youth work#

If you run or work in:

• Daycare centres, nurseries, and after-school care are exempt
• Youth work, fostering, and care work for vulnerable people are typically exempt
• But educational tutoring, private lessons, or coaching may not be—this crosses the line into education or commercial services

Other exempt activities#

• Residential care and nursing homes
• Certain cultural services (libraries, museums, cultural events—though this can be complex)

How VAT exemption differs from the small business scheme (KOR)#

Many freelancers are confused between exemption and the KOR. They sound similar but are fundamentally different:

The practical difference: if you're a physiotherapist with €50,000 turnover, you're exempt—no choice, no VAT, no return. If you're a consultant with €15,000 turnover, you could register for VAT (if B2B clients want it) or choose KOR (if B2C); either way, you opt in.

The sticky problem: mixed activities#

What if you do both taxable and exempt work?

Example 1: A physiotherapist who also sells fitness programs#

• Your physiotherapy sessions: exempt
• Your online fitness course or group classes: might be taxable (not formal education, so 21% VAT)
• Your sale of home exercise equipment: taxable (21% or 9%, depending on the item)

In this case, you're partially exempt. You must:

1. Separate your invoices clearly—show which services are exempt and which are taxed
2. Reclaim VAT only on costs attributable to the taxed activities (the fitness course's software, the equipment's cost)
3. File a VAT return quarterly—but only report your taxable supplies
4. Allocate shared costs fairly (e.g., office rent, insurance) between exempt and taxable work

Example 2: A healthcare provider who sells branded merchandise#

• Your medical consultations: exempt
• Your branded notebooks and t-shirts sold to patients: taxable (21% VAT)

Again, you're partially exempt, and must track and separate the two.

What you cannot do#

• You cannot choose to charge VAT if you're exempt (e.g., a doctor cannot charge VAT "to make invoicing easier")
• You cannot reclaim VAT on business costs, even if most of your customers are businesses
• You cannot apply the KOR if you're exempt (exemption is mandatory and overrides KOR rules)

How to invoice when you're exempt#

Your invoice must clearly state that the service is VAT-exempt. Common phrasings:

• "Service exempt from VAT (Article 132 VAT Directive)"
• "Healthcare service—VAT exempt"
• "Educational service—exempt from VAT"

• State the service and amount (without VAT) clearly
• Note 'VAT exempt' or the article that applies
• Do not show a 0% VAT line—just omit the VAT entirely
• If partly taxed, split the invoice: exempt services in one section, taxed in another

Frequently asked questions#

Next steps#

If you're unsure whether your work is exempt, check the Belastingdienst VAT guidance or ask an accountant—the cost of clarity now is far less than the cost of a correction later. If you are exempt, make sure every invoice clearly states it, and keep good records separating any taxable income from exempt income.

For more on how VAT fits into your quarterly return, see how to file a VAT return. If you earn taxable income alongside your exempt work, the small business scheme (KOR) and VAT rates explained will help you decide your next move. And when invoicing, remember the invoice requirements for exemptions are simpler than for taxed supplies—just state the exemption clearly.

Using ZZP Belasting can help you track which services are taxable and which are exempt, so your quarterly filings are always accurate and stress-free.

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