The hygienic behavior of honey bee workers contributes to the social immunity of colonies. The ability of workers to detect and remove unhealthy or dead brood prevents the transmission of brood diseases inside the colony. Over the last five decades, this trait has been extensively studied and improved in several research and breeding programs. Given the strong interest for hygienic behavior, we here review the costs and benefits associated with this trait, extending preceding reviews on this subject from the late 1990s. Since the 1990s, there have been no major new insights on the efficiency of this behavior against American foulbrood and chalkbrood. However, the number of publications on hygienic behavior against the mite Varroa destructor has considerably increased, fueling the debate regarding the efficiency of hygienic behavior against this parasite. Breeding programs have shown that selection for a specific trait might also impact other traits. Thus, we also review the cost of trade-offs between hygienic behavior and other economically important traits for bee breeders. Overall, the benefits of hygienic behavior seem to largely outweigh its costs for both colonies and bee breeders.