No one wants to be poorly and have to visit a doctor or hospital but expats living and working in France at least have access some of the best healthcare in the world.
That’s the verdict from the World Health Organisation, which puts the French healthcare offering at first place.
However, one reason why the healthcare system in France is so effective is that it requires mandatory health insurance and consists of both private and public hospitals.Most of the health costs for people in France is met by a public health insurance scheme so expats must be registered with a doctor to access treatments under the healthcare system.
To fund the system, expats will have mandatory contributions deducted from their salary, known as Sécurité Sociale or social security, at a rate of 7.5% while their employers have to pay just over 13% of the worker’s salary towards the nation’s health costs.
Once an expat is registered for making social security contributions, known as CMU, and is considered to a permanent resident, they will need to carry a French health insurance card. These are issued to everyone aged 16 and over and it will have the expat’s photo along with a microchip embedded within it containing their social security details, name and address and any payment exemptions.
The French health insurance card
The French health insurance card carries no medical information about the person concerned. It can be presented for all health appointments whether they’re with a GP, a hospital, specialist or the pharmacy. The European health insurance card is dealt with later in this article.
The system also means patients have to pay a small amount for their treatment or doctor’s visit though they can reclaim most of this payment. It’s usually around 70% of their GP’s fees and long-term and major illnesses can have 100% of the patient’s costs reimbursed.
By law, people in France must have medical health insurance with a recognised provider or they may take extra health insurance that is offered by a mutuelle to reclaim the balance of their medical bills.
These top-up insurance costs with a mutuelle are between €25 and €100 a month depending on the level of healthcare cover the expat wants.
For those who cannot afford to pay health insurance premiums, they may be eligible for free coverage with a mutuelle provider or with a private health insurance firm.
However, it should also be noted that medical insurance providers are unlikely to reimburse some medical expenses, for instance, those that have been incurred from participating in dangerous sports.
On top of this, most GP surgeries – or doctors’ offices – have a low out-of-pocket surcharge for each visit made. It’s usually a €1 charge but it needs to be paid.
The other issue for expats living in France wanting to access the healthcare system is that there are restrictions in place. For instance, they must be paying French social security contributions and have a valid residence permit.
There are also rules about living in France; they need to spend more than 183 days in the country and must register for CMU through a Caisse Primaire d’Assurance Maladie or CPAM office – these can be found on the Ameli website.
Essentially, expats who have lived in the country for at least three consecutive months and are considered to be a permanent legal resident – which means they have spent 183 days every year in France – can apply for public healthcare cover.
This is a new rule that was introduced in early 2016 and helps expat retirees, for instance, since they previously were not eligible for coverage until they had lived legally in the country for between one and five years. They had to pay the private health insurance to cover medical costs, which can be expensive.
Also, expat retirees had to visit their CPAM every year with documents to prove they were still able to receive cover and provide documents proving their status.
For those who are in the process of applying for residency and need to access a GP or a hospital, there is state medical assistance, known as Aide Médicale d’Etat, available but again there are restrictions. The CMU can offer more advice about this situation.
Health insurance from a specialist expat health insurance provider
It’s also possible for expats to provide their extra health insurance from a specialist expat health insurance provider such as Cigna, Bupa and Axa PPP.
For expats living in France who are legally self-employed, the system to register, pay Social Security contributions and claim reimbursements is slightly different and there’s more information on the government website (see below).
When it comes to making a claim for any expenses incurred for French healthcare, the expat will need to contact the CPAM office and provide various documents including a national ID card or their passport and also proof of residence.
The office may also ask for proof of income as well as a permanent address and perhaps a birth certificate or marriage certificate if it’s a family claim.
Generally, permanent French residents will have their medical costs reimbursed directly because they have used their French health insurance card and the payment usually takes less than a week.
Expats from around the European Union, Switzerland as well as the European Economic Area (EEA) who have been issued with a European health insurance card (EHIC) can also access healthcare in France and do not have to be registered to do so.
Expats carrying the EHIC should also get health insurance cover since the card is not a replacement for this and should there be a need for major surgery or disease treatment then the expat will have to foot the bill.
EHIC enables expats to access medical treatment
The EHIC card enables expats to access medical treatment as result of sickness or accident and also access doctors, hospitals and dentists. It should also be noted that the EHIC card does not cover the full cost of any medical treatment in France, which is why private health insurance cover is also highly recommended.
Indeed, expats will have to pay and use their EHIC card to claim a reimbursement from the CPAM office. For accidents and emergencies, the bill will be paid directly by CPAM to the hospital though the expat will still have to pay their 30% share – and this amount cannot be reclaimed using the EHIC card.
British expats should also be aware that they cannot make a claim on the EHIC for a reimbursement from the NHS when they return home – this changed in 2014.
Secondly, the new rules brought in during 2016 also created minimum thresholds for people before they were called upon to pay into the healthcare system.
For retired expats who have legal residency they have to pay 8% of their net income above this amount into the fund, under the single person’s threshold of €9,611.
This enables the expat to reclaim 70% of government fixed fees when seeing a doctor, specialist or a dentist. It also means they can claim 80% of fixed hospital costs and up to 100% of medication costs.
Expats pay €23 for a GP appointment
Because the fees for seeing a doctor are fixed by the government, expats pay €23 for a GP appointment and can claim 70% of that fee back. Doctors in the private sector will charge more which could be anything from €45 to €120, though the patient can still reclaim 70% of the figure.
When the time comes for an expat to arrange an appointment with a doctor, they will find there is a very good network of family doctors across France who are mostly self-employed and they may work within a group practice.
The process for registering is straightforward and there is a form to be completed. This must also contain the doctor’s stamp. After being filled out and stamped, it is then sent to the CPAM office.
However, expats should be aware that they must pay for any doctor’s consultation upfront. The rates are determined by the government and are also published on the walls of the doctor’s surgery. The fees vary depending on whether it’s a weekend or evening visit and there are separate rates for home visits too.
Again, expats will be able to claim 70% of the doctor’s fee with the remaining 30% being funded by themselves, the mutuelle or the health insurance provider. Visits to private doctors, known as secteur 2 doctors, may be reimbursed at a lower rate since these doctors can effectively charge whatever they want.
Referrals to a specialist
Should the expat be referred to a specialist they may find that under the healthcare system in France that they work within their own practice, hospital or clinic. Many also work within a group practice.
Specialists also typically charge more than a GP, though many of the rates have been set by the health service. The expat will only be able to reclaim a proportion of the official allowable rate. The health insurance provider may pick up the rest of the bill but the expat should be prepared to pay the remainder themselves.
The doctor may also refer the expat to a specialist and help coordinate any follow-up treatments and the expat will still be able to claim 70% of medical consultations and treatments. However, if they decide to choose their own specialist then the medical fees may be higher and they may only be able to claim back a lower amount.
The French healthcare system also enables expats to arrange a consultation with a variety of specialists without having to visit a GP first and these include paediatricians as well as gynaecologists.
Should the expat need to be referred to a hospital, like most countries, there are private clinics and also state-run hospitals. They will find the standards of care are very high. A GP can refer an expat patient to any of these with 80% of the bill being reimbursed. However, there is an element of board and lodging charged by the hospital which cannot be reclaimed from the CMU – this is where health insurance will help.
Expat prescriptions for medicines
Should the expat be handed a prescription for medicines they can take this to a pharmacy and part of the prescription costs will be picked up by the state while the remainder will need to be paid. This amount can be claimed back but the amounts vary depending on the type of medicine so the proportion ranges from 15% to 100%.
For those expats that need to visit a dentist, they’re not restricted to which one they can visit for treatment and the costs are reimbursed using the same process for medical treatment. The expat will need to pay for their treatment up-front and they will be reimbursed afterward.
Again, these reimbursements are for 70% of the treatment cost while children have free check-ups. Expats wanting specialist treatments such as orthodontics will find that the treatment is not covered by the state.
Essentially, the French healthcare system is exceptional and expats will gain access to quality doctors and health services no matter where they live in the country and the treatments and medical visits will be refunded at a rate of 70% by the country’s social security system.
The remaining 30% is the expat’s responsibility but as we have explained in this article there is medical insurance available and also low-cost coverage with a mutuelle and for many expats – particularly US expats – the costs involved are surprisingly reasonable for the quality of care on offer.
The CMU website offers advice on accessing healthcare while applying for legal residents. Register for CMU on the Ameli site.
Self-employed expats working in France should consult the Regime Social des Indépendants website for more information.