Not so long ago Timothy Egan, a New York Times columnist, referred blithely to the “free” healthcare available in France. This is a deeply misleading notion and anyone coming here needs to understand the realities of the situation. Treatment is genuinely “free” – that is, the person receiving care pays nothing – in two cases: pregnant women from their 33rd week and for 12 days after giving birth; and then those benefiting from the special provisions for the poor, CMUC, as they’re known.
It’s worth expanding on some basic coverage points (see below). First, for some serious illnesses and treatments full cover is available if the doctor or treating establishment is charging only the Sécu approved rate (tarif conventionné). These include cancer, heart disease and diabetes; most surgery is also covered, though, usually not if undertaken for aesthetic reasons. Other conditions can attract full cover if defined as long-term (maladies de longue durée). There is, it should be noted, a clear and on- going tendency for the Sécu to reduce its generosity – this in the face of its massive deficit which this year is estimated to be around €12 billion. Some reasons for this are clear enough and just have to be lived with: increasing cost of medical care and an ageing population. Many critics, however, are ready to identify other contributory factors, including poor management of the system, the greed of the medical profession (some would say) and the voracious, indeed, inflated appetite of French consumers for therapies of all kinds.
Despite its catastrophic financial state, the Sécu is still ready to offer free care to those genuinely unable to pay. This comes through what’s called the Couverture Maladie Universelle (CMU) and applies to EU citizens who’ve been accepted as “permanent residents”. Under this system you get state healthcare even if not otherwise eligible and, if you’re really poor, the equivalent of “top-up”, insurance is also offered to you. Sounds fine, and in general it is, but some medics are less than enthusiastic about taking those on CMU/CMUC, and that’s notoriously the case with tooth pullers. The guys in white coats bluster when this is mentioned but it’s well documented. One Irish middle-aged woman told us, “I was sick and I was treated like a beggar.”
Some readers will need full cover, almost all others a top-up
One point to take on board is that doctors are either conventionné (charging the approved Sécu rate) or non-conventionné (free, more or less, to set their own fees). To indicate how the system works, a visit to a GP costs €23. Of this sum 70% – or €16.10 – is reimbursed by the Sécu, the remaining 30% – or €6.90 – by the mutuelle. It’s important to understand the figures quoted by the top-up insurers: 100% means 100% of what’s paid above the Sécu contribution (so: €6.90), 200% means twice that amount up to the total sum paid (you can’t claim beyond that, obviously). What you get back on fees paid to a doctor who’s non-conventionné can be very variable between providers. A positive point to make: insurers can’t hike premiums in direct relation to a client’s medical condition, only on the grounds of increasing age. Also they can’t cancel top-up insurance once it’s been running for two years except in cases of non-payment of premiums.
So what’s your health coverage situation?
You’ve retired from an EU country and you’re drawing a state pension so you can join the French system of assurance maladie. This doesn’t mean that everything comes automatically “free”. Unless you’re on a poverty level income you’ll be left with a certain proportion of costs to pay yourself and for this you’ll need to enrol with a mutuelle, an organisation offering “top-up” cover (assurance complémentaire).
You choose to settle in France at any time below pensionable age so you’ll not normally qualify for cover under the Sécu, the social security system. This may soon change but currently you have only one option: to take out full private cover. However, after five years living here you can apply to your préfecture for recognition as “a permanent resident” and then apply to your local CPAM.
You come here as a salaried employee and so get automatically insured under the state system just like any native colleague. This is the easiest situation.