French national health insurance

We've been renewed for 2011. We have to send in our renewal application every September, when the income tax bill comes. That's the document that the Caisse Primaire d'Assurance Maladie — the office of the national healthcare system up in Blois — wants to see.

The premium we pay — notre côtisation or contribution to the system — is based on our annual income. I see that the portion of your income that is exempt has now been increased to just over 9,000 €. That's more than $12K U.S. right now. Any revenue you declare over and above the exemption is taxed at 8% for coverage under the national healtcare system — over and above what you pay in income tax.

So if you declare income of, say 20,000 €, you pay on the basis of 11,000 € x 0.08 = 880 € per year for basic medical coverage at 65% to 70% on the cost of doctor visits, prescription drugs, and dental care. For purposes of medical coverage, Walt and I get one exemption of 9,000 euros, not two. In other words, we declare our combined income and our contribution is calculated on that basis — because we live at the same address, and despite the fact that we are not allowed to file a joint tax return either in the U.S. or in France.

I won't go into specifics, but let's just say that we find our contribution to the national health insurance system to be very reasonable for the coverage we get. If we wanted to, we could pay for a private, top-up policy that would bring our coverage up to 100%. I haven't needed to look into that option yet. We make do with the standard coverage. People who have very low incomes can, in fact, qualify for 100% coverage under the public system. I'm pretty sure we wouldn't qualify for that level of coverage.

Remember, too, that the fees doctors and dentists can charge are regulated by the government in France. It costs 22 € to go see your GP. You get about two-thirds of that fee (about 14€) back, so you're out only eight euros. It costs less than 30 € to get your teeth examined and cleaned, and you get two-thirds (20 €) of that back too. It's very reasonable.

The prices the pharmacies can charge for prescription medications are similarly regulated. I pay less for my prescription medications here than I did when I worked in California, and back then I had very good medical insurance, provided by my employer. My co-pays were pretty low, but not as low as in France because the drugs themselves cost so much less here. In France, on the other hand, I think over-the-counter drugs are pretty expensive. But maybe I'm out of touch with prices for such products in the U.S.

One thing that has made it easier for me to get into the French national healthcare system is the fact that I will get a small pension from the French government when I turn 65 — I worked in Paris for a few years when I was younger. I could have taken the pension at 60, but it wasn't worth much at all then. Even at 65, I'll get only about 100 € a month. The fact is, though, that even such a small pension means I'm "in the system" and automatically qualify for healthcare benefits.

In theory, any legal resident of France, even temporary residents, qualify for basic medical coverage. But they ask you a lot of questions when you are in that situation. I know, because I answered many questions over a period of several years. The people asking them were always helpful, polite, and informative, but they were being thorough.

Besides documents showing my income, one thing they wanted to see was my passport, to make sure I really was residing in France for more than six months out of the year. They looked at all the stamps in the passport to check up on the length of my visits to the U.S. (or other countries). If you spend more than six months per year outside France, you don't qualify for the government-sponsored medical plan.