07 October 2010

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.


  1. 28,42€ is what I paid to have my teeth cleaned in France yesterday. It is a very reasonable price. But I think that the Dr's here wouldn't mind earning a little more for the long hours they put in.

  2. I'm sure you're right, Meredith, but who wouldn't want to earn more? I think you really have to be dedicated to be a GP here in France.

  3. So I wonder why many people in the USA are trying to overturn the new health care bill? They have to put it in use and one day, just one day they may find it very useful to them.

  4. Is there a reason why you guys don't get PACSed? You could declare joint taxes in France if you did...

  5. Milkjam, no, nothing is stopping us but inertia. The PACS is a project for 2011.

    Islandgal, we'll see what happens in the U.S., where not-wealthy people seem to love voting against their own interests and for the interests of the very rich. Oops, I've entered the political realm!

  6. If you were to move to France
    in 2011 as an American citizen
    and without your French pension,
    what would be the situation?
    Surely, one would need to have
    private coverage at least for a
    period of time.

  7. This is a great entry with a lot of valuable information. Thanks.

  8. Thanks Ken for making this all very clear.

  9. I think it's neat that your work in France is going to benefit you when you are 65.

  10. For me dental cleaning = $165, filling = $300+, doctor visit = $175. These are partly covered by insurance.

    I have freinds that are in their 50s that have minor pre-existing conditions. They are self employed. One pays $700+ a month for sub-par health insurance, the other about $920.

    It is a crazy system in the US, and yes, I agree, many vote against their own best ineterests.

  11. Very informative! I get a lot of questions about this subject so would like to point them to this post in the future if that's ok?

  12. Ken, I appreciate your wanting to keep your blog out of the political realm, but as you bring up medical and dental care, I have to throw in my 2 cents worth.

    Over the past 5 years, I've had major dental & periodontal work done including 2 implants and crowns, plus the accompanying surgeries. Even with dental insurance, my share has come to $7,000-plus. Along this line, I read some time ago about US citizens who fly to Costa Rica for dental work done there by American dentists. Including airfare and 2-3 week stays in a resort environment, the cost is under half what it would cost in the U.S.

    The HMO that provides medical coverage for me, Norma, and our 23 year old son (the new national health law allows children to stay on their parents' insurance through age 25) costs me $230 per month. That's considered a very good deal, even with co-pays for visits to the doctor and prescriptions.

    You make a good point about people in the US "voting against their own interests." This election season is like none I've ever seen. People are understandably frustrated, especially about the high unemployment rate, record number of foreclosures, and the sense that the bailouts (TARP and the stimulus package) benefited the haves rather than the have-nots.

    And the campaigns are awash in anonymous corporate money, which makes it impossible to turn on the television without being assaulted by mindless attack ads.

    Thanks for providing such detailed information about your day-to-day experiences living in France. You're helping to put "French" back into French fries.

  13. Great post, as usual. I couldn't agree with you more, but when you write reasonable a read cheap as opposed to what regular folks have to pay for coverage in the good ole US of A. I'm so glad, as a former civil servant, I have the same coverage as Repubs in Congress! I'm sure they don't want to dismantle their own coverage, do they?

  14. Ken, your timely column today with the added comments have made me rethink my plan (just this morning) that I would cancel my private health insurance ($7,000 deductible with no co-pays, no RX benefit and no dental) that I pay $467/month just for me. I do have a pre-existing diagnosis of osteoporosis but I have never had any injuries do to it. I still have 4 more years to wait until Medicare kicks in. I guess from the other comments I really am only paying a lot compared to you in France.

    On a side note: I read that if an American is a resident (over 6 months) in France and dies there the government takes 50% of the estate. Can you confirm?

    Thank you.

  15. In line with Bob F's comment about people going to Costa Rica, I have known several Americans that went to Bumrungrad Hospital in Thailand to save money on expensive procedures:


  16. Now that you mention it . . . this link is to a very interesting series at Slate in re income distribution in the U.S. It's well worth some reading time: link to article

  17. Emm, thanks, I'll be interested to read that article.

    Mary, I don't believe the French government would take 50% of an American's estate. Americans aren't treated any differently from anybody else, first of all. Under the Napoleonic Code that is the basis for French law, children automatically inherit a fixed portion of their parent's estate. If there are no direct descendants, the deceased parents inherit I think. But if siblings, nieces or nephews are the only heirs, the inheritance taxes are very high -- as you say, 50% or 60% or more. Maybe that's what you meant.

    Bob and Diogenes, I know at least one American who has been going to see an U.S.-trained dentist in Mexico for years...

    Loulou, feel free of course to send people to my posts as you think appropriate. Hope your trip plans are set and that we might see you soon.

    Sheila, you are required by the French consulate to have medical insurance when you first come to France on a long-stay visa. You can then convert that to French coverage after the first year. Walt and I kept a private U.S. insurance policy for expats for three years before we converted. The U.S. policy was expensive and covered only hospitalization in certain designated hospitals in France. My deductible was either $5,000 or maybe $10,000, I can't remember. That made the premium more affordable. I never filed a claim on that insurance.

  18. What you forgot to mention is that all this has a cost, and that you should not compare both systems without considering what the welfare state implies (higher taxes, for example). You've certainly heard about "le trou de la sécu", I guess.


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