Coverture Maladie Universelle (CMU)
The CMU is the French national health insurance scheme, of which all residents in France are eligible for. It covers many medical fees in exchange for 6-7% of your monthly income, which is levied at source. Before considering the option of private health insurance, expats should enroll in the CMU (page available only in French).
How much does the CMU cover?
Typically, the CMU will only cover around 80% of all your medical fees, and that figure is not as black-and-white as it could be. In reality you’ll be compensated for 80% of what the CMU states a treatment should cost, not what you are charged, which can be much higher. Expats often take the option to take out private health insurance in order to cover these uncertain variable costs, taking comfort in the stability of the fixed monthly cost.
The CMU also provides cover for pre-existing conditions, unlike many private and mandatory health insurance schemes elsewhere around the world.
There are three different categories of doctor in France: secteur 1, secteur 2, and non conventionné. It’s important to know which category your doctor falls under, as the costs and levels of reimbursement vary. For peace of mind, ask for their rates over the phone; they are legally required to disclose them.
Secteur 1 doctors:
- General Practitioner (GP) fees are fixed at €23 by the CMU.
- €1 is non-reimbursable.
- The CMU reimburses 70% of remaining €22. This works out at €15.90.
- You pay €6.90 per visit. Even without private insurance, this fee is fairly manageable for most expats.
- GPs can set their own fees, but are held to a standard of setting reasonable prices. The interpretation of 'reasonable' varies throughout France, however.
- CMU still reimburses only €15.90, regardless of fee set by GP.
- Expats without private insurance can end up paying high amounts.
- Fees are entirely unregulated.
- These fees are rarely reimbursed at all by the CMU.
- Expats typically choose non conventionné, however it is recommended only to do so with the addition of a private health insurance policy.
Despite compensation from the CMU, a stay in hospital can get expensive. In addition to a daily fee of €18, there are further costs to consider that are not reimbursed at all by the CMU. Known as dépassement d'honoraires, or ‘hotel costs’, you will be personally billed for costs arising from bedding, food, private rooms, etc. This can lead do the total cost far exceeding €18 per day.
Handing pills out like candy
When deciding on whether you need private health insurance in France, it’s worth knowing that French doctors have a fairly devil-may-care attitude to prescribing medicine, handing out the third most antibiotics in the world.
The cost of this can get rather expensive. The CMU compensates 0%, 15%, 30%, 65% or 100% of the cost of medicine, depending on how 'essential' the medicine is. For example, the CMU compensates 0% of the cost of contraceptives, and 100% of the cost of insulin. A single prescription in France can end up costing expats over €100. Private insurance is recommended to cover these costs, such as the International Outpatient plan from Cigna Global, which covers expats for prescribed outpatient drugs.
Globally mobile expats
As a resident paying into French national security, you will be eligible to apply for the European Health Insurance Card (EHIC), granting free emergency healthcare when traveling to any EU member state. Note that the level of cover offered by travel insurers or international insurers, such as repatriation, will not be available with the EHIC, so private insurance is still worth considering.
For those splitting their time between France and their homeland (or other countries), it can be difficult to get coverage in both countries due to legal stipulations. In this case, taking out a global health insurance from a company like SafetyWing can be a good solution. They are especially geared towards remote workers and digital nomads and offer comprehensive coverage (including Covid-19, just like any other illness) whether you are in your home country, in a new country or even travelling abroad.