Medical Care & Insurance in France
One of the biggest (social) advantages to starting a new life in France is the medical and social service benefits. We were very excited about the idea of socialized health care, especially coming from the States and having to deal with pre-existing conditions, monthly premiums, deductibles, and pre-authorization. For the Legionnaire, pretty much everything is covered. However, France is constantly evolving its system to a more American style coverage, so that even the socialized health care is starting to resemble American plans with pre authorization, paying then being reimbursed for services, and co-pays for treatments.I will try to explain this system, but this will definitely be a post that I will come back to and add more documents and information as I remember different aspects of the health care.
Standard coverage provided by the state is "securité sociale". So this is your infamous green Carte Vitale (CV). Back in the day, this card was gold. You paid absolutely nothing, at the doctor's office, ER, specialists, or pharmacy. However, this has changed a lot since we've been in France. When you visit the doctor, you show your carte vitale. However, especially in the smaller towns, hardly any doctors are "tiers payant". This means that they will accept your CV as payment for services rendered. So at the doctor's, you show your CV but then you must pay the 22-40€ visit fee, a percentage (around 70%) will be reimbursed to your checking account by Securité Socialeʼ. So what about the other 30% you ask? If you want that reimbursed, you must have a secondary insurance, what they call a "mutuelle".
The Mutuelle is an association that targets specific careers. So military and police have a certain mutuelle, bankers have a certain, etc. The mutual is a paid insurance that is deducted from your paycheck every month. So you don't feel like you're paying for the 600-900€ a year but it's there on your paystub. Taking the same doctor's visit above, once the Sécurité Sociale reimburses your 70%, they send the rest of the bill to your mutuelle automatically, who then covers another 20-25%. So what about the other 5-10% you ask? Well, that would require a THIRD insurance (no, I'm not joking), sometimes called assurance supplementaire.
This is another insurance that you must purchase and pay for, normally deducted monthly from your checking account. I do not have a lot to say about this insurance, as we've never had it and never plan to!
There are many advantages to having a mutuelle. You receive a one time "prime" at the birth of your children, around 150€. There are benefits with transportation for emergencies, coverage for medications and additional services like osteopathy and psychotherapy.
So, what if you're not a legionnaire and a foreigner in France? Well, if you have resided in France for more than 3 months, you have the right to ask for Aide Medicale de l'État (AME). What is it?
L'aide médicale de l'État (AME) est destinée à permettre l'accès aux soins des personnes en situation irrégulière au regard de la réglementation française sur le séjour en France. Elle est attribuée sous conditions de résidence et de ressources.
AME is designed to allow access to treatment of people in an irregular situation regarding their visa status in France. It is given based on residency status and resources.
Here is a link to the application.
So again, with AME you will not have a mutuelle but just the Carte Vitale for basic medical care.
Again, you are eligible for this after 3 months in France (I WISH I would have known about this before my pregnancy!), As the spouse/girlfriend of a Legionnaire, it is not difficult to justify why you are in France and why you need the AME until you can finalize your paperwork.
Another aspect of medical care in France is the difference between private and public hospitals. Like in the US, there is a reputation for the quality of care between the two. However, public hospitals tend to be less expensive and also tend to have more social and financial assistance for paying the bill (AGAIN something I wish I had known before choosing my OB/GYN and a private hospital for my delivery!). The military social workers (see IGESA) will also coordinate with the public hospital social workers to help you apply for financial aid.
OK, so this is just my first pass at explaining the system. Please comment below with your specific questions so that we can share information together!