You are now affiliated with the French Social Security (also called Assurance Maladie or CPAM)! Well done! However, you’re not sure how the French healthcare reimbursement system works and what level of reimbursement to expect. French healthcare is different from the healthcare system of the other countries I’ve lived in (Ireland, UK, Argentina, Spain among others).
And the system can be a bit complex, especially if you want to know how much you’ll be reimbursed.
If you are not affiliated yet, read my article about affiliation as a worker in France and another one about the specific situation of the European inactive citizens.
French healthcare reimbursement system
This is the first important difference to other public healthcare systems. First, it works on a reimbursement system and not free access.
You will always pay upfront the medical examination unless you are affiliated with the solidarity top-up insurance for very low incomes (called Complémentaire santé solidaire). Then, you will receive a reimbursement of a proportional amount directly on their bank account from the Assurance Maladie. CPAM reimburses about 70% of most healthcare costs and 100% of the fees for serious or chronic illnesses.
Even if you are eligible for universal healthcare cover under the French social security scheme, you will have to pay upfront for doctor consultations. If you have not yet received your healthcare card (“Carte Vitale”), the doctor will give you a medical receipt called “feuille de soins” to complete and send to the healthcare system (CPAM) to claim reimbursement.
CPAM partially reimburses medical expenses. Reimbursement rates vary depending on the type of treatment. They are usually around 60% to 70% of the fee set by the social security scheme.
Pharmacy expenses, given by prescription only, are reimbursed from 15% to 65% depending on the type of medication. The medicines you buy without a prescription will be paid at the full price. Note that many medicines in France are not available to buy without a prescription compared to other countries.
Considering, the CPAM reimburses part of the total cost; it is recommended to take out private supplementary health insurance (“mutuelle”), especially if you have children or need special medical care.
Private health insurance supplements social security reimbursements, avoiding costly expenses for unexpected dental care or hospitalization for example.
How to get the best reimbursement?
To get maximum reimbursement from the French healthcare system, you need to choose a GP (general practitioner) and declare your chosen general practitioner to the social security scheme. This doctor will then become your “médecin référent”. When taking an appointment with a doctor for the first time, ask if they take new patients. If so, ask the doctor to make the declaration on the CPAM online platform.
This choice is the first step of what the CPAM calls the Parcours de soin (“approved healthcare pathway”).
For any medical problem, you must consult your chosen doctor, and only if the GP considers it necessary he/she will refer you to a specialist.
NOTE: Only dentists, ophthalmologists and gynaecologists can be consulted without a GP referral.
How to choose a GP?
Rates will vary depending on the doctors.
In France, there are two main types of doctors (including general practitioners and specialists):
State-certified doctors (médecins conventionnés)
They have signed an agreement with the French national healthcare system. Most doctors in France fall into this category. The State-certified doctors are divided into 2 categories:
- Secteur 1 category: These doctors must follow the CPAM medical fees (the cheapest fees).
- Secteur 2 category: These doctors can charge a higher pre-agreed rate with the CPAM. Their fees are higher than the sector 1 doctors but within limits agreed with the CPAM. People covered by the French national healthcare system, or a private health insurance scheme benefit from a higher reimbursement rate when consulting State-certified doctors.
Non State-certified doctors (médecins non-conventionnés)
They have not signed an agreement with the CPAM who will not reimburse their fees. However, your complementary or private health insurance may cover these medical expenses.
In practice… when visiting a GP
The State agreed on a fee for a GP consultation is 25€ in 2021 and the reimbursement percentage for a GP consultation is 70% of the state fee. All the Sector 1 State-certified GP (médecins conventionnés secteur 1) charge 25€.
When giving your Carte Vitale, the CPAM will be informed of the fee you have been charged and the doctor category you have seen. You will automatically receive reimbursement of 17,50€ (70% of 25€) on your bank account.
If your doctor is a Sector 2 State-certified doctor (médecins conventionnés Secteur 2) and charges, for example, 40€ for a consultation, you will still be reimbursed 17,50€ (70% of 25€). Then, depending on your complementary health insurance you may be reimbursed up to the full amount you have paid.
How to find a GP?
First of all, I would recommend asking around you if people recommend any. Ask your colleagues, your neighbour or your friends. It is always better to choose it near your home or your workplace.
Consultations by Sector 1 general practitioners benefit from optimal reimbursement by the social security scheme. Refer to the health directory for information about doctors’ fees.
The healthcare system website AMELI provides a doctors and specialists directory Their certification type is also provided to avoid unpleasant surprises regarding fees.
You can also search for doctors and specialists on the Doctolib website by specialisation and location. The doctors can be filtered according to the languages they speak and if they are state-certified or not. You will also be able to make the appointment online, which avoids the challenge of a phone call in French!
I hope this article helped me understand the French healthcare system a bit better. Follow me on Facebook @ExpatInFrance not to miss my next articles.
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