health insurance - France v. US

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health insurance - France v. US


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Old 14th August 2013, 12:14 PM
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Default health insurance - France v. US

Hi,

Another question I have never got a good answer to is about health insurance costs in France v. US. First, for a "normal" person who is not old, I don't see a tremendous difference between US and France. And as for people who are older, I have heard that some people with double nationality prefer to live in France just to take advantage of the health insurance system.

Why is that? How much would an older person pay in the US v. France?

I know it can all vary depending on the health problems the person comes to have, but just to have an idea, what kinds of major differences are there?

And in Britain, does one pay more health insurance than in France as well?

TIA.

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Old 14th August 2013, 12:25 PM
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Hi,

Another question I have never got a good answer to is about health insurance costs in France v. US. First, for a "normal" person who is not old, I don't see a tremendous difference between US and France. And as for people who are older, I have heard that some people with double nationality prefer to live in France just to take advantage of the health insurance system.

Why is that? How much would an older person pay in the US v. France?

I know it can all vary depending on the health problems the person comes to have, but just to have an idea, what kinds of major differences are there?

And in Britain, does one pay more health insurance than in France as well?

TIA.
There is a massive difference between France and the US and not just in costs.

If you are not receiving any coverage from the Social Security (CPAM) then I don't know what a full private insurance is but I suspect it would be a heck of lot lower than the $800 per month I was quoted for myself only three years ago. Pre-existing conditions don't seem to be as big a factor in France - in the UK if you have pre-existing conditions you won't get private insurance, it's NHS or pay the doctors direct. In the US pre-existing conditions will result in increased premiums and/or non-coverage for that condition. And they can cancel your insurance if you get sick although this is supposed to change in 2014. I could not afford the health coverage or the attendant risks if I was to return to the US.

The French system is focussed on patient care, not making money in most places and the quality of care is first class and readily available at short notice. So far it is the best system in the world I have encountered.

I can't tell about National Insurance charges in the UK (or France) as I'm retired and don't pay them and haven't for over 22 years. No doubt those with recent experience can add to all this.

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Old 14th August 2013, 01:31 PM
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I don't know how the costs compare either, but I do know that UK v. France, here you get an awful lot more than what you pay for, and it's timely!

The recent experience of friend here illustrates that:
French health care is amazing. Doc phoned on Monday, admitted Tuesday. Saw specialist same day and every day plus lung xray"s. abdominal scan, liver scan, gynae, dermatologist, etc, etc, etc. Oh and a general anaesthetic for a colonoscopy and endoscopy plus loads of other stuff. Amazing hospital.

Her particular situation is that she's qualified for state cover (Carte Vitale) and also CMU-C (free top-up 'cos of her financial circumstances and her previous qualification into the French system), so it cost nothing to her.

In the UK, she'd have to be in her box before they even put her on a waiting list !!!

hils

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Old 14th August 2013, 02:14 PM
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Basically, in France you get your main health insurance as part of your cotisations, assuming you're working. Add about 60 to 110€ a month for a mutuelle, though if you have a mutuelle through your employment, the employer shares part of the cost.

On retirement, you continue on the sécu health insurance if you are receiving a state pension. And the mutuelle is on your tab. But the mutuelle payments are a fixed per person fee for a certain level of coverage - the only difference is an adult vs. a child. Rates don't rise when you get older, and as far as I know there is no "penalty" for pre-existing conditions.

For retirees without a French state pension (or any EU state pension that would give them access to the French system by reciprocity), private insurance is your only option (and if you're resident in France, you must carry private health insurance if you don't have sécu coverage). Private insurers can charge pretty much what they like - and the plans I have looked at increase in cost as you get older.

In the US, health insurance for those age 65+ is nearly always predicated on the individual being eligible for US Medicare. For a newly arrived immigrant over the age of 65, health insurance can be damned difficult to get at all - and if they can find it, extremely expensive.

One of the big differences between the US and French systems is that, in the US an insurer can (and often will) fight paying a medical bill, for no particular reason at all, just because it's expensive. In France, you have the published list of treatments and procedures and what the Sécu allows for each one. If you receive the treatment and have the documentation from a registered professional (doctor, kiné, lab, etc.) both the sécu and the mutuelle will pay/reimburse according to the sécu tariff and your mutuelle contract. In the US, the insurance companies can stall, obfuscate or just turn down payment on a pretext or because they don't feel the particular treatment was "appropriate" for whatever your ailment was.
Cheers,
Bev

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Old 14th August 2013, 02:26 PM
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Basically, in France you get your main health insurance as part of your cotisations, assuming you're working. Add about 60 to 110€ a month for a mutuelle, though if you have a mutuelle through your employment, the employer shares part of the cost.

On retirement, you continue on the sécu health insurance if you are receiving a state pension. And the mutuelle is on your tab. But the mutuelle payments are a fixed per person fee for a certain level of coverage - the only difference is an adult vs. a child. Rates don't rise when you get older, and as far as I know there is no "penalty" for pre-existing conditions.

For retirees without a French state pension (or any EU state pension that would give them access to the French system by reciprocity), private insurance is your only option (and if you're resident in France, you must carry private health insurance if you don't have sécu coverage). Private insurers can charge pretty much what they like - and the plans I have looked at increase in cost as you get older.

In the US, health insurance for those age 65+ is nearly always predicated on the individual being eligible for US Medicare. For a newly arrived immigrant over the age of 65, health insurance can be damned difficult to get at all - and if they can find it, extremely expensive.

One of the big differences between the US and French systems is that, in the US an insurer can (and often will) fight paying a medical bill, for no particular reason at all, just because it's expensive. In France, you have the published list of treatments and procedures and what the Sécu allows for each one. If you receive the treatment and have the documentation from a registered professional (doctor, kiné, lab, etc.) both the sécu and the mutuelle will pay/reimburse according to the sécu tariff and your mutuelle contract. In the US, the insurance companies can stall, obfuscate or just turn down payment on a pretext or because they don't feel the particular treatment was "appropriate" for whatever your ailment was.
Cheers,
Bev
Just to add a little to this - we were eligible for Medicare but that doesn't cover everything and is only offered by certain health care professionals - our dentist didn't accept Medicare. To gain better coverage you have to buy a Medicare top-up (just like the mutuelle) and that can get very expensive. Also as the insurance company then basically takes your Medicare benefits to itself and then meets claims (or doesn't) just like regular private insurance.

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Old 14th August 2013, 03:12 PM
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National insurance rates in the UK for those employed (it's different for self employed) are generally 12% of income between two thresholds, but note that this contribution covers unemployment insurance, other welfare benefits and the state pension, not health cover. Access to the National Health Service is based on residency rather than contributions so if you aren't working but are resident you still gain access to healthcare which is free at the point of use.

More information is given here

HM Revenue & Customs: National Insurance - the basics

Edited to add: you do pay for dental and optical care in the UK, unless you qualify for free treatment, eg unemployed, pensioner etc.


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Old 14th August 2013, 03:48 PM
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I am an American with Pre-existing health issues, 53 years old. In my opinion, French healthcare is the best in the world. My wife provides coverage through her employer and her mutual covers the rest.

When I go to my family doctor, we pay 23€ and are fully reimbursed for the visit by the mutual. We see this back in our account in less than one week. No forms to complete and mail in, fully automatic! We pay nothing for all the medications we take. We go to the pharmacy, give our Carte Vitale and they hand us the drugs prescribed. When we went to two specialists recently, we paid 43€ up front and got back everything except 1€. The other specialist, last week at the hospital, nothing. When I had surgery at the hospital earlier this year, we paid 20€ for a private room and nothing for the nurses who came to the house for 10 days to look at me and change my bandages. My only thought is that when I do need to see a specialist, I could be forced to wait up to two months to meet them. Then again, I saw the same issue when I lived in NYC.

Right now, my job back in NY is begging and pleading with me to return due to our business requirements. If I went back, I would be forced to pay $350.00 per month as my share of medical coverage, plus doctor co-pays and co-pays for medications. Huge difference. I hope this helps. Warm regards!
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Old 17th August 2013, 07:56 AM
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I've had experience with all three, though fortunately will probably not need surgery under my French coverage, but did in the US and UK. Having a pre-existing condition, life in the States was crap because if I ever changed jobs I'd have to have loads of certificates to mail off blah blah blah. I was covered immediately in the UK and when I needed to go to the hospital I was given a specialist to manage my chronic condition, but they liaised with my GP. When my surgery was scheduled, because it wasn't urgent they said it would be within two months, however when I went to the ER with complaints they fit me in for the next day. And I never paid a dime and the knowledge of all the doctors and nurses was impressive.
Being in France I've had to jump through a few hoops to get my prescriptions covered for having a chronic condition and just to get my carte vitale. I did end up having to pay a few times because I wasn't in the system yet and out of pocket I shelled out around €400. And after nearly a year of living here my meds are finally covered.
One last thing: because my prescriptions are special orders I don't quite like having to make a trip to the pharmacy each time I need them. In the UK I did at least have the option for a third-party pharmacy to coordinate with my doctor for a refill and they'd mail them to me. With my hours at work it isn't always practical for me to even get to the pharmacy right around the corner!

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Old 17th August 2013, 08:02 AM
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Being in France I've had to jump through a few hoops to get my prescriptions covered for having a chronic condition and just to get my carte vitale. I did end up having to pay a few times because I wasn't in the system yet and out of pocket I shelled out around €400. And after nearly a year of living here my meds are finally covered.
The care provider(s) should have given you a brown form (feuilles de soin) which you submit to the CPAM for reimbursement once you get your Carte Vitale. You may be able to go back and get them if you have records.

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Old 17th August 2013, 08:11 AM
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The care provider(s) should have given you a brown form (feuilles de soin) which you submit to the CPAM for reimbursement once you get your Carte Vitale. You may be able to go back and get them if you have records.
Yes they did, however CPAM refused it even though I submitted all my paperwork at the same time. So, no reimbursement for one visit and full coverage for another. :-) c'est la France non?

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