Paying for Private Medical Services

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Paying for Private Medical Services


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Old 10th June 2019, 04:11 PM
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Default Paying for Private Medical Services

I clearly recall reading (months ago) that medical costs outside of the national healthcare system (NHS) are priced by the government. I think somebody even mentioned that a routine doctor visit was something like 30 Euros. So I stumbled across this article:

https://www.marketwatch.com/story/th...ack-2019-06-03

No, as much as I liked my visit to Chile and the wonderful people almost 30 years ago, I'm not looking at it as a destination but the reasoning for those Americans to live there are applicable to my own thinking and goals for retirement. They also mentioned a specific cost for a medical MRI being $300 and I thought I'd just throw that thought out here. Can anyone give specific examples on what the costs are for medical procedures like a MRIs, childbirth, and other items? When I selectively promote the idea of retirement in France to others (mind you, there are many Americans whom I'd not suggest the idea to), one of the most common questions they ask is what the medical expenses are if you need a procedure done outside the NHS. I'm curious, too.

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Old 10th June 2019, 04:28 PM
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Quote:
Originally Posted by Heinz57 View Post
I clearly recall reading (months ago) that medical costs outside of the national healthcare system (NHS) are priced by the government. I think somebody even mentioned that a routine doctor visit was something like 30 Euros. So I stumbled across this article:

https://www.marketwatch.com/story/th...ack-2019-06-03

No, as much as I liked my visit to Chile and the wonderful people almost 30 years ago, I'm not looking at it as a destination but the reasoning for those Americans to live there are applicable to my own thinking and goals for retirement. They also mentioned a specific cost for a medical MRI being $300 and I thought I'd just throw that thought out here. Can anyone give specific examples on what the costs are for medical procedures like a MRIs, childbirth, and other items? When I selectively promote the idea of retirement in France to others (mind you, there are many Americans whom I'd not suggest the idea to), one of the most common questions they ask is what the medical expenses are if you need a procedure done outside the NHS. I'm curious, too.
I'm totally baffled by this post.
Are you asking about medical costs in France, or where?
To me, NHS=National Health Service=the UK state healthcare provision. The NHS doesn't operate in France, nor does it set prices in euros, so I'm not sure how it's relevant if you're asking about France.
I'm also having trouble getting my head round childbirth costs being an issue in retirement, but maybe I'm being ageist there...

France's healthcare system is called PUMA and I think the cost of a consultation with a doctor is around 25€ these days, but if you affiliate to PUMA you usually get around 70% of that cost reimbursed. Likewise with most procedures. A lot of people take out top up insurance to cover some or all of the part that the state doesn't reimburse.
If that helps at all.
It's not a simple question because there are different tiers of tarifs for each procedure, depending on whether the provider adheres to the state-approved fee or charges more. But I believe there are websites where you can find out all the details.
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Last edited by EuroTrash; 10th June 2019 at 04:33 PM.
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Old 10th June 2019, 05:44 PM
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Originally Posted by EuroTrash View Post
I'm totally baffled by this post.
Are you asking about medical costs in France, or where?
To me, NHS=National Health Service=the UK state healthcare provision. The NHS doesn't operate in France, nor does it set prices in euros, so I'm not sure how it's relevant if you're asking about France.
I'm also having trouble getting my head round childbirth costs being an issue in retirement, but maybe I'm being ageist there...
Hello ET,

I'm sorry to have sent you spinning into confusion. Some was due to my ignorance of not knowing what the French healthcare system is named, and now I know it is PUMA. I knew of the NHS from having lived in the UK in the 90's and I tried to use it as a general term by attempting to qualify it that way early in my post, but that is easily lost in meaning.

No, childbirth expenses are not in my retirement plans unless I get reckless with a young tart. Joking aside, I used it as an example of a routine medical procedure which could be used to compare costs. For example, a hospital once quoted me $10,000 for a birth if there were no exceptions in the procedure. In the article I posted the link to, the person talks of having a MRI for about $300, but if one pays out of pocket for a MRI in the US, I'll venture to say it might cost $8000 (yes, thousands).

All I'm looking for is specific examples people might have for the actual costs for a procedure that I can use as a comparison against pricing for the same procedure paid out-of-pocket in the US. As I stated, I'd already been advised on what a doctor visit would cost for someone who is not in the PUMA system, and was told that pricing for medical services was set by the state.

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Old 10th June 2019, 05:46 PM
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Quote:
Originally Posted by Heinz57 View Post
...I think somebody even mentioned that a routine doctor visit was something like 30 Euros.
  • Doctor’s office visit: 26 €
  • Doctor’s visit at your home: 30 €
Quote:
Originally Posted by Heinz57 View Post
...Can anyone give specific examples on what the costs are for medical procedures like a MRIs, childbirth, and other items?
Below are the procedures that I paid for out of pocket before we had French health insurance:
  • Hip Replacement (including prosthetic, anesthetist, hospitalization in private room, other doctor & dentist visits prior to surgery, etc.): 8,000 €
  • X-rays (including consultation with radiologist immediately following x-ray): 30 €
  • Emergency Room Care (4 days): 1,200 €
However, all that said, there’s no reason whatsoever to not get French health insurance and a supplemental private insurance policy, in which case all of the above would have been included!
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Originally Posted by Heinz57 View Post
...When I selectively promote the idea of retirement in France to others (mind you, there are many Americans whom I'd not suggest the idea to), one of the most common questions they ask is what the medical expenses are...
I’ve no idea why you would not promote French healthcare to Americans. It’s the best healthcare we’ve ever seen (I’ve lived in the US, Canada, and the UK). It’s way better than US healthcare and the costs are incredibly low. The cost of medications is also very low. What’s not to like?!

Ray
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Old 10th June 2019, 06:02 PM
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Like EuroTrash I'm a little confused about just what you're asking here.

However, I'll take a stab at trying to answer what I think your question might be.

On the Ameli website https://www.ameli.fr/ you can click on the tab marked "REMBOURSEMENTS prestations et aides" to see details about what is reimbursed and what the "standard" fee schedules are for various types of appointments and treatments.

The French system is not like the UK's NHS - where you get either public treatment (i.e. NHS) or private (not-NHS). France has a reimbursement system, where the national system reimburses you a set percentage of what their standard fee schedule sets as the cost of each treatment or service. It is expected that you have a mutuelle (a "top up" insurance) to reimburse you the difference between the percentage the national system pays and your actual cost of the service. The mutuelle costs you a monthly premium, depending on how extensive you want or need your coverage to be.

For your example, let's say that the MRI has a standard fee of 300€, of which the CPAM (French system) reimburses 70% or 210€. Your mutuelle (for which you pay) will then reimburse the remaining 90€.

But, it's possible that the center where you had your MRI charges more than the schedule, say 500€. In that case, CPAM would reimburse no more than their 210€ (70% of the standard fee schedule). If you had a mutuelle that was limited to covering only 100% of the standard fees, they would reimburse you the same 90€ and you'd be out the "extra" 200€ you paid. Most mutuelles, however, would cover 150% or 200% or possibly more of the standard schedule fee - depending on how much you are paying for that top up insurance.

That's a very simplified explanation, but gives you a general idea of how it works.


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Old 10th June 2019, 06:05 PM
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Quote:
Originally Posted by Heinz57 View Post
I'm sorry to have sent you spinning into confusion. Some was due to my ignorance of not knowing what the French healthcare system is named, and now I know it is PUMA. I knew of the NHS from having lived in the UK in the 90's and I tried to use it as a general term by attempting to qualify it that way early in my post, but that is easily lost in meaning.
No worries, I'm easy confused.
But for anyone familiar with both the NHS and PUMA, there really aren't many similarities beyond that they are both state healthcare systems.

Another point to consider is that everyone who moves to France must have medical insurance in place. It's one of France's residence criteria, you can't legally live here without. Either you affiliate to PUMA, or you take out full private health insurance. So it's hard to see how anyone moving to France would be in a situation of regularly paying for their medical care out of pocket.
What people usually ask about when they're looking at moving here, which you might find more relevant, is the cost of PUMA contributions/top up insurance/full private health insurance

EDIT - where the frig did that person in a clock come from ????????? I never invited them into my post.
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Old 10th June 2019, 06:12 PM
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The health care system in general isn't quite the same as PUMA (and even PUMA has been replaced with another acronym now if I understand things correctly). PUMA is the system of paying for your sécu (Sécurité Social) cover if you aren't working or drawing a pension or unemployment.

CPAM is the organization that handles payment/reimbursement of health care costs and claims.

Evidently, the system has recently changed so that anyone legally living in France who is drawing a pension received sécu coverage basically free of charge. What costs a retiree is a mutuelle to cover the unreimbursed health care costs (both the portion that CPAM doesn't reimburse and fees charged that are over and above the standard fee schedule).

The one trick to all this is that, to retire to France, you still need to have private health cover for the period in which you are establishing legal residence in France (technically 3 months) and processing your application to the sécu system - which at the moment can take "several" months.
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Old 10th June 2019, 06:43 PM
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PUMA = Protection Universelle MAladie. It covers retirees, inactifs, salaried employees, independent workers, the lot. You access it via different routes and your cotisations are collected in different ways, but it's now the same system for everyone - unlike the old system which could involve moving from one scheme to another when your situation changed.

https://www.service-public.fr/partic...sdroits/F34308
Toute personne qui travaille ou réside en France de manière stable et régulière est couverte par l'assurance maladie.
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Last edited by EuroTrash; 10th June 2019 at 06:49 PM.
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Old 10th June 2019, 06:48 PM
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CPAM is the local social security office, which is directly in touch with patients and health professionals.

CRAM is the Regional level.

CNAM National level.

https://assurance-maladie.ameli.fr/q...t/organisation

As for AMELI, it's Assurance Maladie En Ligne.

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Old 10th June 2019, 06:55 PM
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Quote:
Originally Posted by RayRay View Post
  • Doctor’s office visit: 26 €
  • Doctor’s visit at your home: 30 €

Below are the procedures that I paid for out of pocket before we had French health insurance:
  • Hip Replacement (including prosthetic, anesthetist, hospitalization in private room, other doctor & dentist visits prior to surgery, etc.): 8,000 €
  • X-rays (including consultation with radiologist immediately following x-ray): 30 €
  • Emergency Room Care (4 days): 1,200 €
However, all that said, there’s no reason whatsoever to not get French health insurance and a supplemental private insurance policy, in which case all of the above would have been included!

I’ve no idea why you would not promote French healthcare to Americans. It’s the best healthcare we’ve ever seen (I’ve lived in the US, Canada, and the UK). It’s way better than US healthcare and the costs are incredibly low. The cost of medications is also very low. What’s not to like?!

Ray
Thank you very much, Ray, that is exactly the sort of info I was looking for. I have been promoting France to friends and co-workers, especially since I read two MarketWatch articles in April which talked about 65yo retirees (couple) in America right now can expect to pay $289K - $500K in out-of-pocket expenses in their average retirement. That is awful! I'm with you 100%!!!

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