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Discussion Starter #1
Sorry to keep coming back with this healthcare issue - it seems to be a hydra, with every helpful answer generating more questions.

We're dual US/UK citizens, retiring and in the process of moving to France. We left the UK in 1980, worked in France for 6 years (so did pay into the French system, and do have French SS#s), and have worked in the US since. So we should be able to affiliate to the French healthcare system via CPAM. But given that we're selling the US house, plus a couple of other income windfalls, if we go the CPAM route I'm realizing we'd pay a not-so-small fortune in cotisations for the next couple of years. So I'm starting to think I'd rather do private health insurance, which'd be significantly cheaper.

Question - do we HAVE to affiliate with CPAM, or can we just take out private health insurance for expatriates? Or is Law DDOS of 4 February 1995 still in force, which I think would forbid this?

An alternative is that we already have a comprehensive American-based health insurance which we're planning on keeping going for at least a few years, as a back up, and which provides and will continue to provide all our medications, and for emergency care. Could we just purchase something like AARO top-up insurance to cover longer hospitalizations?

OR simply go the AARO US citizen route with private insurance?
 

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Are you entitled to a French pension? Or to a UK pension? That's actually where your health care entitlement (as pensioners) comes from. You'd probably have to check with CPAM first to see what they have on your case/situation and if you'd qualify for coverage as pensioners in France (either because of your French or UK pension).

The mutuelle (top-up) coverage isn't what you'd need to cover hospitalization over and above whatever your US policy covers. It's a rather different concept. A mutuelle coverage pays for the difference between the French sécu reimbursed amounts and the actual charges for the services you received.
Cheers,
Bev
 

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Discussion Starter #3
Bev,

The first thing to say is that your prompt replies are amazing.

We're entitled to a French pension, and have had our dossiers de carriere brought up to date at CRAMCO. My husband "may" also be entitled to a UK one but I don't think I am; we're checking on that. So we're in the CRAMCO system, but we're not in the CPAM system (because our French connection was so long ago.)

So really the question is if we're OBLIGED to get healthcare via CPAM, or if I can ignore that right, and just get private health care. That's because I think we fall into a small category where the cotisations via CPAM are going to be horrifically expensive for us, due to a perfect storm of a very high income over the last two years from our US house sale, and a settlement of a lawsuit. I'm happy to pay for healthcare, but it goes against the grain to pay a good multiple of what I pay in the US - of all places! - for excellent healthcare. Especially since I'm going to keep paying for that US healthcare (to keep the option open of going back for long visits).

I feel pretty dim, since I thought we had this sorted out months ago, but the devil's in the details.
 

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Discussion Starter #4
PS And when I said "top up", I wasn't thinking mutuelle, but one of the expat private insurances that only covers in-patient care. The regular stuff we've got covered via our US insurance, or can pay out of pocket.
 

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What is CRAMCO?

If you're entitled to a pensioner coverage under CPAM, I believe that is part of your pension. I don't entirely understand why you're expecting your "cotisations" to be so expensive - unless you're planning on working when you first arrive in France.

The French national coverage isn't an option. If you're working, you have to pay cotisations. If you're entitled to a French pension, the sécu coverage should be part of the deal.

Something like the AARO coverage is either the whole megilla (i.e. full expat coverage, sufficient to meet the visa requirement - which is "equivalent to the French national system") or it's a "mutuelle" coverage, which is a supplement to the French sécu coverage. AFAIK, there isn't an option to get "top-up" to whatever your US health insurance covers.

But perhaps someone here has a different experience.
Cheers,
Bev
 

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Discussion Starter #6
I'm expecting the cotisations to be high because they're based on year N-2 (2010) and N-1 (2011) resources. And since we weren't retired in those years, we were pulling down hefty US salaries, of which 8% would be a lot of money.

And even though our income will drop in retirement, that income isn't limited to pensions - we'll also have investment income coming in, since our US retirement university retirement is stock market-based rather than a pension, and my husband gets royalty payments from some patents he has. And we're selling our US house, so that's another chunk.

It's the right sort of problem to have, of course.

CPAM is closed this week because of the vacances scolaires, hence the unresolved questions. Next week, I'll sit down with them and chew this through.
 

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The 8% isn't the cotisation for health insurance - it's the "surtax" to pay down the debt and you won't be hit for that until you're resident in France. (It's part of the income tax form, and you get charged the 8% on nearly every sort of income, including interest and other investment income.) Normally referred to as CSG/CRDS.

I don't believe you have an "option" to enroll in sécurité social - either you are eligible (through your pension) and you MUST enroll, or you aren't, and then you must have private insurance. The so-called "top-up" insurance only applies to the French national coverage (i.e. because it reimburses at something less than 100%).
Cheers,
Bev
 

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Sorry to keep coming back with this healthcare issue - it seems to be a hydra, with every helpful answer generating more questions.

We're dual US/UK citizens, retiring and in the process of moving to France. We left the UK in 1980, worked in France for 6 years (so did pay into the French system, and do have French SS#s), and have worked in the US since. So we should be able to affiliate to the French healthcare system via CPAM. But given that we're selling the US house, plus a couple of other income windfalls, if we go the CPAM route I'm realizing we'd pay a not-so-small fortune in cotisations for the next couple of years. So I'm starting to think I'd rather do private health insurance, which'd be significantly cheaper.

Question - do we HAVE to affiliate with CPAM, or can we just take out private health insurance for expatriates? Or is Law DDOS of 4 February 1995 still in force, which I think would forbid this?

An alternative is that we already have a comprehensive American-based health insurance which we're planning on keeping going for at least a few years, as a back up, and which provides and will continue to provide all our medications, and for emergency care. Could we just purchase something like AARO top-up insurance to cover longer hospitalizations?

OR simply go the AARO US citizen route with private insurance?
If you are in receipt of a French pension, then as far as I know you will be entitled to healthcare WITHOUT any contribution required.
Check here for the regulations.
http://www.ameli.fr/assures/droits-et-demarches/par-situation-professionnelle/vous-etes-retraite.php

If you are not in receipt of a French pension then, as I understand it, you are asking if it is obligatory to join the CMU (Couverture Maladie Universale) system and pay the 8% contribution based on your income. I believe that since 2007 when the new rules on inactifs came into effect, it is no longer mandatory to join the CMU, you are perfectly entitled to take out private health insurance. There is even a movement amongst the French who have realise that in some circumstances, private health insurance is cheaper/better than CMU.

Have a look here
Libre Assurance Maladie
 

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Discussion Starter #9
Thanks

I really appreciate the patience and help of posters here. You've cleared up some confusion - I'd not realized the CPAM cotisations WERE the CSG/CRDS contribution. Paying that once is OK, paying it twice over would not be amusing at all. :)

Onward!
 

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I really appreciate the patience and help of posters here. You've cleared up some confusion - I'd not realized the CPAM cotisations WERE the CSG/CRDS contribution. Paying that once is OK, paying it twice over would not be amusing at all. :)

Onward!
I think there's still some confusing.

CPAM is the agency that pays out health care benefits, and in some cases may collect certain forms of contributions toward benefits.

CSG/CRDS is part of the income tax system here in France. While it pays for the longstanding deficit in the health care system, it's not an option. If you are subject to French income taxes, you pay CSG/CRDS on everything that is taxable in France. (Taxation in France is confusing until you've been through the loop a few times.)

Couverture maladie universelle : cotisation - Service-public.fr is the explanation of paying for the CMU. Because the charge is based on your revenue fiscal, I'm not sure what they would do in the case where you were not subject to French taxes in the prior year. Probably best to just plan on getting private health coverage for your first year or two in France, and then you can decide from there how to proceed.
Cheers,
Bev
 

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I really appreciate the patience and help of posters here. You've cleared up some confusion - I'd not realized the CPAM cotisations WERE the CSG/CRDS contribution. Paying that once is OK, paying it twice over would not be amusing at all. :)

Onward!
As Bevdeforges says CSG/CRDS is definitely NOT the same as the contribution to healthcare cover via CMU.

CSG/CRDS/PS is a tax paid on income at the following rates:
8% for salaries
7.1% on pensions and benefits
13.5% on investments, rental or capital gains.

The contribution (cotisation) to CMU is 8% of taxable income over a threshold of €9164.

However, if you have private health insurance then you will not be subject to CSG/CRDS/PS on pension income received from outside France. BUT you will still be subject to CSG/CRDS/PS on all investment/rental/capital gains.
 
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