TAPIF Tip / Lecteur Lesson: Everything You Need to Know About the French Healthcare System

In France, everyone legally residing in the country is entitled to health insurance to cover the cost of medical care– this includes assistants and lecteurs with valid visas.

There are two parts to the French system: The basic coverage (la sécu) and the extended, paid-for private supplementary insurance (la mutuelle).

As an American in France, the health care system at first may seem daunting, confusing, and best to be avoided. However, the system in France actually works very well and can be very convenient for assistants and lecteurs. I have compiled some information about everything I have learned, according to my experience, during the past few years.

Basic Health Insurance Coverage (La Sécurité Sociale or La Sécu): CPAM (or MGEN)

**As of 2015, all assistants are covered under CPAM. As a lecteur, your health insurance will most likely be covered by the MGEN (Mutuelle Générale de l’Education Nationale).

Médecin Traitent (GP/Primary Care Doctor)- In France, if you have a médecin traitent (a primary physician, whom you see for all of your basic consultations or refferals), you will be reimbursed approximately 70% for any general visits or prescription costs. If you do not have a médecin traitent, you will be reimbursed 60%. For example, in France, a standard doctor’s visit is 23€ for a consultation. As a legal resident of France (with a visa) you will be reimbursed approximately 16€ under La Sécu if you have a médecin traitent, and approximately 13,80€ if you do not. If you want to be reimbursed between 90-100% of your medical costs, you will need to also purchase additional private insurance, called a mutuelle.

mgen

How do I find and declare a Médecin Traitent?

As an assistant, you will be given all of the necessary paperwork for registering for CPAM as well as finding and declaring a médecin traitent (primary care physician) at your first TAPIF orientation. For lecteurs, usually the university has an MGEN representative called an Intendant on campus who is available to help you fill out paperwork. If you for whatever reason either miss the orientation or do not have access to a representative, you can visit any local office in your region of France to obtain, fill out, and turn in the necessary paperwork (just Google the nearest location). Remember to do this within the first two months of arriving in France!

To find a médecin traitent, I would HIGHLY recommend using this website: mondocteur.fr. or ameli.fr, or by asking around (colleagues, past assistants, other expats, etc.) I love Mon Docteur because you can create an account, search doctors, and book appointments right online- such a time saver! If for some reason you cannot find what you’re looking for, you can also pop into any local pharmacy for a recommendation. To make a doctor’s appointment, either book online or call the number provided. Finally, when you visit your médecin for the first time, ask if they will be willing to be your médecin traitent, have them fill out this form, and then turn it in to CPAM or MGEN.

When looking for a specialist (ie: dentist, optometrist), there are often long waiting periods or refusal of new patients. So, shop around, and use the “who-you-know” technique (ie: I give private lessons to the children of an optician, which meant free a and convenient eye appointment!) Additionally, specialists can charge more money than the standard 23 euros for a consultation, meaning that if you are not properly covered by your sécu or mutuelle, you may not be reimbursed the full amount. On both Mon Docteur and Ameli, each doctor states if they accept a carte vitale or not, as well as if they are a part of section 1 or 2. Do not go to a doctor who does not accept a carte vitale. Additionally, if they are apart of section 2, it means that they charge more than standard prices, so you will best be off staying with doctors who are apart of section 1 if you don’t want to pay more money out of pocket.

Additional Private Insurance: Mutuelle

Long story short, a mutuelle reimburses what la Sécu does not. In order to be reimbursed between 90-100% of your medical costs in France, you must purchase a mutuelle. Usually, depending on the company as well as your age or status (ie: it is sometimes cheaper for people under the age of 26 and it is cheaper for students) a mutuelle subscription can cost anywhere between 20-35€ per month (and can be automatically be  deducted monthly from your checking account). There are tons mutuelles you can choose from.

As of 2016, I am now subscribed to a mutelle with my employer; during my lectrice years I used MGEN’s mutuelle, and when I was an assistant I didn’t bother with a mutuelle because I didn’t really understand how the system worked (plus I was still covered under my parents’ insurance in the US; I simply took care of my medical needs at home during that summer between my assistante and first lectrice year, and brought enough medication with me.) You can have your health insurance with CPAM and your mutuelle with a different company. As of 2016, I pay 0€ for my mutuelle, but with MGEN I paid 26€ per month.

When it comes to mutuelles, you need to take your personal healthcare needs into consideration. For me, this included bi-annual dental cleanings, an annual gynecological visit/pap smear (and birth control prescriptions), an annual optician visit (I wear glasses), and thyroid specialists/included lab work (I have a thyroid condition which requires daily pills and yearly blood work).

My advice again would be again to speak to your colleagues or other people you know in France or network on the various Facebook pages to find the best coverage for you. Otherwise, do a simple Google search for either mutuelle or assurance complémentaire santé, and figure out what each plan will cover or reimburse, and find out if they have any specific requirements before joining (ie: working for a certain sector, etc.) Also, find out if their benefits kick in right away, or if you need to wait a few months before receiving coverage and reimbursements. FYI, the MGEN mutuelle gives you three months of free coverage (which begins right away!) meaning that you may only need to pay four months worth of coverage during your assistant stint!

**Something to keep in mind: Mutuelles usually have partnered dentists or opticians, so if you use specific doctors/specialists within your mutuelle’s network, you are more likely to be fully reimbursed (this is where I made my mistake when choosing my optician provider!) If you go outside the mutuelle networks, you may not be reimbursed the full amount, and it may take longer to be reimbursed.

Social Security Number: 

As a legal resident in France you will receive a social security number. If this is your first time in France, your first Social Security number may be temporary (ie: if it contains any letters). But, around November you will receive an official piece of paper from the MGEN with your real social security number, which you can use when visiting the doctor to get reimbursed for your prescriptions and visits. Your number will also be on your carte vitale and your monthly pay stubs.

A French SS# contains this pattern of numbers:

  • First set: Either a 1 if you are a man; or a 2 if you are a woman
  • Second set: Birth Year
  • Third set: Birth Month
  • Fourth set: Where you were born– 99 for foreigners
  • The rest of the numbers will be a random cluster

La Carte Vitale

This green card contains all of your health insurance information, including your numéro de sécurité sociale. It must be presented to the doctor and pharmacy each time you visit. With this card, you still have to pay the 23€ consultation fee (check to make sure your doctor’s office accepts debit/credit cards, because some will only take cash or check), and then you will be reimbursed directly to your bank account a few days later. Your pharmacy fees will depend on you and your personal needs/prescriptions/coverage.

220px-CarteVitale2

Sometime in winter, you will receive a piece of paper with your social security number and information, which you can use until your carte arrives. After that, you will receive various paperwork in the mail, all which ask you to fill in and sign a few forms, provide a passport-sized photo, and send the paperwork back via lettre recommandée avec avis de réception. Unfortunately, I never received my carte vitale when I was an assistante (it usually doesn’t arrive until around March or April, and some départements never bother giving temporary workers a carte.)

Regardless of your carte situation, as soon as your contract starts, you are covered under la sécu, and have the right to be reimbursed for your medical expenses. While waiting for your carte, just need to ask for a feuille de soins when you visit the doctor, which replaces your carte vitale until it arrives. Then, fill out your information (name, address, SS#), and mail it back to the MGEN or CPAM. Although it takes a bit longer, you will still be reimbursed.

La Carte d’Europeenne d’Assurance Maladie

This card can be used in all EU Countries (except France, where you use your carte vitale) if you seek medical attention while traveling. With this card, you maybe will be reimbursed for your overseas medical costs (just make sure to keep EVERYTHING, including bills and receipts!) The card is free and valid for one year, but you need to ask for it. You can either order it in person or through the MGEN website.

carte-europy-en-f9286095703-original

US Citizens: The Affordable Care Act (Obamacare) Regulations:

As of 2015, American citizens now must prove/declare that they have health insurance (via Form 8965 on your tax return) or else pay a tax penalty. In order to be completely exempt from this new penalty, American citizens must be out of the United States 330 days per calendar year. Therefore, most TAPIF assistants do not qualify for this exemption. If you do qualify, you must file form 8965: Health Coverage Exemptions. Simply check letter C “Exemption Type” as well as the “Full Year” box in Part III. If you moved back to the US in 2015/2016, or didn’t have US coverage for part of 2015/2016, you will need to fill out both Forms 8965 and 8962. You can use Exemption Type C for the months you were in France (and covered under the sécu). There is also a 3-month grace period for health care coverage, so you can also tick Exemption Type B for up to three months of exemption (as needed). On Form 8962, you will need to answer No to Question 10 in Part II and figure out your monthly premium tax credit.

If you need proof of coverage, go to your sécu provider (MGEN or CPAM) and ask for an Attestation des Droits (and perhaps a translation– or translate it yourself) to prove your coverage, and send that back to the IRS with your returns (as needed). **Please remember that this is all new information and 2016 is the first time the US Government is enforcing this law, so I will update this section as I learn/discover more about it. To read more about filing French/US taxes, click here.

My experiences with Doctors in France:

Primary Care Doctor:

When it comes to my primary care physician, it’s quite simple to pick a doctor and schedule an appointment. Usually you can be seen later that day or early the next if it’s urgent. Once you have your carte vitale, it is all very simple and you are reimbursed in a matter of days. I’ve changed doctors quite a few times, simply by filling out and turning in a new form, and it’s very easy to do so.

Dentist:

I’ve been for a détartrage (teeth cleaning) several times in France. However, the appointments lasted approximately 15 minutes and the dentist just sort of just scraped tarter off my teeth, claiming they were perfect.  Overall, I am not a fan of dentistry in France and pay out of pocket in the US. Read more about my post here.

Orthodontist:

While living in France, I had to get fitted for a new retainer in order to fix my shifted front tooth. For my one-year treatment, which included several appointments, consultations, x-rays, teeth molds, two new retainers, and a new permanent wire, I paid 200 euros and was reimbursed in full. Overall, a good experience.

Gynecologist:

For my annual pelvic exam and second-time pap smear, I paid around 48 euros but I was reimbursed almost in full. However, it was up to me to send my results off to the lab (about 4€ in stamps) as well as pay the lab (16€) to process the results. I received about 15€ back for that reimbursement.

Unfortunately the NuvaRing (my choice of birth control) is not covered, so I pay 44€ for 3 rings (about 11 euros per month). However, most other forms of birth control are covered, including the IUD. Ladies, if you are thinking of getting an IUD but are put off by the cost, COME AND DO IT IN FRANCE!

For my entire OBGYN experience in France, click here!

Thyroid Specialists:

I have hypo-thyroidism, meaning my thyroid does not produce enough hormones. So, every year I need to have blood tests and consultations, as well as take daily pills with hormone supplements. My general doctor referred me to a lab, where I simply came during walk-in hours. I have never had to pay anything for the blood samples. However, I always had to come back later to pick up the results, as well as go back to my primary care doctor for a follow-up appointment. In France, it’s also common to do ultrasounds on your thyroids. I had never had this done in the US, so I did in France. Again, I didn’t pay anything out of pocket. I don’t pay anything for my monthly pills, either, thanks to the mutuelle.

Do you have any questions, comments, or concerns about medical expenses or experiences in France? Let me know in the comments.

Bisous,

Dana

22 thoughts on “TAPIF Tip / Lecteur Lesson: Everything You Need to Know About the French Healthcare System

  1. Hi there. Thank you so much for all your dedication to this question. For me, I don’t qualify for any of the exemptions (long story), UNLESS the CPAM system gets “qualified” under Obamacare. To my knowledge, the Swiss medical system applied for a qualification successfully. Do you know if CPAM has yet done this? The hadn’t for 2015, and I am having difficulty finding out any information.

    Many thanks

    1. Hi! Interesting question; you should be exempt as CPAM is healthcare. You either are exempt for the months you are in France or for the option of being out of the USA for 335/365 days during the tax calendar year… This whole law is new and a complete mess… I’ve been out of the USA since it went into affect, so I’ve just been able to tick the box with a “Full year exemption.” If you get an “attestation des droits” translated, that may help you? Does this help?

  2. Hi Dana,
    I was an assistant two years ago and wish I had found your blog earlier!! I’m heading off to do TAPIF for year two but won’t be covered by my US health insurance this time. I’m not worried about going to the doctor or specialists often, but I hope to do a lot of travel outside of France during the year and I know I won’t be covered abroad on the sécu. Does a mutuelle cover you while traveling outside of France?
    I’m also interested in La Carte d’Europeenne d’Assurance Maladie. Is there an additional fee for this? Can it be used in addition to the sécu or do you need a mutuelle to qualify for it?
    Thanks in advance!

    1. Hi! The secu and mutuelle will cover you inside Europe if you have the carte europeene (which is free, You just need to ask for it at any office). And then if anything happens while abroad, Keep all your receipts !

      As for other forms of travel insurance I r commend legal nomads 🙂 bisous!

  3. Hey Dana, this is super last minute, but I was wondering if you knew anything about how American assistants should deal with Obamacare. I haven’t been able to find any clear information on the subject. It seems that anyone who lives outside the US for more than 330 days out of the year are entitled to an exemption, but since most assistants only live in France for 7 or 8 months (and that’s splits between 2 separate filing years), it seems like most assistants won’t qualify. Otherwise, we just pay a tax penalty for the months we aren’t covered. Do you have any helpful info?

    1. Hey Joseph! All of your information is correct in regards to the exemption rules and filing years. What you’ll need to do to avoid the tax penalty is prove that you are insured in France and have coverage abroad. You should ask an MGEN (or CPAM, whomever you’re with) to provide you with an “Attestation des droits” to send to the IRS (perhaps with a translation?) this is the first year all of this is being enforced so there probably isn’t a lot of information out there yet.
      Are you under 26/still covered under your parents? I’m exempt this year as I’ve been out of the US for more than 330 days in 2015 so thankfully I don’t have to worry too much (yet!) 🙂

      Hope that helps, let me know how it goes!

      1. Awesome! Thanks for the helpful information. Unfortunately, I’m 29 so I’m on my own for insurance. I was covered by Starbucks but that ended when I quit to leave for France 🙂 I shared this with the 2015-16 Facebook group, hope you don’t mind!

  4. Of course I’d find this after I’ve been in France for more than 2 months as an assistant. They gave us an informational flier about MGEN at the orientation but didn’t explain what it was for, so I figured it was one of the optional private mutuelles I’d read about in the CIEP guide because it said “mutuelle” in the name, and I didn’t think anything of it (kept the flier though). Most of the other assistants’ schools in my department did all the Secu paperwork for them, but mine didn’t. I eventually figured out how to send in the Assurance Maladie application they gave us at orientation. When I turned it into my school so they could mail it for me as the instructions said to do, the secretariat mentioned something about MGEN, but it sounded like it’s something I’m supposed to initiate, so it’s tally-ho onto the next bureaucratic adventure.
    At least the wine is cheap here, right?

    1. It took me until my third year in France to write this post because it took me this long to understand and benefit from the system! So you are definitely not alone! Ha yes, thank goodness for wine 🙂

  5. A year later and I finally received my carte vitale! Apparently the woman in charge of the primairy assistants lost my birth certificate, so, I had to order a new one, which took time, and then send it to MGEN. It was a pain in the ass! But, I’m so excited that I finally have it! After 12 months of feuilles de soins… I no longer have to deal with that! I’m so happy.
    Thank you for explaining the mutuelle. I’ve been toying with this idea since I now have a daughter, so, it’d be very beneficial as she has monthly dr. visits.

  6. It took me eleven months of back and forth with the Sécu to finally get my Carte Vitale. (They did not care for the way the State of California had apostilled my birth certificate.) It was a happy day!! I’m still figuring out mutuelle land – I never bothered to get one because healthcare is already so cheap here, and since I didn’t need to be covered for anything in particular, I figured paying the mutelle and paying extra costs would come out around the same. I have the option to get one now, because I’d like to be able to go to the osteopath and get new glasses, but it’s 40 euros a month which seems a little steep… What I really want is to be covered during travel to the US – it’s nerve-wracking to even be in the country without health insurance. What if I’m hit by a car and my family goes bankrupt?!

    Thanks for writing about all of this! It is a complicated topic.

    1. Haha yeah like I said I didn’t even have one the first year! I signed up for the mutuelle not really understanding how it worked but now I have a much better grasp/idea. I had never had to deal with health insurance in the US before so that was all new… So far what I pay seems worth it, but I guess I never sat down to do the math … You’re right about being covered in the US; I am still under my parents for a few more months but after turning 26 in March I’ll be SOL on that… Covered thru next August at least!

  7. Bless you, it is so nice to have a simple/easy to understand explanation of all of this !! One thing to add: my conseilleur pédagogique also told us we could go to the local pharmacy for a médecin traitant recommendation. I never ended up declaring one, and thankfully never had to visit a doctor, so I cannot vouch for the reliability of tho method. Just thought I’d include it in case people don’t feel comfortable asking their colleagues or other contacts to recommend someone..!!

    1. Thank you Anne!! This took me forever to write because it took me two years to understand how everything worked!! Thanks for the tip, I’ll definitely add it in!

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