Guide to French Health System

5. Assistance with Health Costs

  1. Introduction
  2. Who is Entitled?
  3. How Much do you Pay?
  4. How to Apply

5.1. Introduction

Under President Macron, France has been moving away from its social insurance based health service towards a more national system, free at the point of delivery and funded centrally.

Nevertheless, it remains a system in which the State is responsible for only a proportion of your health treatment costs, with a voluntary insurance system which sits alongside to pick up those charges not met by the State.

Even here there are some exceptions, for major illnesses are fully covered and those on a low income are also entitled to 100% cover.

In addition, those of modest means who hold a complementary ('top-up') health insurance policy are entitled to get assistance towards the costs of such a policy.

In the past the two schemes that have provided support based on income were called CMU Protection Complémentaire (CMU–C) and the Aide au paiement d'une Complémentaire Santé (ACS).

In both cases, the receipt of either of these aides means that for the patient there is:

  • No consultant surcharges, known as dépassements d’honoraires;
  • No payment to the doctor/hospital for treatment, due to the use of a direct payment system called tiers payant'
  • Exemption from the €1 obligatory patient charge, called the participation forfaitaire;
  • Reduction or exemption from charges for spectacles, dentistry, and auditory care.

In 2019 the government consolidated these arrangements into a single scheme called the Complémentaire Santé Solidaire (CSS), which offers the same entitlements.

Under the CCS scheme, if your income is below a certain threshold you can obtain free health treatment, as was the case at present for those entitled to CMU-C; if it is around 35% higher than the threshold, you will only need to make a contribution of up to €1 per person/day towards a complementary 'top-up' policy,

In effect, the State itself offers a complementary policy, although the voluntary insurers remain administrators.

Where you obtain 100% cover it is called 'complémentaire santé solidaire sans participation financière'; where you are required to make a financial contribution it is called 'complémentaire santé solidaire avec participation financière'

5.2. Who is Entitled?

Access to the schemes is available to anyone legally resident in France, whether retired, employed or working.

However, we are aware of some households who hold an S1 certificate of entitlement from their home country being excluded from the scheme. This is because as an S1 recipient your health costs are covered by your home country. Thus, Article 160-6 of the social security code, it states the following persons do not benefit from health cover in France ie S1 holders:

3° Les personnes titulaires d'une pension étrangère qui ne bénéficient pas par ailleurs d'un avantage viager d'un régime obligatoire de sécurité sociale français lorsque, en application d'un règlement européen ou d'un accord international, la prise en charge de leurs frais de santé ainsi que de ceux des membres de leur famille qui résident avec elles relève du régime étranger qui sert la pension

If you are eligible, application is made on behalf of the whole household, not on an individual basis.

In order to be eligible your income must be below a threshold. The income thresholds for the period April 2022 to April 2023, for each element of the scheme, are as follows.

Those whose income is below the threshold in the first column pay no charges (Sans Participation), whilst those in second column pay a small charge (Avec Participation Financière).

Household Size Sans Participation Avec Participation Financière
One Person <€9,203 <€12,424
Two People <€13,805 €18,637
Three People <€16,566 <€22,364
Four People <€19,327 <€26,091

The threshold is increased by €3,681 or €4.970 (as applies) for each additional person.

The basic threshold for one person has been increased since April 2023 to €9,719, with commensurate increases for larger households. We will update the table in full when all the figures are available.

However, the test of resources is not entirely that simple, for if you are an owner-occupier without a mortgage your income will be increased by a fixed sum (forfait) per month. Single persons are subject to a forfait of €67,84 a month (€814 a year) and couples to €118,72 a month (€1,424 a year), with increases for larger households. (2021/22)

Accordingly, an owner-occupied couple with an income of €15,000 per year without a mortgage will be assessed as having an income of €16,424.

The reference period for determination of your total income is the previous 12 months.

5.3. How Much do You Pay?

Where you do not obtain entitlement to 100% cover (that is to say, you are in the second column), the amount of the monthly contribution is calculated according to the age of each member of your household on January 1st of the year in which you are granted the right to assistance, as follows (2022/23):

Age 'Participation Financière'
Up to 29 Years €8
30-49 Years €14
50-59 Years €21
60-69 Years €25
70+ Years €30

So, for example, for a family with a 51-year-old parent and two dependent children aged 16 and 22, their contribution would be €21 per month for the 51-year-old and €8 per month for each of the children, giving a total of €37 per month (€444 a year).

A household composed of two people, one 67 years old and the other 72 years old, would pay €55 per month (€660 a year), i.e. €25 per month for the 67 year old and €30 per month for the 72 year old.

There is an on-line Simulator available to assess whether you might be eligible.

If you already have a voluntary health policy, and your application is successful, you will transfer to the CSS and pay less in premiums, although in a small number of cases the scope of your cover may be lower. You can retain your existing insurer to administer the CSS, or have it administered through your local health authority, the CPAM.

5.4. How to Apply

In order to apply you can either do so on-line, using your 'assurance maladie' account. If you do not have an account you can set one up at Ameli, the on-line health system.

However, the application process is a herculean task, so for most applicants it may be better to apply direct to your local health authority, completing the application form and sending in to your local health authority (CPAM) or visiting their offices.

The application form and accompanying notice provide details of the documentation that you will need to provide. It includes, most importantly, an Avis d'impôt ou avis de situation déclarative à l'impôt (ASDIR), which you should normally receive when you have completed your annual tax declaration. It is not your tax notice.

You can also approach your voluntary (top-up) health insurance provider to assist you with the application, if you have such a policy. They are administrators of the complémentaire santé solidaire avec participation financière, although not all insurers are participants.

The health authority have two months to consider your application. If successful it is backdated to the date of your application, although it is possible to apply it retrospectively in the event of hospitalisation.

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