15. Dental Care in France
Most dentists work within the framework of the public health system, so your general dental treatment is reimbursed in very much the same manner as that of other medical specialists.
That is to say, you will receive reimbursement from the social security system at 70% of official rates and your voluntary health insurance policy will pay for balance, assuming you have such a policy.
There is no €1 surcharge as there is with other medical treatment.
Fillings, extractions, treatment for gum diseases and most other general treatment are covered by the social security and voluntary health insurance systems.
The level of the charges will depend on the type of treatment, but they are not excessive by the standards of many countries.
Thus, treatment for minor tooth decay costs €16.87, of which 70% is reimbursed by the social security system. A tooth extraction will cost €33.44, again reimbursable at the rate of 70%.
For emergency work on a Sunday or a public holiday there is an additional charge, but this is equally reimbursable.
The charges are kept artificially low by the government to ensure that basic dental treatment is available for everyone.
The problem, however, is that these rates have remained unchanged for decades, as a result of which few dentists could afford to be in practice if this were all they charged.
As a result, the system allows for many dentists to impose charges above the standard tariff. These additional charges are called dépassement d'honoraires and they are not reimbursable by the State.
In addition, dentists are free to impose their own charges on all non-routine dental treatment work, such as crowns, prosthetics and orthodontics.
The charges for such work are substantial, and the level of reimbursement very low; a crown may cost anything from a few hundred euros to over €1,000, of which only €75 is reimbursed by the State system.
Although voluntary ‘top-up’ policies (mutuelle/complémentaire santé) are available to assist with the costs, the annual premiums payable are high and only gold-plated policies are likely to reimburse the whole amount.
The effect is that many households are not able to afford the dental care they may need.
In order to overcome the lack of access. in 2018 the government agreed new arrangements with the dental profession and top-up insurers in an initiative called '100% Santé'.
Under the deal:
- The dentists have agreed to reduce their charges for a range of non-routine treatment, such as crowns;
- The government agreed to an increase in the reimbursable tariffs for basic and preventative care;
- The health insurers agreed to widen the scope of their standard policies to include basic dental cover.
The changes are being introduced on a progressive basis between 2019 and 2021.
However, although heralded as '100% Santé' it is not quite universal free dental health care for all.
There are various reasons why this is so, not least because under the deal there will be three levels of treatment, for which different tariffs and controls apply:
- Standard quality prostheses (metal for molar teeth), where charges will be capped to a maximum of €500 and fully reimbursable by the State and health insurers;
- Intermediate quality crowns, dentures and bridges, where charges will be 'moderated' and partially reimbursable.
- High-end dental prostheses as well as implants and certain other procedures where the charges are not controlled and not reimbursed by social security system.
The government estimate that the fully reimbursable 'standard' dental care will cover 46% of prostheses work that is undertaken, whilst intermediate work 25% and non-reimbursable treatment 26% of all dental care.
Nevertheless, even these improvements will not be enough for many households, for in order to obtain '100% Santé' it requires that you hold a voluntary (complementary) top-up policy, as the State will only continue to be responsible for reimbursement of 70% of dental charges.
Around 4 million households in France who do not hold a complementary policy (including many expatriates) will remain liable for 30% of the charge that the State does not pick up, and a higher percentage for intermediate standard treatment.
The slogan '100% Santé’ does not mean '100% reimbursement by the State', despite the impression that may have been given.
Not only will such households continue not to be covered, but the charges they will pay for basic cover will increase due to the increase in tariffs for dental care.
If the health insurers are going to have to widen the scope of their policies and reimburse the higher basic tariffs, it is also inevitable that premiums will increase. The complementary insurers are already facing tax pressure on a number of fronts to cover savings being made in State funding of the health service.
The Caisse nationale d'assurance maladie (CNAM) have estimated the total cost of the deal at €1.2 billion over 5 years, of which €700 million will fall to the State and €500 million to the health insurers.
The government have also stated that there should be no increase in top-up premiums, with Emmanuel Macron stating; «cette réforme ne saurait engendrer d’augmentation spécifique du coût d’acquisition d’une complémentaire santé...... C’est l’engagement collectif que nous avons pris, et il n’y a pas..... de marché de dupes».
Nevertheless, several major insurers have already stated that premiums will need to increase, with one major survey suggesting a rise of around 10% will be necessary, with the largest increases falling on those contracts that currently only offer the minimum level of cover. Much is likely to depend on the level of demand that will arise following the changes.
The difference between the official level of reimbursement and the actual charge may also be picked up by having a top-up complementary health insurance policy. However, you need to review the terms of the policy to establish the level of cover as many cheaper policies only reimburse at the official rate.
There are also other instances when there is absolutely no social security cover at all for the treatment and where only the best quality voluntary health policies will cover some or all of the cost of the treatment.
The main types of treatment are ‘parodontology’ (oral surgery), ‘orthodontics’ (tooth irregularities) for adults and certain types of prostheses.
If you wish treatment of this kind then you will probably need to pay for it.
All dentists are legally obliged to provide a written estimate of their charges before they undertake treatment.
15.1. Child Dental Treatment
Between the ages of six to 18, all children are entitled to a free dental check every three years ie at 6, 9, 12, 15 and 18.
The service is called le bilan bucco-dentaire (BBD).
If any treatment is needed as a result of the check then most of this work is free of charge, although there are some exceptions, e.g. prostheses and orthodontics (brace).
To qualify for 100% reimbursement the treatment must be started within nine months of the dental check. You will need to pay at the time of treatment, but it will all be reimbursed by your CPAM.
You will be advised by letter from the Caisse Primaire d'Assurance Maladie one month before your child’s birthday of their entitlement to a free dental check.
The check-up must be carried out within six months following their birthday.
The letter will contain tags or stickers that you should hand over to the dentist in order that they can recover their fee.
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