The government have announced free dental care for all, but the reality is a little different.
One of the key campaign promises of Emmanuel Macron was access to free dental care for all*, in an electoral slogan called «Le reste à charge zéro»
Although the State system covers around 70% of routine medical costs, the picture is rather more complicated in relation to dental care.
Routine dental treatment is reimbursed at the same percentage rate, and at tariffs that are very affordable, but that is not the case for complex or major work.
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%.
If you hold a decent voluntary ‘top-up’ health insurance policy, then you will obtain reimbursement of the outstanding balance.
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, with the government estimating that 17% of population never visit a dentist due to the cost of the treatment.
In order to overcome the lack of access the government held substantive talks with the dental profession and top-up insurers to fulfil the manifesto commitment.
The result of these discussions was announced last month, in an historic agreement between the three parties.
Under the deal:
- The dentists 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 will be introduced on a progressive basis between 2019 and 2021.
The agreement was heralded by the government and many newspapers as ‘100% Santé’, but 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 do 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 national association of health users France Assos Santé has stated that: "If the increase in these contributions is too high, the elderly will give up their health insurance, so the 'reste à charge zéro' will not apply. The reform will then be for nothing."
*Optical and auditive treatment will also benefit from these measures, and in due course we shall be updating our relevant Guides pages with the changes.