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Health in France

Rule Changes in France on Health Cover for Early French Retirees

Monday 03 September 2007

The right of access to the State health insurance system is being removed for 'non-active' expats under retirement age, although, contrary to some recent press reports, it is by no means clear this new rule applies to those already settled in France.

As IFP was the first to reveal in our Newsletter 009 2nd April, the French Government have tightened rules on access to French health and social security rights for EU expats.

The basis of these changes is a European directive passed in 2004, which stated that anyone proposing to relocate to another EU state without work (or intention to find work) needed to prove they had sufficient resources to live there, without recourse to assistance from the member state.

In practice, EU countries have approached the interpretation of this directive in different ways. Spain was one of the first to tighten up laws on health rights, and new laws have also been introduced in other countries.

France has been slow off the mark, but new arrivals to France now face more stringent checks on their income and resources, and access to certain social security benefits has been removed.

French officials have also told IFP that the specific changes now introduced in France have come about as a result of an abuse scandal that occurred in the Dordogne in 2006. The case involved dozens of expats (British and others) obtaining fraudulent access to French supplementary social security benefits, which granted them free health cover.

Under the new rules, those under retirement age relocating to France in the future will still be able to get cover for at least two years through the French system, provided they are up to date with national insurance contributions in the UK.

At the end of this two-year period, insurance cover from the UK will cease, and they will have to take out private health insurance, or seek assistance with health care costs under a State health scheme of last resort called L'Aide Médicale de l'Etat (AME).

Hitherto, this scheme was only used for those who were not otherwise entitled to reside in France on a permanent basis, but it will now be opened up to non-working expats under retirement age.

The catch with the AME is that it is only available to those on the bread-line, and if you are in a penurious state, you might not be able to stay permanently in the France in the first place! A couple would need to have an annual income of less than €11,000 to qualify for assistance. If they did so, all medical costs would be met by the State.

In all cases, once someone reached state retirement age, they can be re-admitted into the French health system, as part of reciprocal (E121) agreements between EU countries. In the case of a couple from the UK, they would become eligible on the earlier state retirement age of the wife i.e. 60 years old, and rising!

As far as existing expats are concerned, the picture is a mixed one, with local health authorities themselves unsure how to interpret the new rules.

Some expats who have lived in France over two years, but who are not affiliated to the health service through employment or a business, are apparently being advised that their rights to affiliation to the health service are being withdrawn.

We have made enquiries to seven of the local health authorities, four of whom advised us that the new rules do not apply to existing expats. Only one stated that it did apply to existing expats, and two were simply not informed enough to comment.

We have also made an enquiry direct to the Ministry of Health and we will update you in the next newsletter of any response.

We would be surprised if the new rules were to be applied retrospectively, but then we are frequently surprised!

Certainly for future early retirees the rules of the game have changed. In order to obtain ongoing State health insurance cover those affected will either need to obtain employment, start a business, or make application to the AME.

Whilst the prospect of private health insurance may well be uncomfortable for most people, it is not necessarily going to be a catastrophe for everyone.

If you are a couple in your mid fifties, and in reasonable health, expect to pay around €4000 per year, but with an excess clause that normally excludes routine GP consultations.

Alternatively, there is always the option of taking part-time employment, or setting up a small business, which would then grant access to the State health insurance system.

If your income from employment or business is small, then so it will be the case with the level of your health insurance contributions.

Moreover, if you subsequently lose your job, or your business, there is cover available to you through the French system.

You can read more about the health service in France in our guide to French Health Care.

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