Explainer: Paying to see a doctor or health specialist in France
The medical system in France can seem quite different to people coming here from the UK and US, for example – here are some useful pointers to help you understand
If you are moving from the UK to France, the healthcare system can seem very different upon first glance.
For example, you will often be required to pay the cost of a medical service upfront, but you can usually be reimbursed, at least in part, for this payment.
Here are some key points to remember.
Do I pay my doctor in France?
You will often be required to pay the costs of a medical procedure upfront.
However, if you are a resident of France, the state part of this cost will be reimbursed through the state health insurance system, usually within a few days if you have a carte Vitale.
The state-insured part represents a certain percentage of a state-fixed rate for a given medical act or service - called the tarif de convention.
The part of the tarif that is not state-reimbursed is referred to as le ticket modérateur.
For a standard GP visit costing €25, 70% is currently reimbursed; 80% of the main costs of inpatient care in state hospitals and clinics accredited by the state is reimbursed.
Do costs differ depending on the doctor?
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Doctors come under different ‘sectors’ in regards to their policy on reimbursements, in most cases sector one or sector two.
Sector one means they only charge le tarif de convention whereas sector two doctors can charge more on top of this called dépassements d’honoraires.
A good top-up insurance policy will generally refund you the out-of-pocket costs represented by the le ticket modérateur and any dépassements d’honoraires.
What are the top up insurance policies called?
A top-up insurance policy is called a complémentaire santé, also often known as a mutuelle.
They are generally affordable, and while they increase in cost with age, they usually do not increase based on health conditions.
French employers help to pay towards one for their employees.
What do the different mutuelle policies mean?
Whether you are fully refunded for a given service depends on the level of any dépassements, and the level of mutuelle cover you opted for.
For example, a 100% policy will top up your reimbursement to 100% of the tarif de convention that you paid (if the state did not reimburse it all).
A 200% mutuelle will top up to twice this sum if the doctor’s fee was more (within the costs actually incurred).
Healthcare providers usually check if a patient has a mutuelle and are able to transmit details to the insurance company for reimbursement of this part of the costs.
How are reimbursements paid?
Both state social security and the mutuelle will issue their refunds as direct electronic transfers to your bank.
If this does not happen, check with your local Caisse primaire d’assurance maladie (state health insurance refunds body) to ensure they have your correct bank details.
For early retirees who moved to France and opted for a comprehensive private policy instead, the reimbursement is all paid through your private insurer, depending on the level of cover.
What is le tiers payant?
Some people are exempt from having to advance their medical expenses for the state funded part of their costs.
This is called le tiers payant.
In this case, whether there is anything left to pay upfront depends on the status of the patient and whether or not any dépassements are charged.
Notably, people with low incomes who benefit from a form of state-funded ‘top-up’ called complémentaire santé solidaire (CSS) are relieved from making any kind of up front payment for the tarif de convention part of their care. Doctors should also not charge those on CSS any dépassements, apart from in rare circumstances.
Le tiers payant also applies to the whole of the tarif de convention for care of victims of work accidents as well as people suffering from designated long-term illnesses (affections de longue durée; ALD) or occupational illnesses. Dépassements d’honoraires may, however, in some cases still be chargeable and payable.
Some doctors also opt to offer le tiers payant as a general policy.
When else do patients not have to advance their costs?
Hospitalised patients who are treated in state hospitals or state accredited private clinics generally now do not have to advance their costs for the state-funded element.
This also applies to patients receiving preventative care services, such as a mammogram carried out as part of a breast cancer screening programme.
Others benefitting from this include girls aged 15-18 requiring sexual health check ups or contraceptive related consultations, and pregnant women.
Do pharmacies practice le tiers payant?
Pharmacies generally practice le tiers payant.
This does not apply when people insist on using branded medicine rather than a cheaper generic.
Do doctors always accept bank cards in France?
Many accept bank cards but not all, so it is a good idea to take a chequebook or cash with you to appointments.
Do I have to get a referral from my doctor?
Note that you may be reimbursed at a lower-than-usual rate if you see certain specialists without referral from your médecin traitant.
Failing to obtain a referral, or failing to register with a GP in the first place means you fall outside the so-called pathway of care (parcours de soin). This penalty is not picked up by mutuelles.
For example, if you visit your own GP you will be reimbursed based on a set fee of €25, at 70% (minus a fixed €1 deduction called the participation forfaitaire) ie. €16.50.
If you go hors parcours (outside the pathway) then you are reimbursed at only 30% (€6.50).
If your GP is on holiday, a designated replacement doctor or another member of the surgery is acceptable and if you are away from home you are not bound by the médecin traitant rule.
