What are the healthcare costs in France? Unlike the headlines you may have read, French state healthcare is not actually completely free. Even once you’ve managed to get your famous Carte Vitale and even if you have great supplementary insurance being provided by your employer, you may still have to pay some out-of-pocket charges. So it’s essential to ensure you understand what you’ll be charged, how much you’ll get back through state healthcare coverage and whether or not your supplementary health insurance fully covers you.
How much does the French state cover of your healthcare costs?
The French Social Security system (“Sécu“) defines a price for each treatment it reimburses. This reimbursement matrix is called La Base de Remboursement de la Sécurité Sociale (“BRSS”).
In addition to the price that each treatment should cost, the state also defines the repayment rates per type of care or treatment. In general, it refunds 70% of a care act or treatment. For example, Sécu set the BRSS for a consultation with a general practitioner at €25. You can find all the latest reimbursement rates for doctor consultations, blood tests, medication, hospitalization, and other medical expenses on the Ameli website here.
Let’s look at an example
You go to see a doctor who chooses to charge €50 for their general consultation. As mentioned, Sécu set the BRSS for this at a fixed €25. Sécu will reimburse you 70% of the €25 basis defined, or €17.50. To mitigate potential overconsumption, Sécu charges you a €1 fee if you are over 18 years old for any healthcare treatment you receive that they cover. So actually, your reimbursement from them will €16.50 rather than €17.50. Still with me?
This example leaves €33.50 to be paid by you for the consultation. If you have a private health insurer (mutuelle), this will reimburse you for some or all of the €33.50 amount you owe, based on your specific coverage plan.
Do all doctors charge the same for consultations?
No! Doctors in France are allowed to practice in three different “Sectors”, and each Sector has its pricing. Sectors 1 and 2 are said to be approved, while Sector 3 is outside the conventional system.
Sector 1
These doctors charge their patients the BRSS. You are fully refunded by Sécu minus 1€. Most general practitioners (primary care physicians) are in this category, especially outside of Paris. If you have supplementary health insurance, it will reimburse you for the part of the consultation not covered by Sécu.
Sector 2
These are doctors and health practitioners who choose to set the prices for treatments above what’s stipulated in BRSS. Most specialist doctors and many general doctors in Paris, fall into this bucket. Sécu will refund you based on the rates applicable for Sector 1 doctors, and any supplementary health insurance will cover excess fees according to a contractually defined rate – 100%, 200%, 300%, etc, of the BMSS amount.
Sector 3
These doctors set whatever (meaning very high) prices they want. So, while the amount you are reimbursed by Sécu and your supplementary health insurer is the same as Sector 1 and 2, you will likely still have a very high out-of-pocket portion to cover their total cost.
If you don’t find a sector 1 doctor, and if you want to see one that is in sector 2 without spending too much money, you can check one criteria: is your doctor OPTAM or not? The acronym stands for Option Pratique Tarifaire Maîtrisée. What you need to know is that if your doctor has signed the OPTAM, it means that they are committed to respecting an average price for treatment that won’t be too far above the BRSS. This way you are still fully reimbursed between the Sécu coverage and your health insurer.
How do you know which Sector your doctor is in? Consult this health directory on the Ameli website, where you can search by doctor’s name, speciality and location.
Who is “médecin traitant” and why should you care about having one?
So you’ve found a great doctor you like – great! Don’t forget to declare this doctor as your “médecin traitant“. This doctor is the equivalent of your family doctor or general practitioner (GP) in the UK or primary care physician in the USA.
In France, the “parcours de soins coordonnés” is a healthcare system designed to enhance the efficiency and quality of medical care while controlling costs. It requires individuals to select a primary care physician, known as the “médecin traitant,” who acts as the gateway to the healthcare system. When someone has a health issue, they must consult their médecin traitant first, who then provides referrals for specialist care or tests if necessary.
If you don’t respect these guidelines and see a specialist before seeing your “médecin traitant“, Sécu and your health insurance provider will refund you less (30% rather than the standard 70%). So choose and declare your médecin traitant to reduce your healthcare costs in France.
There are some exceptions when you don’t need to have been referred directly by your médecin traitant to see particular specialist doctors. If you see the following specialists without referral, Sécu will still reimburse you 70% of the conventional rate:
- Gynecologist: for periodic clinical examinations, including screening procedures, prescription and monitoring of contraception, monitoring of pregnancy, voluntary termination of pregnancy (abortion) by medication;
- Stomatologist: except for major surgical procedures
- Psychiatrist: if you’re between 16 and 25 years old;
- Ophthalmologist: for prescribing and renewing glasses, screening and monitoring glaucoma
Another exception is relevant for children under 16 years old. Whether they have a médecin traitant or not, Sécu will still reimburse the costs at the 70% reimbursement rate.
How to choose a médecin traitant
You have the freedom to choose your doctor. However, the doctor you have chosen must give you their consent to fulfil the role of your “médecin traitant“.
The attending physician can be a general practitioner or specialist approved in sector 1 or 2. The doctor can practice alone, in a group, in a health centre or hospital. They may be your family doctor or another doctor. There are no geographical constraints.
It’s up to you to choose the doctor who knows you and suits you best.
Family members may have the same or different attending physicians; in all cases, everyone must declare their doctor individually. There is no collective declaration.
Some doctors may refuse to act as a medicin traitant to a very young child (and instead suggest that theirs is a paediatrician rather than a generalist).
How to declare your médecin traitant
Ask your doctor to declare themselves as your médecin traitant. You’ll need your Social Security Number and Carte Vitale to do that. The doctor will transmit the declaration directly to your primary health insurance fund. It’s simple and quick: no form to fill out, no mail to send, and your declaration is recorded immediately.
