How will Brexit affect healthcare cover for British expats in France?

It seems unlikely that, after Brexit, British expats living in France will enjoy the same healthcare rights as they currently do, so what will change?

What healthcare cover do British expats in France have at the moment?

If you are retired or have been a resident for 5 years or more…

Until now, British expats who have made France their permanent residence for five years, or who have reached retirement age, have been able to join France’s healthcare system, which is rated among the world’s best – better, some claim, than Britain’s beleaguered NHS.

Despite cost-saving measures introduced by successive French governments in the last decade, access to France’s Couverture Maladie Universelle (CMU) system, generally rated the best option for expats, has until now been relatively easy. “There are no medical questions, no exclusion of pre-existing conditions, no age limits, no claims deductible and no delay for urgent necessary treatment,” notes Exclusive Healthcare, which specialises in health insurance for Anglophone residents in France, on its website.

Currently, patients are expected to contribute around 30% of the cost of their treatment, so most people buy a top-up health policy to cover the gap between medical bills and the French national health service’s reimbursement to healthcare providers. A typical top-up policy can currently be bought for around €800-€1,000.

If you have lived in France for less than 5 years…

Since 2007, new arrivals planning to live permanently in France but not yet eligible for the French system have been required to prove that they have personal medical insurance or are covered by British National Insurance contributions, so that the French healthcare system can recoup the costs of treating them from the UK. PUMA (Protection Universelle Maladie – universal illness protection), introduced in 2016, equalised the rights of EU and non-EU citizens to apply for France’s health insurance card, the carte vitale. That made life easier for British and other EU residents, who previously had to be resident for a period of five years before they were eligible.

What will happen after Brexit?

As with every other aspect of Brexit, it’s too early to know exactly what the future may hold for British residents in France. In particular, it is unclear whether they will still be eligible to join the French system, or to have their medical costs in France paid by the UK. However, maintenance of the reciprocal status quo, under which the French health system (like that of other EU countries) reclaims its share of the cost of treating British residents from Britain, looks to be very unlikely.

“The health issue has been mishandled by politicians who just forgot about it,” says Charles Wilson, president and managing director of Exclusive Healthcare and president of the management board of the Institut Hospitalier Franco-Britannique.

Expat Britons will, after Brexit, have to budget for a policy that covers their medical costs in full. That will be expensive. Younger clients and those with a clean bill of health are unlikely to have problems finding an insurance policy to cover medical expenses currently provided under the French national system, says Wilson, who has himself been resident in France for many years. However, for those with pre-existing conditions, it may be difficult or even impossible. For many, the days of quick, no-questions-asked acceptance by an insurer are numbered.

“For those over 65, an insurer will have you, after a medical examination, at a price per existing condition. That price is dependent on your aggregated level of health.” A record of treatment such as hip replacement surgery is unlikely to be an issue for an insurer, but Wilson warns that anyone who has had any form of cancer will pay an extra loading, adding greatly to the cost of their policy, or may even be refused cover. From the insurer’s point of view, this is understandable. “Hospitalisation can be disastrously expensive. If you have a serious bout of cancer you can run up bills of €150,000 or more,” Wilson points out.

“Standard premiums for a 62-year-old buying a fully underwritten health policy will range from €2,290 to €4,977, but the maximum limit and the guarantees are quite low,” says one France-based insurance expert. “For a higher limit and better guarantees the premium would be from €6,702 to €8,412.”

That said, the cost of a visit to a French doctor averages only €23. Common prescription remedies are usually relatively affordable, and Britons may find it makes sense to buy a cheaper policy that excludes minor treatment but provides cover for hospitalisation and more major surgery. Such policies already exist. “We have designed a policy for people who just need cover for possible hospital bills,” Wilson says.