Retirees accessing French healthcare

Johanna Matthews talks through the options open to retirees needing to access the French healthcare system following a move across the Channel

For many people, spending their well-earned retirement in France is an attractive option. As with all big life changes, however, it’s important to be well prepared and to understand how the system works before you take the plunge. This is particularly important when it comes to early retirees accessing the French healthcare service.

Many of the questions raised by those who have taken early retirement or are contemplating it in the near future show that very often the facts are not widely known and the pitfalls not widely recognised by those planning a permanent move to France.

In the same way that you would be well-advised to look carefully into where and what property you buy in France, it is also vital that you are well-informed and up to speed on your entitlement to healthcare. The planning stage is a critical one, and you are strongly advised not to make any final decisions on a move until you have researched the current and valid healthcare information that applies to you.

In particular, note that EU social security regulations are legally enforceable when you move between Member States within the EU. It is a fundamental principle of these regulations that you can only belong to one member state’s social security system at a time.

Healthcare research should be top of your list because, to reside permanently in France, you are legally required to have health insurance – either State or, if this is not possible, private health insurance. When applying to buy private medical insurance, you will have to complete a medical questionnaire and underwriters will then consider the medical information and come back with their proposition.

You will be classed as an early retiree if you are not yet in receipt of a UK State Retirement Pension (UKSRP) and this will have implications on your entitlement to state-funded healthcare in France. Before you leave the UK, therefore, it is important to decide whether or not you intend to work in some capacity following your cross-Channel move.

This decision is important because those who work in France can register with la Sécurité Sociale (la Sécu) and pay social security contributions, a move which then covers them for basic state healthcare.

If you do not work in France, you may apply to the Department for Work & Pensions (DWP) in Newcastle upon Tyne to see whether you are entitled to Form S1. The right to this S1 depends on your UK national insurance contribution record in the last two to three years. But this sort of S1 only lasts for a limited period which may be up to two years – the exact period depends on your national insurance record and also the date when you last paid national insurance contributions in the UK.

If granted, and once you have registered it at your local Caisse Primaire d’Assurance Maladie (CPAM), an S1 entitles you to basic French State healthcare at UK expense during the period of its validity. The French State healthcare system is a reimbursement of medical expenses system, but it only partially reimburses the cost: eg 70% of GP treatment, 80% for hospitalisation, and always in accordance with State tariff rates.

As a result, most people opt to purchase complementary health insurance to top up some or much of the shortfall – French people call this their mutuelle. No medical questions are asked with regards top-up insurance and insurers generally offer a range of policies. Without a top-up, you will have to pay the 20% to 30% shortfall in the State reimbursement system yourself.

A second type of S1 can be issued by DWP when you become entitled to a UKSRP. Again, this will provide you with basic French State healthcare at UK expense. However, this sort of S1 is granted for your lifetime in France.

Top-up insurance works in tandem with the state healthcare system and you should consult your insurance adviser for details concerning the terms and conditions of the particular policy you intend to purchase.

If your application for an S1 is turned down by the DWP or if there is a gap between the end of the limited-period S1 and the start of the UKSRP/S1, you will have to take action.

When your limited-period S1 ends, your medical costs become 100% your responsibility until such time as you obtain alternative health cover. Without health cover you would be in an uncertain situation with regards to the legal requirement to have it while remaining resident in France.

One of the following routes may provide health cover, but in any event do not let a zero health cover situation drift on, because without it you will be billed for all the care you receive and hospital treatment, in particular, can be very costly and bills quickly mount up:

(a) If you work (either employed or self-employed) in France you will be covered for basic State healthcare once you are registered at your CPAM or, if you are self-employed, at your RSI (Régime Social des Indépendants).

(b) If you have no right to any State-funded healthcare whatsoever and you are not working, you can apply to your local CPAM for basic Couverture Maladie Universelle (CMU) insurance, which is a healthcare provision unique to France. Basic CMU, which you have to pay for, becomes a right after five years of legal and continuous residence in France. Before the five-year qualifying period is met, the situation is very ambiguous because CPAMs are autonomous and the rules are often applied inconsistently nationwide. Therefore, there is no guarantee that you will be successful and it would be unwise to rely on this route to cover you for basic French State healthcare.

(c) If you cannot obtain basic healthcare by any route, then your remaining option would be private health insurance, bearing in mind the comments made earlier concerning the required medical questionnaire and potential exclusions for pre-existing conditions.

Public bodies empowered to apply the legislation always work on a case-by-case basis. They have to because everyone is different. In light of this, it is always sensible to seek expert advice that will be tailored to your own particular set of circumstances. Once you know that your healthcare provision is in place, you will be able to move to France with a light heart and make the most of everything the lifestyle, culture and climate has to offer.

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How is permanent residence in France defined?

The French Social Security Code states the following:

“Persons who have their principal household or residence in France are considered as resident in France. Household means the place where persons normally live, that is to say their habitual residence, subject to their residence being of a permanent nature. The condition of principal residence is satisfied when beneficiaries are personally , effectively and mainly present in France. Persons are considered to have their principal residence in France when they stay there for more than six months of the calendar year.”