# Health Coverage



## Jack Duf

Hello. I currently split the year between Florida and Paris, but I am thinking of selling my flat in Florida to live in France full time. I know US Medicare does not pay for health costs aboard but I am wondering how other US expats manage it. I am not in the French health system but I acquired a private French health policy last year when applying for a long-term French visa. I plan to continue to renew this visa on a yearly basis so I presume I will have to continue with the private French health policy as well. Perhaps the combination of this private policy for routine care and US Medicare if there were to be anything serious that would require a return to the US might suffice. 

Any help greatly appreciated.
Thanks,
Jack


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## Crabtree

If you have a long term Visa you do not renew it every year.Once you have arrived in France you should apply for your Carte De sejour at your local prefecture.It is this that you will have to renew annually for the first five years.As part of this renewal process you will need to show adequate health cover.However once you have been a full time resident in France for 3 months you can apply to join the French health system,which will satisfy the requirements of renewing the CDS You do not say if you are retired or not but if you are then you will not need to make health payments to the state but you will be advised to get a "top up" insurance.If you are not retired then you will be expected to make a contribution equal to 8% of your income


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## Bevdeforges

If you are living in France and retired, you are most likely receiving US Social Security retirement benefits. This is actually what entitles you to register with the French health care system (after first establishing at least 3 months of valid residence in France with health insurance cover from another source). So, hang onto the private health cover until you have your 3 months of residence in, and then apply to CPAM for health care cover in the State system. It may take some time for your application to get processed, but once you're in, you will need to designate a "mutuelle" to reimburse for the portion of health care costs that the sécu doesn't cover.

Oh, and I see that Crabtree has already explained about the carte de séjour. Although many people still refer to renewing their carte de séjour as renewing their visa. The carte de séjour is actually your residence permit for France.


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## Crabtree

Think of it like this-The Visa gets you in the CDS lets you stay


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## TomMM

Jack Duf said:


> Hello. I currently split the year between Florida and Paris, but I am thinking of selling my flat in Florida to live in France full time.


A fellow Floridian making the move! (Must be something in our water) I am looking forward to navigating the French system. Luckily there is a number of good knowledgeable people on this forum.


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## Sneetch

Bevdeforges said:


> If you are living in France and retired, you are most likely receiving US Social Security retirement benefits. This is actually what entitles you to register with the French health care system (after first establishing at least 3 months of valid residence in France with health insurance cover from another source).


Back in 2016 when they changed the rules about who can get into the health care system they removed essentially all the old requirements. Presently, the only requirements are either to be working, or to be legally resident more than 3 months. 

To quote the webpage on the subject that I bookmarked a while ago when I was trying to understand how the health care system in France worked for retired expats (in French) : Mise en place de la Protection Universelle Maladie (PUMA) au 1er janvier 2016

Au 1er janvier 2016, la Protection maladie universelle donne droit à la prise en charge des soins de santé aux personnes qui :

exercent une activité professionnelle, ou
résident de manière stable et régulière en France (y compris la Guadeloupe, la Guyane, la Martinique, La Réunion, Saint-Barthélemy et Saint Martin) depuis au moins 3 mois.
For the record, I am presently not getting social security and I got my carte vitale without any problem.

The thing about the health insurance and social security or pensions is that if you are getting any kind of pension then you don't have to pay the cotisations for the health insurance.


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## Bevdeforges

Sneetch said:


> The thing about the health insurance and social security or pensions is that if you are getting any kind of pension then you don't have to pay the cotisations for the health insurance.


And just to clarify - if you aren't receiving US SS (or anything recognized as a pension for French purposes) they will assess an annual charge for the insurance based on your income for the prior year. (So, whatever you declared on your visa application for the first year.) It's a small percentage (at least compared to US health insurance norms) and on the start of drawing your Social Security (or IRA or 401K) benefits, will revert to the aforementioned "freebie" status.


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## Peasant

Bevdeforges said:


> If you are living in France and retired, you are most likely receiving US Social Security retirement benefits. This is actually what entitles you to register with the French health care system...


Depending on the person at CPAM that you're dealing with be prepared to explain that the US's Social Security system is not like the French one, in that it is (as far as living in France) only a retirement system, not a comprehensive health care system too. They might ask you for an S-1 form (a EU showing that you've paid into the health care system). The US doesn't issue one. They might ask you for a letter from your previous US health insurance plan saying that you're no longer covered by them. You then explain that in the US, if you stop paying premiums, they just stop covering you and don't bother sending you a letter telling you that you're no longer covered.

That's what happened to me when I applied It took about four months for the approval to come through and have a Carte Vital issued. Well worth it though as the French health care system (in my experience) rocks.

You should also figure on paying €100-150 per month for "top-up" insurance from a Mutuelle (a not-for-profit, co-operative insurance company) to pay for the things that you may want that the system doesn't pay for (ceramic tooth caps instead of steel and a wider choice of eyeglass frames for example) and the 20-30 percent of some medical charges that the system expects you to pay for.

My wife and I (retired) are paying around €125 per month, each, for our Mutuelle but we're greedy and got the top-tier plan. Still much less than what we'd be paying for Medicare Parts B and D. In fact, I recently did a "what if" on the extra charges I'd have to pay with Medicare if I was still living in the US and it came out to beat least €650/month, not including various co-pays for doctor visits and tests and such.


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