Social Security only reimburses a percent of medical costs in most cases, and the reimbursement rates are relatively low for some types of care. Doctors’ visits, for example, are reimbursed at 70% of the “tarif conventionné”, or of €23, and certain prescription medications are reimbursed at anywhere from 15-65% of the price set by the government.
Pharmacies, however, can set whatever rate they want, and you’ll only be reimbursed up to the government-set price.
While most doctors’ offices won’t break the bank in France, other healthcare services can get expensive. Dental care and opthamology have REALLY low reimbursement rates compared to the cost of services – teeth cleanings and glasses or contact lenses. If you expect to need certain prescription medications that are reimbursed at a low rate, or significant dental or eye care, you may want to consider getting a mutuelle.
A mutuelle is a “complémentaire santé,” or a complementary health insurance plan that covers what Sécu doesn’t. For doctors’ visits, the mutuelle may reimburse the 30% not covered by sécu for a Secteur 1 Tarif Convetionné doctor, or 200-300% of the “tarif conventionné” for a Secteur 2 doctor.
For a hospital stay, a good mutuelle may cover part of a private room.
And many mutuelles cover 300-500% of the “tarif conventionné” for dental and eye care and prescription medications.
How much do mutuelles cost?
Like other forms of health insurance, the monthly rate you’ll pay for a mutuelle depends on several factors: your age and gender, your status (student, salaried employee, unemployed, etc.) and where you live.
Some companies offer a mutuelle through a collective coverage agreement (similar to employer-sponsored healthcare in the United States) and pay part of the cost, reducing your out-of-pocket expenses.
Other mutuelles are sold directly to consumers, at all different prices and coverage amounts, but prices typically range from €25-40 per month.
How do you sign up for a mutuelle?
There are a few different ways to sign up for a mutuelle if you’d like complementary healthcare:
1) Through your employer: if you have an employment contract, check with the human resources department in your company (or the Rectorat for language assistants) to see what mutuelle options are offered to employees.
2) Through your university: If you’re a student, you’re required to enroll in student health insurance through SMEREP or LMDE, both of which offer low-cost complementary student health plans. Check out their health plans if you’re eligible, even if you’re over 28.
3) Through your significant other’s employer.
4) Purchase individually on the open market. Prices and reimbursements can vary greatly from one provider to another, so do your homework before signing up for a plan. There are several online price comparison tools that you can use by entering your age and gender to get a price estimate. There are literally dozens if not hundreds of companies offering plans, and not every plan is included in every tool, so use several comparison tools to find the plan that’s the best deal for you.
(Pro tip: use a throwaway email address from Mailinator and enter a fake phone number to avoid spam. Once you have the quotes you need, you can contact the mutuelle directly to enroll.)