Free healthcare?

Health Care & Carte Vitale
1

This from yesterday’s Connexion:

“Today, some foreign nationals can live in France, access public healthcare without any contribution, and in some cases without paying any tax. Certain agencies, especially in the United States, even promote France as a destination for retirees by promising free access to the French health system.”

Please, someone agree with me, this is a nonsense - a) the fact that it is possible and b) my highlighted bit is completely out of order…no wonder there is such a high number of US people arriving.

It is well known that the US is a dangerous place to be if one needs healthcare insomuch the first thing that is demanded of foreigners is a credit card.

And of course it is well know how discriminatory their general system is to the ‘unwashed’ - but this is another subject..

How dare they - these agencies - promote this idea that health cover is free here. I find this particularly repugnant in our current state of trying to find money for anywhere possible for the budget.

I find it extremely odd as well, that only now is someone in the French parliament waking up to this situation:

“This measure addresses a real anomaly,” said François Gernigon, an MP from the centrist Horizons party, who tabled the amendment along with Horizons colleague Nathalie Colin-Oesterlé.

The amendment was adopted by 176 votes to 79.

It might appear surprising that the amendment did not have a 100% support, until this:

Left-wing parties voted overwhelmingly against it, calling it discriminatory and politically motivated.

I do not know far The Connexion checks for fake news, but I would be very happy to hear that this is indeed an Ai intervention.

-And we are surprised that the Right are gaining popularity! Of course they are with such nonsense going on…!

Marine is getting more of my attention as time goes on.

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Delving further into the subject - this is interesting:

When applying for the visa applicants must prove they have medical insurance for the first year covering expenses up to at least €30,000.

After three months of living in France, holders can apply for a social security number and subsequently a carte Vitale, coming under the coverage of France’s state healthcare system.

This includes the same coverage as any other carte Vitale holder, such as 70% of many doctors’ appointment fees.

Many holders then choose to cancel their original health insurance in place of a less expensive top-up mutuelle to ensure they are fully covered.

At least though, better off immigrants from outside the EU do pay their way:

Well-off Americans (and anyone else who does not have social security rights via work, a French pension or an S1 form) are already required to pay a ‘Puma tax’ (official name Cotisation subsidiaire maladie) if they have income above a certain level.

This includes, for example, income from rent, shares, bank accounts and other investment schemes or capital gains from the sale of property.

There is an allowance of €23,550, after which the fee is charged at 6.5% to a certain ceiling. This means it is possible for wealthy individuals to pay up to €24,492 per year to be part of the French health system.

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International treaties are generally very difficult to unpick. And this results from the France:USA double tax treaty. It means that in calculating the cotisation subsidiaire maladie certain US income streams are excluded, and these are ones that many of the US retirees coming here rely on.

As far as I recall the same applies to British people arriving post Brexit with British pensions. If one’s unearned income exceeds a threshold excluding pensions then you pay the CSM too.

The right wing are blowing hot air as they would be as incapable of unpicking this as anyone else.

And I am surprised you are not aware of this. Most third country national immigrants are, if they have done basic groundwork about requirements moving here.

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I think if you’re drawing a pension, you’re exempt from the CSM/PUMA tax, wherever you hail from:

image
image750×1334 141 KB

https://www.urssaf.fr/accueil/particulier/beneficiaire-puma.html

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If it’s true, then you can see what would happen with the ‘influencer effect’. Plenty of things this happens to get shut down due to people piling in. My colleagues on another forum then say “This is why we can’t have nice things” . :slight_smile:

If it’s true and there’s a treaty this might be hard to unpick or revise as Jjones says. And other third oarty nationals (guess who!) could also become subject to any measures taken.

The other thing to wonder about with all news that represents a particular point of view or turns people or categories of people against each another is “Who is pushing this?” and “Why are they doing that now”?

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Mmmm helenochka but I do recall kind people on the “How to fill out your application for…was it to register on CPAM ?” threads here on SF have urged people applying not to tick the Retraité (ie retired) box as their status. Even if they are retired and on a pensìon.

Because if you do, the system won’t work. As if you tell it you’re retired it will then look for you in French government records of retired people, not find you, and stop.

So the definition of existing words and how they are interpreted might come under review. Was certainly done for me in one area by CPAM mid-covid. LIke the nationality applications and the circular from M. Retailleau, an application I made to CPAM was not given a reply until it could be refused that year based on new guidance they knew was coming. (They agreed that was what had happened when they accepted me with exactly the same application circumstances, the following year.)

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There is a similar discussion underway of this issue on the French budget thread, for completeness

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Yes, that rings a bell. For the initial application procedure.

When it comes to billing, though, once you’re in PUMA, I understand the tax office / DGFiP forwards your August tax assessment to Urssaf and then Urssaf decides how much to bill you in November. If you’ve declared a pension in your tax return, there should be no PUMA tax to pay in November.

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Perhaps for PUMA then they’ll change that practice as to which pensions are eligible then, if they feel they need to, via a reinterpretation.

(My case wasn’t PUMA).

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Yes, wouldn’t surprise me if they did.

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If they do, others whose rights don’t stem from the EU, broadly speaking a lot of non-EU nationals, are likely to get caught up in it.

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Indeed. A few months into the application process, I was kicking myself for not giving my husband’s nationality as British and simply attaching a copy of his carte spéciale. Because I’d put him down as Irish, and not mentioned the carte spéciale (which was issued when he was British only) we had to produce a ton of paperwork to show he was in the country in a lawful and stable manner.

But am glad I did it this way now.

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I’m pretty sure that’s only for those of state pension age, with an S1. That’s part of the complication for early retirees and as @KarenLot says, the French system gets confused if we call ourselves retired.

For we early retirees, pensions are subject to tax and social charges except where the occupational pension is a government one.

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I had sort of assumed that when Urssaf lists being in receipt of a “pension de retraite” as grounds for exemption (from the CSM) they meant a state pension.

Husband will be eligible for a very small French pension in a couple of years and I was thinking it would be worth claiming it just for the exemption. If we’re still here!

Are people with S1s part of PUMA? I thought they were covered by their home country with the insurance administered by the local CPAM, not URSSAF.

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American here. I expect to be paying CSM this year, but it is true that many Americans, and not just American retirees haven’t paid for CSM up to now.

The US-France tax treaty , which went into effect in the 90s, effectively exempts all retirement income from French tax. PUMa came along in 2016, I think, and failed to account for this phenomenon. So, for US retirees CSM is only calculated on non-retirement income that exceeds something like 23k euros/year. Last year , I sold my house and the interest generated in money market exceeded that figure. I expect that even without the new amendment, which is sorely needed, I would continue to pay CSM because of the way US IRA and 401k accounts are structured. The USG will soon force me to liquidate my IRA accounts and then when these investments become non-retirement, the interest/dividends would be subject to increasing CSM charges.

It is certainly true that the poorer Americans relying solely on retirement funds to live in France, might not get charged CSM without some sort of compensating mechanism. It is possible for a couple to live on US Social Security here, though it would not be a very comfortable existence. It is sad that there apparently are firms directing people here and profiting from this mistake in PUMa.

It isn’t exactly true that US retirees are getting a free ride., though some are in France. We are paying for benefits in the US that we will never use. I paid $53k in medicare taxes since 1970- that sum may be worth close to $100k now that I will never use and is available to some other American retiree. I wish there was a way to transfer it for the use of the French health system, but there isn’t. But I am happy to pay to support the system here, as long as it reflects French rates of healthcare.

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Out of interest, Nunthewiser, are Americans in receipt of social security (ie a US “state pension”) liable to the CSM? I’m thinking they’re not, because of the exemption that URSSAF grants to anyone in receipt of a “pension de retraite” regardless of what other “revenus passifs” they might have.

Reading the info on Urssaf’s site, it looks like it’s possible to qualify for an exemption on the ground that one is drawing a (presumably state) pension. And still have lots of other passive income, which then escapes the PUMA tax.

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Not to my knowledge. Wouldn’t that be interpreted as a French state pension?

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I don’t know. There’s nothing on the URSSAF site to indicate it has to be a French state pension for someone to qualify for the exemption.

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It seems URSSAF provided some clarification a few years ago. John is correct.

Re: Are capital gains tax exempt in France for a US Citizen?

“Post Tue Dec 06, 2022 2:14 pm

You are right, I had not noticed they lopped off the additional subparagraphs 24.1.b.ii, 24.1.b.iii, 24.1.b.iv and 24.1.b.v

On the issue of CSM, you’ve hit upon a bit of a controversy. The French code is very broad in the exemption of the retired. However, the URSSAF, the department chartered with assessing the CSM, has issued the following declaration as it applied to pension received by non-EU/EEA residents not in possession of an S-1:
https://www.urssaf.fr/portail/home/espa … ement.html

La cotisation subsidiaire maladie est-elle due par les personnes bénéficiant d’une pension de retraite étrangère ?
Si elles n’exercent pas d’activité professionnelle complémentaire en France, la cotisation subsidiaire maladie n’est pas due par les personnes résidant de manière stable et régulière en France et percevant une pension de retraite d’un État relevant de l’Union européenne ou de la Suisse.

Pour les pensions de retraite servies par un État hors Union européenne ou la Suisse, la perception de cette pension permettra d’exonérer la personne uniquement si la prise en charge de ses frais de santé, ainsi que ceux des membres de sa famille qui résident avec elles, est supportée définitivement par le régime étranger qui sert la pension de retraite.

Pour justifier que la prise en charge de ses frais de santé et de ceux des membres de sa famille sont supportés par le régime étranger, le titulaire de la pension de retraite adresse à l’Urssaf le formulaire prévu dans le cadre de la convention bilatérale de Sécurité sociale conclue entre la France et l’autre pays (formulaires similaires au formulaire S1 prévu par le règlement CE n° 883/2004).

La cotisation subsidiaire maladie est-elle due par les personnes bénéficiant d’une pension de retraite étrangère ?

This is a bit controversial as people rightly note it is not in alignment with the broad language in the French code.

In practice, some people (non EU/EEA) have still received exonerations (those of age, and receiving social security). Others who are pre-retirement age but not economically active have received their CSM bills.”

Here’s the whole conversation. I confess I lost the will to live after page 1.

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Granted, but not impossible when there is an obvious need.

Exactly - and it applies to everyone if I remember - ie no loop holes. (sad, yes, but this is what they voted for)

Great on them then - at least someone is aware that France needs to find every cent that has fallen behind the cushions. I am happy to tell Marine how to do it. It really could be simple.

I have no need to be aware. My ‘basic groundwork’ was to look at the requirements that clearly showed that I was entitled to an S1 for which the UK Govt physically paid France my contribution. Why would I need to be aware of anything beyond this?