Medical Care in France after B-Day

We lived and worked in France for 13 really happy years [ we are both British, but I have Irish Nationality too.
We returned to the UK 5 years ago, which was always going to be a short term thing, as our hearts are still in France!! We planned to semi retire there by 2019.
Brexit has thrown a spanner in the works!!

We now need to make a decision about a date to return, and because of work and other commitments we would prefer to return in 2020.

By then we would not be able to take advantage of the UK system of a S1 type arrangement, to cover Health Care in France.

Although I could live there with my husband as an Irish citizen, I have never contributed to the Tax system of Ireland so there is no way I could expect my Health Care to be covered by the Irish Health Care system.

Has anyone any ideas about how to have French Health cover in these circumstances?
I did know some Australians a few years back who paid a fee and had French Health Cover-do you know if this could work?

Thank you if you have any bright ideas!!!

Puma-That replaced CPAM is open to one living in France in a legal stable manner. Have an American friend who got her carte vital about 2 years ago with no problems. She had to have her carte de sejour-lots of hops to jump through but uou won’ need thst if you have an Irish passport. Yes you have to pay your cotisations if you have no S1-but unless you have a very high income it must be cheaper than private health insurance.

Dear Sue,
That’s really kind of you to have made a response.
Thank you, and I’ll look into the level of contributions we would need to pay.

Kind regards,


S1 after brexit? Been no mention of the S1 only mention of continuing with the EHC type cover, that’s not been agreed either. No one has any idea of what will happen after the UK leaves. At the moment its just all pure speculation.

Hi Jacqueline,
I believe that the contributions payable under PUMa are 8% of your joint annual income in excess of €9655. (No doubt someone will correct me if there’s been a recent change.)
So if the joint annual income is €25,000 then the contributions work out to €102.30 per month which covers both members of the couple. The bills are usually sent out every 3 or 4 months.

Dear Trevor,
Thank you so much for that information. Just to be clear, we would pay this + pay into a Mutuelle as well?
I really appreciate that you took the time to reply.

Kind regards.

Dear Roger,
I apologise for calling you Trevor!!
There was a reply from a Trevor too !!

This is how it was calculated under CMU but PUMa assesses each individual separately.

The official explanation is:
(my bold)

"1. Assiette de la cotisation
La cotisation subsidiaire maladie est notamment assise sur les revenus fonciers, de capitaux
mobiliers, des plus-values de cession à titre onéreux de biens ou de droits de toute nature,
les bénéfices industriels et commerciaux non professionnels et les bénéfices des professions
non commerciales non professionnels, retenus pour le calcul du revenu fiscal de référence
selon les modalités fixées au IV de l’article 1417 du code général des impôts. Le tableau
annexé en précise les composantes (annexe 2).
En cas de déclaration commune au sein d’un même foyer fiscal, l’assiette retenue est la part
de revenus qui peut être attribuée à chaque membre du couple. Lorsque les revenus des
époux ou partenaires de pacte civil de solidarité ne sont pas individualisés dans l’avis
d’imposition, la part de revenus de chaque redevable est égale à la moitié des revenus.
Toutefois, si le redevable est titulaire d’une part supérieure ou inférieure à 50 % des revenus,
il peut fournir aux organismes de recouvrement tout élément probant permettant de
déterminer la part exacte des revenus qui lui revient (cf. III. 2).
Pour la détermination de l’assiette, ces revenus sont abattus d’un montant égal à 25% du
PASS, soit 9 654 € au titre de 2016, conformément à l’article D. 380-1 du code de la sécurité
sociale. Dans le cas d’un foyer composé de deux redevables de la cotisation, cet abattement
est appliqué à chacune des parts de revenu attribué à chacun des membres du couple. "

So instead of one allowance and one payment per couple, you get two allowances and make two payments. I haven’t done the sums, logically this should work out at the exact same figure, but calculated differently.

Do you know anyone who has been billed for accessing healthcare through PUMA? Are you sure they are billed every three or four months?

Hello Anna,
Fantastic-thank you so much.

We had a bill for our first year in the French system-the year before it changed from CPAM to PUMA. Nothing since then I think that’s 2/3 years with no demand for payment. Hope they don’t want it all in one go!!

1 Like

Over the past few years there have been quite a few changes to various systems in France, stuff like RSI payments, RSA and child allowance, all of it has been a monumental mess. Overpayment underpayment, no payments whatsoever to some people. If you have underpaid they will eventually catch up with you, as they will if you have been overpaid. Their usual argument is that you should have known you were overpaid or underpaying and put the money to one side.
Completely opposite to the UK, the French social security system pays you out before you update your info just in case you need the cash. Overpaid hundreds of millions of euro’s and is now trying to get it all back.
I personally think everyone who didn’t have the right to vote in the referendum, should be apologised to and given a million quid tax free in compensation for all out grief.

Presumably you were sent your avis for 2015 cotisations at the end of 2015 and paid them in 2016.

If you’re due to pay anything for 2016, you’ll be receiving the avis soon. Payment for year N is now calculated on your income tax return for year N, which you submit in year N+1, therefore the avis for year N is issued at the end of year N+1. Hence why no avis were sent out at the end of 2016 - because 2015 had already been paid, and cotisations for 2016 aren’t due until the end of 2017. Likewise your cotisations for 2017 won’t be assessed until around this time next year.
If that makes sense.
Don’t worry Trevor, yes the system has changed but there is a plan.

I know there is a plan, and I know when systems are changed things don’t always go to plan, but what I don’t understand is why they never ever seem to go to plan.

That’s what I thought. Quite different from the situation suggested by Robert Hodge.

I don’t know about “never”, personally touch wood I haven’t had a single problem, but at the same time I’m surprised by your comment that

because that’s been very far from my experience. I’ve always had to provide full information and wait for everything to be validated and my rights to be confirmed, before I’ve received anything.

Trevor, this has all been discussed and agreed. The only spanner in the works could be if the UK crashes out and everything that’s been negotiated so far is chucked out of the window.

Persons whose competent state is the
UK and are in the EU27 on exit day (and
vice versa) - whether on a temporary
stay or resident - continue to be eligible
for healthcare reimbursement,
including under the EHIC scheme, as
long as that stay or residence position
The withdrawal agreement also covers
entitlement to healthcare
reimbursement under the SI scheme
that arises by virtue of past residence or
work, in accordance with the personal
scope ofthe agreement in relation to
social security rights.

Thanks for the update Anna. I must say that I find it amazing how you manage to access such interdepartmental government notices with such apparent ease. You must have a direct line to the Elysee Palace.

It would seem that the base for the calculation of PUMa contributions has changed in one important way. I’ve looked at the text you suplied and my best efforts of translation are as follows :
Subsidiary health insurance contributions are based in particular on income from land, movable capital, capital gains on the sale of goods or rights of any kind, industrial and commercial nonprofessional profits and profits of nonprofessional non-commercial professions, used for the calculation of the reference tax income in accordance with the procedure laid down in Article IV of Article 1417 of the General Tax Code.
What is remarkable is not so much what it does say but what it doesn’t, as there is no mention of pension income.
Therefore it would seem that only income from land, shares, investments, capital gains, and income from non-professional profits (whatever they may be — royalties perhaps ?) are taken into account to calculate the contributions. Add to that the fact that each person in a couple is now given the personal allowance of 25% of the PASS (€9,654) to offset against the above income before the 8% rate is applied to the remainder, and it would seem that the contributions for PUMa are substantially less than those for the old CMU system.

When one considers this reduction, together with the reductions for Taxe d’Habitation which are about to come into force, it really does make me wonder as to where the government will find the money to actually run the country. Perhaps it is those who have employment income who will end up bearing the burden.
Whilst a reduction in bills is always welcome, we are actually starting to feel a bit guilty about benefitting in such ways, so we’ll have to review supporting local health charities a bit more I reckon.

I haven’t received my bill from URSSAF yet, but then I haven’t had the Avis d’Imposition for our income tax either, and no doubt it is the detail on the latter which URSSAF uses in their calculations.
With the inception of the new computerised online tax return system it seems to be taking an absolute age to have anything sorted out this year, especially when two different bi-lateral tax agreements have to be taken into account for the same declaration. The online system seems to have been designed only for the less complicated categories of tax return.

That’s correct, there are no cotisations on pension income, though I’m not sure exactly what types of pension income are included. I have a feeling that early retirement “pensions” don’t count but could be wrong on that. ‘Non-professional’ earnings would notably be rental income eg gites, chambres d’hôtes etc. Most benefits are also excluded.

Yes but don’t forget that for a couple, both partners now pay cotisations separately, whereas I think previously a couple was only charged one set of cotisations?

Presumably you did already receive something and you queried it? Cos all the avis d’imposition should have been received well before now. If you literally haven’t received anything I think you need to find out why not.

I don’t think you need feel guilty! France is aware that it’s one of the, if not the, most highly taxed countries in the EU, and Macron is trying to reduce the burden across the board; there are also plans to reduce the burdens on workers next year. The objective is to try and treat everyone fairly and make France a nice place for everyone to live, it doesn’t always get it right but if you think it’s succeeding, I’m sure Macron will be very chuffed.

All ifs buts and maybes for the moment, but due to the financial aspects of brexit I for one expect the UK government to cave in and agree to absolutely everything.