If people are on very small incomes then presumably they can get CMU or if their income is a little higher then they can get help towards a mutuelle called l’ACS. I think the names of these may have changed but here’s a link.
Izzy x
On page 19 of the November edition of “The Connexion” , there is an article on top-up health cover.
The article includes mention of the CSS scheme (which replaced CMU-C and ACS). This provides free complementary health insurance for people on low incomes.
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That is very helpful Jane. I appreciate your time. I am reading and researching all the time I have. It is complicated and I struggle to grasp much of what the experts say even in English! However I use some valuable sources and will look into your link.
Positive is I have a copy of my S1 and will take a look at the carte de séjour form at the end of the week. I will continue to look in on Survive France as I find it really informative.
thanks particularly to Jane and Stella for those explanations.
Our insurance lady who has been great in setting up the policies tried to explain, said most French people don’t follow exactly what their re-emburesements so what chance do we have.
Though she said in her experience Cpam and Mutuelle generally get it about right.
I’ll just have to get used to trusting the refund is accurate, not how it is arrived at!
The knack is to get the max paid . CPAM + Mutuelle… and not leave much for you to pay out once they’v e put their dosh in the kitty…
(I should also have given an example… if Mutuelle pays, let’s say, 400% (for a medical whatsit)… that means Mutuelle pays 4 times what CPAM pays… and that might or might not cover the actual costs…)
If Mutuelle covers “frais réels” = actual costs …yippee
In my experience the refunds are accurate (unless exceptionally something has been entered wrongly). However what is worth keeping track of is how much you spend and on what, so you can get an idea whether your mutuelle cover is right for you.
So in this year you have paid your mutuelle fees, plus an extra 200€. And got 150€ back from the mutuelle… Which means your top up insurance has not actually saved you a bean, but instead cost the fee plus 50€. I would suggest you reflect on this!
I take the opposite view to Stella in that it is important to have hospital cover, as that’s where costs can get astronomical. But for the rest, unless you are in poor health with lots of optical and dental problems and generally visit doctors a lot, then full mutuelles are often not good value for money. Many French people have them paid for by their employer, and so don’t question them much.
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I agree with you Jane, we have never actually had a mutuelle and have just paid ‘the rest’ (until more recently when unfortunately due to a down turn in our circumstances we now have the CSS). My middle boy had his tonsils out with a private dr at the clinique in Perigueux. I paid €70 direct to the dr then I think it was €36 (2x18) for the hospital stay. Four our family (of them 5) we’d have been paying over €150 / month. When the private dr asked if we had a mutuelle and I said no he actually said ‘and quite sensible too - most people pay a lot more to have it than if they just paid’. As it is I go to the dr once a year, kids about the same and hubby twice a year. As a nurse / midwife I tend to be comfortable treating the kids minor illnesses (or will go and get a 2nd opinion from the pharmacist). In 5 years we’ve probably not paid almost €10,000 on mutuelles - that would cover a lot of hopsital stay imho.
I think my ideas will change as we get older and perhaps more likely to need more medical care. I’m also not at all criticising those that do have them but as Jane said have a really long, hard look at what you actually get for your money and if it is really worth it!
Friends tell me that if you say you don’t have a mutuelle sometime private specialists are happy to drop their fees a bit when they know it is coming from your own pocket…
Interesting thread.
Each person has their own ideas and their own experiences… on health situations…
Me, I have witnessed many stories with unhappy endings… but there is always the other side of the coin… there are folk who have never needed cover… fair enough.
However, please don’t assume one has to have top-flight Mutuelle… there are many grades to choose from… not expensive… just don’t dismiss the idea out of hand, would be my advice.
and if someone chooses to fly without a parachute… I wish them happy landings on a thick feather mattress…
Now I’m stepping back from this saga…
I have no compunction about paying for a mutuelle from our pension income. Perhaps we are fortunate in that neither of us smokes or drinks alcohol and you can’t take it with you when you fall off your perch 
We also pay car and house insurance; the car hasn’t been stolen, written off or involved in an accident and the house hasn’t burn down - but that is the nature of insurance, surely. Self insuring can be a risky business…
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I would just like to add that I’m coming from a very different perspective from you from the UK where you are so used to a NHS that pays everything for you. In Australia the health system is a bit of a nightmare and even for those using the regular health system (as opposed to going private and having private health cover - which makes France’s look insanely cheap). My mums generation wouldn’t have ever considered not having it - the vast majority of families, even ones earning well, can’t afford it now and of course there is a growing gap 
. Dentistry is horrific - a root canal started from $4000 - we paid cash to have dh’s mouth sorted here and I think it was €550 cash for the root canal and a crown. Most meds you pay for - or at least a good whack - and not at French prices either! Even at my doctor I had to pay $35 on top every visit. I guess what I’m saying is that for me I find the cost of health care / drugs etc so cheap here compared to Oz (where I was used to paying it) that I don’t mind paying the small top up. I probably will look into getting at least hospital cover as as far as I can see that would be about the only thing that could be an issue (but then 2 nights in the lovely Clinique in Perigueux for €36 - that is one weeks mutuelle!). Again there is I think also the age issue for us!
I’m not suggesting that, merely choosing the best value and most appropriate parachute for your particular circumstances. For me the hospital only policies make sense. A 150% mutuelle rarely seems to provide value, and we can’t afford a 300% one. So 300% for hospital alone at a small cost is out choice.
How many people do actually calculate what the benefit of their mutuelle cover has been at the end of each year?
And you are legally required to insure your car… as for house insurance that’s a whole ‘nother can of worms.
never as easy as that Jane… hindsight is a wonderful thing, isn’t it.
Not getting car insurance, not having an accident or some other uninsured nutter write it off and not having a contrôle by the Gendarmes during a year means I wasted my money?
I leave actuarial risk to the actuaries… but there again, my FIL was a marine broker and a member of Lloyds…
No, as I said car insurance is mandatory so not an option. I was referring only to health cover.
And yes the actuarial risk for a mutuelle is carefully calculated by actuaries to make sure the firm remains in profit. And it is something that an individual can make a personal judgement about based on their own health, financial circumstances and need for certainty. You are happy with your choice, which is good. I am not happy to pay out 2,500€ a year and get on average 300€ back. So prefer to pay out 600€ for a mutuelle, 300€ on direct costs and (hopefully) get nothing back.
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“my FIL” .???
Father in Law
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An illuminating thread…it underlines there is more to be considered than just signing up for a Mutuelle. I’ve surprised at the “net” cost in first year.
About €1950 for mutuelle and we’ve probably paid out net (cost less total re-embursements ) about €350 so total medical about €2,300 at minimum. I naively thought mutuelle repaid all out of pocket payments!
Wife and I do need regular doctor visits and drugs, (blood pressure, type 2 diabetes) but no for serious underlying problems and I had simple day op’.
But the net cost of health care is significantly more than expected, balanced against excellent care …rang docs 09.00 yesterday and went to see him 17.40 in the afternoon.
Before renewal in Jan 2021 I need to decide what level of cover is sensible balanced against possible cost if we had a big issue, need to understand how much we would pay if a serious problem arose…aka heart attack, stroke or cancer. Information please!
But on upside our income tax and “Council tax” is significantly less than UK. 
We have a comprehensive mutuelle for the four of us, costs a fortune but my business pays it. If it were down to me I would have just hospital cover (as had already been mentioned and what I used to have when I was footing the bill). The figures just don’t add up but other half being French, she can’t believe anybody would not have a mutuellle and all the other millions of insurance policies that we have for all sorts of eventualities, especially with the kids. It’s just different here, why do you think there are so many insurance offices in every town and even in large villages!
My specialist in Macon is a very strong critic of the Mutuelle system, as there are far too many and they provide jobs for the boys.
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You can do not better than address this question to @fabien who, I am sure, will give you a fair and balanced assessment suited to your needs…
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