Patient Health Charges
5th Jan 2024
What are the health charges in France payable by patients?
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Patient Health Charges
5th Jan 2024
What are the health charges in France payable by patients? UPDATED 25th Jan 2024.
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Although the health system France has a podium place as one of the best in the world, as a general rule it is not free at the point of delivery. With minor exceptions, certain major illnesses are fully reimbursable and low-income households are also entitled to 100% cover.
For everyone else, the social security system picks up most of the costs, but a complementary (and voluntary) insurance system runs alongside it.
Those who do not take out a complementary policy (mutuelle/complémentaire santé) pay the remaining charges from their pocket.
Nevertheless, not all charges are covered by mutuelles; it depends on the extent of the cover, and some charges are specifically excluded.
Whether these complementary policies are always good value for money is questionable, an issue we will cover in a future article.
So what are the charges not covered by the social security system?
Ticket Modérateur
This charge is not reimbursed by the state system, which remains the responsibility of the insured.
The amount of the charge varies according to:
- The type of procedure or treatment (care, medication, equipment, etc.);
- The nature of the risk (illness, maternity, work-related accident, etc.);
- Whether or not the patient was referred for treatment by their general practitioner (GP).
A standard consultation with a GP costs €26.50. If it is your GP (médecin traitant), the social security system (CPAM) will reimburse 70% (€18.55) minus a flat-rate contribution of €1 (€2 from Feb 2024) (see below) i.e. a reimbursement of €17.55. Patients are responsible for the charge of €7.95. That is a total out-of-pocket cost of €8.95.
Complementary health insurance can cover all or part of the amount of the charge depending on the policy.
However, the charge may be higher, especially if the patient does not have a GP, or they make an appointment directly with a consultant without being referred by their GP. In such cases the level of reimbursement by the state is only 30%.
Participation Forfaitaire
This is a flat-rate patient contribution of €1 (€2 from 1st June 2024) for all consultations or procedures performed by a doctor or for laboratory tests and x-rays. Under 18s do not pay it.
The charge does not apply for a consultation with a dentist, physiotherapist, or home nurse. Hospital interventions are similarly excluded.
The flat-rate contribution is automatically deducted from your reimbursements and it is not reimbursable through a complementary insurance policy.
The total contribution is capped at €50 per year per person.
Franchise Médicale
This is the amount deducted from the reimbursements made by the social security system for prescription medicines, paramedical procedures (physiotherapist, nurse, etc.) and medical transport (ambulance). Under 18s are exempt.
The amount of the deductible is:
- €0.50 per medicine;(€1 from 1st March 2024.)
- €0.50 per paramedical procedure; €1 from 1st March 2024.(up to a maximum of €2/day);
- €2 for medical transport (up to €4/day). ( €2 from 1st March 2024.)
The amount deductible is capped at €50 per year and per person, for all the acts.
Forfait Patient Urgences (FPU)
The FPU is payable for non-admitted, unscheduled emergency care in a hospital.
The charge is €19.61.
The FPU is fully reimbursable by a complementary health insurance policy.
In certain situations, you may benefit from a reduced amount of €8.49, particularly for those with a long-term illness. There are also other exemptions (see our guide below).
Forfait Hospitalier
This charge is payable for hospital stays of more than 24 hours. It is a contribution to the costs of accommodation and maintenance.
The charge is €20, payable only once.
Once again, certain exemptions apply.
The charge may be covered by complementary health insurance, depending on the contract.
Dépassements d’honoraires
Although the government sets official tariffs that can be charged by consultants, they can be exceeded. Such excess charges, called dépassements d’honoraires, are not reimbursed by the social security system. Once again, these costs may be reimbursed by a 'top-up' health insurer, depending on the terms of the policy.
The excess charge is not substantial for routine consultations – expect to pay between €10 and €30 over the official rate. The official rates vary, but average between €50 and €60. However, beyond a routine consultation, the charges for subsequent treatment can become a lot higher than the official rate.
Some consultants operate completely outside of the official charging system and are free to set their own charges.
Doctors and specialists are required by law to display their charges and charging policy.