Thursday 20 December 2012

Getting healthcare in France

This is a riveting entry and unless you are very interested in what we are up to (ie our mothers) I would not bother to read it :)

At the moment we are covered until the end of 2013 because the UK is paying France for our cover, but we have started thinking about what we will do at the end of that time. I may have mentioned it before - French health care is not quite like the NHS where everyone is entitled to access. You have to pay in to the system via a tax similar to NI, if you don't make the correct contributions you are not covered and you need private health care. Not everything results in you making the correct contributions, for example income from rental property in the UK or from shares does not count. Each profession pays their NI like contributions to a professional body who administers healthcare and some other things for that profession, these are called mutuelles - so for example farmers pay NI to the MSA (Mutualité Sociale Agricole).

We have had a number of thoughts on how we might get cover
Private health care - this is likely to be prohibitively expensive given our rather small income.
Registering as farmers and joining the MSA - we had high hopes for this one, but after extensive investigation it seems it is not possible. The theory was that we would start some kind of farming activity (breeding pigs, breeding sheep etc) and we could register with the MSA and pay the relevant tax to them. We weren't thinking we would make much money out of it or that we would set up anything big, but we thought it could get us cover for doing something we would enjoy doing anyway that made a little money. However after extensive investigation and talking to a lot of different people with different opinions it seems that you have to have more land that we do to register fully with them. As far as we can understand if we started a farming activity we would have to pay ridiculous amounts of tax to the MSA, but because we don't have sufficient land we would not be covered for health care as we wouldn't be 'full members'.
Starting a company as an Auto Entrepreneur - This option is a bit complex. There are various structures in France under which you can start a company. This one was introduces only a few years ago to simplify the paperwork as well as limit the tax a company has to pay before it is really up and running in an attempt to make France more entrepreneurial. It is only for sole traders and with limited turnover. The current government doesn't like this structure (if you are REALLY interested which I am sure you are not you can read about it here or here truly it is riveting stuff) so it may not still be available in 2014. There is the other minor detail of what the company would do. Knitting? Wooden walking sticks? Ski rental apartment? Computor programmer?
Paying in to the CMU - Once you have been resident in France for 5 years you qualify to pay in to a thing called the CMU. You essentially pay 8% of your net income above a threshold (net of what I am not sure) and you are covered for health care. You pay other taxes on top of that of course - this is France after all. This would be a good option for us apart from the minor detail of having to be resident for 5 years before qualifying. The 5 year rule was introduced in 2007 to much uproar from foreign residents. The EU have now accused France of contravening EU laws around free movement of citizens and there is a case going through the courts at the moment. Perhaps this will have been sorted out by the end of next year. Although I doubt it despite the many years it has been running already.
Failing the success of the court case we could perhaps pay for private care for 3 and a half (or possibly 4 as a lot of things only count full years and that is possibly the case for the residency) years and then take this option or get a job for a few years that would cover us until we qualified.
Get a job in France - For example if we could qualify as ski instructors this would cover us or failing that we could do something with less difficult qualification criteria (work in a bar!!)

On top of the above health care you also need to pay for something called top-up insurance because the state health care only covers something like 70% of your costs. It all seems very complicated (and expensive) but the healthcare system is held to be one of the best in the world and our interactions with it so far (visit to A&E and a visit to the doctor to get certificates for ski insurance) have been very efficient and good.

2 comments:

  1. Unfortunately, I have nothing to contribute to the discussion about the healthcare plans, but we have had some experience with the french healthcare in the past, when Lawrence broke his arm skiing (going down a very easy blue slope, on a crazy speed, and crashing into me, after I suddenly turned into his path after seeing some puff snow). Hospital was very good, it was properly staffed, so I could always someone to ask questions, and they even had a little room full of books, which was useful when I was waiting for the end of the operation.

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    1. Skiing is very dangerous! I hope Lawrence recovered ok!

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