Long Term Health Care

[clairegs]

My husband & I, who are both American citizens, will be moving to France permanently within the next year. I have been reading as much as I can about the French Health Care system and am unclear what benefits, costs are available for Long Term Care. . In the United States these policies are very expensive however I am able to purchase a world wide policy, but the cost of the policies are based on American health care costs and care. We are both in our 50s but now is the time to purchase a policy based on US pricing

I would ask if anyone knows a website or give some first hand knowledge of Long Term Health Care for residents in France and what, if anything, is covered under the French Health Care system. Are there similar top-up policies for long term as there are for mutuelle policies. I am trying to make an informed choice of whether to purchase a policy before we leave as the younger one is the better the rates.

Many thanks and I look forward to any information

[suein56]

clairegs wrote : Are there similar top-up policies for long term as there are for mutuelle policies. I am trying to make an informed choice of whether to purchase a policy before we leave as the younger one is the better the rates.

Hello and welcome ... could you say what you mean by long term health care ?

When I googled it it seems that 8% of people in America buy it against <1% of people in France (perhaps these buyers are US expats ?) but it didn't say what it was.

Sue

[Pommier]

You may do better asking on a forum specifically for Americans https://www.internations.org/france-expats/americans

[Mac]

Providing you live permenantly in France and fulfil all the criteria why don't you just join the french health service? I helped an American lady near me get her paperwork together and she applied and was accepted. She has her carte vital. Check on the Ameli website for details of what you need.

[suein56]

Pommier wrote : You may do better asking on a forum specifically for Americans https://www.internations.org/france-expats/americans

or even here : http://www.expatforum.com/expats/france-expat-forum-expats-living-france/

as there are lots and lots of US expats on there who have retired to France and asked questions and received helpful replies plus have written about their experiences here n France.

Sue

[clairegs]

thank you Sue, I did not know of this site.

[clairegs]

Hello. Thank you for your response. Yes, will definitely join the French health Service as is the plan. the long term health care is similar to assisted living when one can no longer care for one self and needs additional assistance for day to day chores and personal care. It helps cover if one needs to live in an assisted living facility or nursing home. American government medicare/medicaid provide only a small portion of this expense

[idun]

The more I read of this thread the more confused I become.

Unless people are working in France, how do they get onto the french health care system if from the USA. I ask because we had a poster a few years ago from the USA and unless my memory has let me down completely she had to have private full health care and had lived in France for a number of years, and she had to renew her paperwork too.

To the OP, what does your local french embassy say about all this, as I know that you have to see them, be interviewed by them, before such a move.

[lindal1000]

I think with PUMA anyone who is normally resident can apply to join. It isn't free...and if you are a non EU citizen you have to have a decent income. You then pay 8% of your income for healthcare.

From expat website:

However, under PUMA, all the legal permanent residents are entitled to public health insurance, as long as they have lived in France for three consecutive months on a regular and stable basis. This reform has made the eligibility requirements for foreign students, workers and pensioners much easier. Moreover, they will now have the automatic and continuous right to unlimited healthcare access, regardless of their previous medical history, age and contribution towards French social security (cotisations sociales). This applies even to people who have lost their means of employment. Anyone who was covered by the old CMU system will no longer have to put in an annual renewal application, thereby reducing administrative efforts.

Another advantage of PUMA is that it equalizes the rights of EU and non-EU citizens applying for their health insurance card (carte vitale). In the past, the locals and non-EU nationals enjoyed this right while those from the EU had to wait for a period of 5 years before they were eligible for state health insurance; this law was severely criticized as it undermined free movement of EU nationals within the Union.

The good thing is that that the CMU-Complementaire (CMU-C) program will also be in place, to provide free health insurance for the unemployed or people from low income groups. Like the name suggests, it will act as a supplement to PUMA.

The reforms in the policies are most likely to affect those foreign residents who weren’t covered by their employers.

PUMA for foreigners

Any outsider can apply for access to state health insurance under the new program, as long as they meet certain criteria. Expats who have been residing in France for more than 3 consecutive months are eligible if they:

- Have lived in the country for under 5 years

- Don’t have paid employment

- Aren’t receiving pension from a European nation

Non-EU students below the age of 28 and British early retirees are also eligible to apply for this scheme, as long as they aren’t drawing a salary. If the application is approved, the government decides whether the applicant has to contribute towards the Unions de Recouvrement des Cotisations de Sécurité Sociale et d'Allocations Familiales (URSSAF). If the application gets rejected, private health insurance is the only other option.

[idun]

WOW! And I hear how the french health service is broke on the news and they dish out this cadeau, because 8% is just that. I understand that there is supposed to be some sort of equality for EU ressortissants... but why non EU..... Don't get it!

And I am very much aware of the cutbacks, nibbling away at various things including certain medications, increases in the forfeit journalier. Has the health service suddenly won the lottery????

[Chancer]

Have lived in the country for under 5 years.................

 

What if they have lived here for more? Or should it read "over 5 years"?

[andyh4]

Idun wrote:

WOW! And I hear how the french health service is broke on the news and they dish out this cadeau, because 8% is just that. I understand that there is supposed to be some sort of equality for EU ressortissants... but why non EU..... Don't get it!

But surely for a non EU resident to be granted leave to stay for more than 3 months (ie are given a visa), they either have to be registered refugees or to have a significant personal income so that they cannot be a burden on the state. So 8% of that significant income will in itself not be insignificant.

[lindal1000]

Indeed..it isn't a 'cadeau'. In many cases private health insurance may cost less.

Chancer, I think the 5 years in specifically for non EU citizens, although I agree that bit is confusing.

[clairegs]

Thank you so much for your in depth response. This is also as I understand. I have found some more details in my initial query and will do some research on APA qualification.

I am curious if anyone has had experience with retirement homes in France and if it is advisable/available to take an insurance plan that helps with any out of pocket expenses associated with living in an assisted living/retirement home.

I realize my initial query should have been on APA qualification as well as retirement living in France and what is covered and available. It is a very different approach in the United States which I know from experience.

[lindal1000]

I don't know if there are any private insurance schemes for long term care. In France if the person doesn't have the money to pay for the nursing home their children are liable for the cost. I do remember when I went to a meeting at my bank they tried to sell me some sort of policy that sounded like that, on the grounds that we have no children..I said they could sell the house to pay the bill. One of the standard insurance companies such as AXA could probably give you an idea of what they are and what they cover. Homecare for basic care (not nursing) is about 25 euros an hour in rural France. The French healthcare system is essentially a private system that is heavily state regulated. So, a consultation with a GP is 25 euros, In the big cities Doctors can charge more but it will be nothing like you are used to paying in the USA. That said, nursing home care can be expensive.

[clairegs]

Thank you again for your thoughtful response. I will take your suggestion and contact AXA, I had started to gather other French insurance companies as well as we will need to show proof of health insurance for the long term visa application and our current American policy will be cost prohibitive and not applicable when we make our move.

[suein56]

Depending on the kind of residential care you mean there are various establishments in France.

For example the cost of a nursing home - une maison de retraite médicalisée - for a dependent resident is just over 2000€ per month here in Morbihan. This includes room, meals, laundry etc.

This cost is subsidised by the health authorities. If the resident cannot meet all the cost there are various options for defering payment or obtaining assistance from the person's family.

There is more info here :

http://www.pour-les-personnes-agees.gouv.fr/choisir-un-hebergement/choisir-une-maison-de-retraite-ou-une-residence-pour-personnes-agees

http://www.maisons-de-retraite.fr/Bien-choisir-sa-maison-de-retraite/Les-differents-types-d-etablissement/Les-maisons-de-retraite-medicalisees-Ehpad

Sorry you will have to copy and paste the links.

Sue

[idun]

Care homes, in my old region are also from about 2000€ a month. My friend's mother has recently taken up residence in one, that cost a bit more than that. Self financing, and my friend goes in and feeds her every evening because the staff do not have time. This lady also shares a room.

My old neighbour's grandmother used to live with them, the old lady was in her 90's. She ended up in a care home and the children and grandchildren had to participate in the costs, some living abroad and the french authorities did chase these amounts up.

If you are after reasonably priced care homes, then maybe doing as the germans have been doing, sending their old folks to Poland. No I haven't made this up, this is happening.

[mint]

Poland?  Oh, just across the border then?

I read of a case in the UK when a poor old chap was sent to THAILAND because it was so much cheaper!

[Hereford]

My mother was in an EHPAD  run home. Absolutely wonderful care and the staff were amazing. The point about children having to contribute should not be taken lightly. The Social Services are not interested in what their nationality is or where they live! They will and do insist on details of income and assets and if these are not forthcoming from children the "aide" will be refused. Once sorted though it works very well and if need be "they" chase overseas children for the assessed contribution.  (I can attest to this from personal experience - although it was not me that was refusing to co-operate! We ended up having to get a judge to decide who paid what., which then unblocked the aide.)

Another thing to bear in mind is that the good Homes have waiting lists. The APA à domicile scheme works well too, but like all "aide" my recollection is that one has to have been living in France for at least five years.  My mother had this before she went into the Home, but even if one qualifies the money given does not, in our experience, cover the whole cost. You can have the helpers from an agency (who are paid direct) or pay them yourself by Cheque emploi. This latter was better for us as we could choose the helpers. In any case proof of expenditure of the money given must be sent to the Social Services every month.

I have no idea about insurance/mutelle policies for this.

Mrs H.

[clairegs]

Dear Mrs. H. Thank you for your detailed response and very helpful information. I need to read through again and do some research on my own with all the information that has been provided. I may be back to ask you some questions if you do not mind. It is such a different system than the US where so little is provided by the state and one must plan many years ahead to ensure a decent place to live when you are unable to fully care for yourself any longer and the cost is astronomical - more than 3 times the average of 2,000 euro per month.

[Hereford]

Hi

I should have added that any aide given by the Soc. Serv. (i.e. towards board & lodging) once the patient/spouse and child contributions is theoretically repayable - for instance from assets left on the death of the patient. The notaire that deals with the estate will be in touch with Soc. serv. to find out - one does not have the option of refusing!!

It was a steep learning curve for us.

Mrs H