Is top-up health insurance really necessary?

[Blossom]

My partner and I (early 50s) are looking at the different levels of top-up health insurance cover from various companies.  We are happy to pay for the occasional visit to our doctor and  to cover our own optical and dental costs.  We are also happy to use state hospitals should the need arise.

We have noticed that the top-up premiums range from around 400 euros for 'hospitalisation' only cover to around 2000 euros for a more comprehensive policy.

Our question is: as we have a Carte Vitale and are in reasonably good health, is complementary health cover really necessary?

[NormanH]

"State" hopitals will still charge for the part not covered by the Assurance Maladie. There isn't the same distiction between "cliniques"  which are privately run, but where the payments are made from the 'Sécu' and the Hospital Publique as there is in the UK.

Both are state-funded.

Can you afford to pay 20% of a major operation, not to mention all the ancillary charges ?

I pay 800 euros a year for a mutuelle which covers me for everything 'normal' except for certain expenses in the dental and optical field.

You can never be certain to remain in good health, either.

My advice would be to pay for the peace of mind, and the fact that at an awful moment you wouldn't have to be bothered about being able to pay.

[Clair]

This was discussed fairly recently here:

http://www.completefrance.com/cs/forums/3/1179568/ShowPost.aspx#1179568

[Weedon]

Like all insurance premiums, they are a complete waste of money.  That is, except when you need to make a claim, then they are worth every penny.  If only you could guarantee never to become ill you might be able to save yourself a bit of money.

[NormanH]

In the thread to which Claire refers there seems to be a belief that the patient doesn't have to pay the 20% of  treatment for things that are life-threatening.

This is not my understanding.

Certainly if you already covered at 100% for an ALD, or in some other specific circumstances

Le montant du ticket modérateur varie en fonction de votre situation, notamment selon :

• la nature du risque (maladie, maternité, accident du travail, etc.) ;
• l'acte ou le traitement ;
• si vous souffrez d'une affection de longue durée exonérante ;
• si vous relevez du régime d'Alsace-Moselle ;
• le respect ou non du parcours de soins coordonnés ;
• si vous percevez une pension d'invalidité

 you don't pay the 20%, but I believe that if you have fairly standard  surgery you would.

Logan had a particular experience with ab operation from which I think a dangerous assumption is being drawn.

[mint]

Of course we all have different priorities and we choose to spend our money on what we think is most important.

In the case of top-up insurance, I thought long and hard about it and, in the end, decided that, in an ideal world, I'd be able to afford to pay it all my life and never have to claim off it for any major health problems.

[Blossom]

Thanks to everyone for your replies. (I have also read the thread that Clair kindly pointed out – apologies for not spotting it!).  What I found most frustrating while reading the discussion, was that no one gave any real figures on how much any particular hospital operation cost or a definitive list of what is classed as a life threatening condition.

While it is certainly true that it is better to err on the side of caution, without the appropriate information it is difficult to assess any risk.  For example, if a major operation and all the ancillary charges came to 10,000 euros, 20%  would still only be just over two years of NormanH’s premium.  

I realise that medical conditions are not always cut and dried, but does anyone know of a website that outlines French hospital costs?

[NormanH]

There is a list of ALD conditions which are covered at 100% on this thread:

http://www.completefrance.com/cs/forums/1180182/ShowPost.aspx

A few other points to consider are:

The Sarkozy government is trying to save money on health care, in making people behave more "responsibly".  That is to pay more and more of the costs themselves.

Recently the idea that all optical care should be paid by the Mutuelles ( or the patient if you don't have one) was floated by Rosalyne Bachelot (the Minister)

"la ministre de la santé, Roselyne Bachelot, n'a pas écarté, dimanche,

l'éventualité que l'Etat se désengage dans certains secteurs de la

Sécurité sociale, comme l'optique, au profit des assurances

complémentaires. La ministre de la santé, Roselyne Bachelot, n'a pas

écarté, dimanche 13 avril, la possibilité que la Sécurité sociale se

désengage complètement de certains secteurs, notamment l'optique, au

profit des assurances complémentaires, provoquant l'incompréhension des

responsables de la Mutualité française et la colère de l'opposition,

qui dénonce "une privatisation annoncée" du système de santé."

( From 'le Monde 14th April)

( The Health Minister didn't rule out the possibility when she spoke on Sunday that the State would pull out of certain sectors of Health Cover, such as Optical care, leaving them to be paid for by 'Top-up' Insurance.

This made those responsible for the Mutuelles claim that they didn't understand what she was talking about, and the opposition denounced a 'privatisation' of the Health Service...) My very free translation

It might be assumed that this won't be the last such initiative

If you read French easily there is much to learn here

Secondly there is also a move afoot to re-examine the 100% cover.

Nor can it be assumed that the CMU as it exists will remain untouched. It has only been in place since 2000 and was the brainchild of a Socialist government (the same one that brought in the 35 hour week)

Given this general drift towards having to pay more towards Health Care I am happy to have Mutuelle which enables me to pay monthly rather than in a large sum just when I am least able to pay.

As a last point, don't just assume one health problem.

My payments top up several things at the same time: last year I broke my ankle, had to have a number of fillings in my teeth, an eye test, and 3 Xrays.

None of these are 'life-threatening', but the costs mount up.

[Blossom]

I am very grateful for the additional information, NormanH (the excellent ALD list will be very useful).

On your first point, as I said at the outset, we are happy to cover our dental and optical costs as we do not think that Mutuelles offer value for money here.

Your second point is well made. However, we have to make our decision based on things as they exist now. If at some time in the future reforms are made to the CMU and 100% cover then we may have to revise our thinking.

Your last example is interesting because it coincides with the starting point of our own discussion on health cover. As such, it would be useful to have a breakdown of the costs for the broken ankle and the 3 Xrays. In other words, the total amount charged by the hospital; how much was reimbursed by the state; how much was covered by your Mutuelle; and how much (if any) you paid yourself.

[Gastines]

Perhaps worth including in your calculations.Did you pay for private health insurance in UK? We found that the cost of 100% top up was virtually the same amount  as we saved just on the difference in Council Tax in UK and the French equivalent. Our C.Tax in UK £1800 P.A. a 6 bed house here Total Tax H & F E1200. Top-up was E1200.After E121.now told it's E800 .that is for both of us. The main thought might also be peace of mind,it would be very nice to guarantee that neither of you would be ill or need any specialist treatment for some years.

Also it is very nice to know that a system you are contributing to will give you the very best and quickest attention,like phoning a Dentist/Doctor/X/Ray dept and getting an appointment within a day.Getting immeadiate advice after your X-ray/blood tests etc.Last blood test I had in UK my Doctor was still waiting the result 3 weeks later.

Regards.

[Jay]

[quote user="Blossom"]T......... no one gave any real figures on how much any particular hospital operation cost

[/quote]

We have had the basic rate top up from Gan since we arrived

here 5+ years ago. Shortly after signing up for the top up (couple of weeks) my

wife had an investigation into arthritis in he shoulder which was diagnosed by

a specialist in the UK, the GP here having refused to give her the morphine

based painkillers she had been on for 3 years in the UK, without a full medical

investigation. After a succession of blood tests, a full upper body scan, dye

injections and x-rays it was discovered she had a broken tendon in her shoulder

and no sign whatsoever of arthritis. Total cost to us so far - nothing. Top up

paid approximately 200€. Three weeks later she was in a private clinic having

an operation to fix the tendon, total cost to us - 7.30€ for telephone calls,

this time top up paid in excess1500€. Following hospitalisation there was 3

months physio, 3 visits a week for 3 weeks by a nurse plus a lot of medication,

bandages, sling etc., multiple visits to the GP and specialist follow ups. We

didn't keep detailed records of the cost but our top-up must have paid in

excess of 400€. This was all for a relatively simple operation. I can't imagine

the cost of something more complex!

Having said all that I went into the same clinic the following year for a

double hernia operation and they didn't even ask for my top-up insurance and I

didn't have a cent to pay. There was, of course, all the medication afterwards

plus visits from the nurse and doctor.

I have always thought that you could wait until you are diagnosed with

something nasty and hope it was nothing urgent that required immediate

hospitalisation, then invest in top-up as there are no special conditions to

obtaining it (i.e. not like PHI), but do you really want to take the chance? I

can recommend obtaining decent top-up insurance and wouldn't be without it.

[Logan]

I hestiate to spoil the party but Mutuelles actually pay out very little in comparison to the amount they receive in premiums. I believe if you can afford to pay a full 300% tarif cover Mutuelle then you can afford to take the risk yourself. They may be called Mutuelles but profit is their motive otherwise they would fold.

The current government are currently pushing more and more of medicare cost on individuals. In addition they are ring fencing Mutuelles from excessive costs. I believe this is to try and reduce the French dependence on the medical service. French hypocondria is legendary and costing the country a fortune.

The fear factor is really the motivation for any assurance. The dark threat of the unknown. Assurance companies play on our human insecurities and sell us this odd modern concept named by the advertisers as 'peace of mind'. It's as if they offer you some fluffy place where you can inhabit, worry free from the woes of being alive. 

Personally I prefer a large dose of common sense and control my own affairs. If I shell out 1500 -2000 Euros per annum to a Mutuelle company I want to see large slice of that cost returned in reimbursements. The truth is you will not. Yes, you may be unlucky and have a string of problems where the Mutuelle occasionally takes a hit. That is rare. Normally they pay out relatively small amounts of 20% to 30% for medication, visits to the Doc, lab tests etc. Small beer in the actuality.

If you are hospitalised for a condition which is not life threatening you will have a cost bill of 30%. Ask yourself how often that's likely? This year it will be expensive, maybe next but you might well find for the following 5 years you are home free. Mutuelles premiums saved and in your bank account not theirs.

Courage mon brave!

[mint]

I don't think you realise that some of us don't "cost" out everything and want our money back just because we have paid.

As with contributions to the NHS, I was happy to pay and not use the service.  Can you not see that, to paraphrase Oscar Wilde, you might know the cost of everything and the value of nothing?

To me, there is an intrinsic value and justice in paying into a pot and then drawing out only the amounts that I need.  I'd rather pay, enjoy good health and let other poor souls benefit from the money that I have paid in and do not want or need. 

[Jay]

[quote user="Logan"]

Mutuelles actually pay out very little in comparison to the amount they receive in premiums.

[/quote]

We have paid out approx. 4520€ in premiums in the last 5 years and had about half that back so I can see your point. I have also paid house insurance for the last 40 years and never had a penny of that back but would hate to be without it if our house burnt down. Insurance is a risk business, if you have the money put aside to take that risk then fair enough.

[Mr Coeur de Lion]

With the extremely high social charge rates and other taxes in France, it amazes me that you still have to look at paying high top up charges. Where does the money go?

[Blossom]

[quote user="Jay"]I have also paid house insurance for the last 40 years and never had a penny of that back but would hate to be without it if our house burnt down. Insurance is a risk business...[/quote]

I do not think that it helps to conflate all insurance cover when considering risk.

For example, at today’s rates, 40 years of ‘buildings’ insurance cover on a house worth £250,000 would be, say, £8000.  This, I would argue, represents good value for money should your house burn down. Whereas 40 years of top-up health insurance could be anywhere between £30,000 - £100,000! I therefore find it hard to disagree with Logan. 

[Patf]

 Blossom - you asked for estimated costs of operations. Here are a few (from 2-3 years ago.)

Operation on broken leg   800€

Hip replacement   6000€   

Treatment in intensive care for heart attack plus stent placement 9000€

All estimates, without cost of "B andB".

[Jay]

[quote user="Blossom"]

I therefore find it hard to disagree with Logan. 

[/quote]

Conflate - that's a good word! If you agree with Logan then

perhaps you have, at last, made your decision and top-up is not for you.

[Logan]

[quote user="sweet 17"]

I don't think you realise that some of us don't "cost" out everything and want our money back just because we have paid.

As with contributions to the NHS, I was happy to pay and not use the service.  Can you not see that, to paraphrase Oscar Wilde, you might know the cost of everything and the value of nothing?

To me, there is an intrinsic value and justice in paying into a pot and then drawing out only the amounts that I need.  I'd rather pay, enjoy good health and let other poor souls benefit from the money that I have paid in and do not want or need. 

[/quote]

Well sweet 17 you are entitled to be generous to others with your resources if you wish. I support personal choice in all things. I also like the principal that France allows us to choose if we have a mutuelle or not. The country is a very high tax society and seeking value for the disposable part of our income is for me a priority. Contributing to the profits of assurance companies is not.

The 'value of anything' is very much a subjective principle. I value self help and incentive and taking responsibility for our own lives. The government is responsible for the health of the nation through the large slice of taxation we already pay. A mutuelle is just in reality more taxation which you don't really need to pay. It is not the same as house insurance or any other risk cover.

[Keith CHANNING]

[quote user="Logan"]

It is not the same as house insurance or any other risk cover.

[/quote]

Which is, of course, fine if you know you will always have a few thousand Euros available for your portion of the expensive treatment - usually at the most inconvenient possible time. For the rest of us it is, like most non-mandated insurance, trading a known, regular outgoing for an unknown (in time and amount) occasional outgoing that could be difficult or impossible to meet.

For some the former makes sense, for others the latter.

[Logan]

[quote user="Keith CHANNING"]
For some the former makes sense, for others the latter.
[/quote]

I agree Keith but for those on low incomes the state pays 100% of the costs not just the tarif de convention. If you pay a mutuelle why not set aside the premiums instead in a savings account on a monthly basis. Livret A is tax free up to a reasonable figure. Then you have the cash if it's needed.

Example - Break a leg and require hospitalisation. Cost say 800 euros. State pays 70%, you pay 240 euros. That is on average 2-3 months premiums. Unless you are very unlucky I doubt you would need that more than once or twice in a lifetime. If you have a heart attack and require more hospitalisation it's life threatening therefore costs are paid by the state. I could give more examples but in essence the amounts paid out by a mutuelle contract are small.

[suein56]

[quote user="Logan"]

I could give more examples but in essence the amounts paid out by a mutuelle contract are small. [/quote]

Where you can break even with a mutuelle is if you need to take a number of medications, as does my OH following insertion of a stent during an angioplasty. He takes 3 tablets a day and our share of the cost is 45 euros a month after CPAM's contribution. This is because we only have hospitilisation cover at the moment so no cover for drugs. We are thinking of swapping to 100% cover for him as this will give give him greater cover for his drugs and in general, and re the dentist and the optician in particular, than hospitilisation alone does.

Sue

[Gastines]

I suppose if you had just paid a couple of months premiums on your house,your top up health cover and car insurance you would be in a better financial position than those who think they can save for 10-20 years to pay any hospital/car repair and house rebuild costs especially if you came home to find the house on fire,the shock gave you a heart attack your wife crashed the car rushing you to the hospital and broke her leg preventing you from going on your world cruise. Sometimes fires and accidents don't wait untill you are in a strong financial position.That might be worth taking into your calculations.Having had 3non-insured drivers prang cars of mine,I do feel that insurance is what it says on the tin INSURANCE.

Regards.

[Patf]

Logan - the example of the heart attack. The cost was  covered only 70%, for some reason. Possibly because it was done via SAMU, not the medecin traitante. The hip replacement was covered 100%.

[NormanH]

[quote user="Patf"]Logan - the example of the heart attack. The cost was  covered only 70%, for some reason. Possibly because it was done via SAMU, not the medecin traitante. The hip replacement was covered 100%.[/quote]

I have already stated that I believe Logan's premise that 'life threatening' conditions are automatically covered at 100% to be incorrect.

This seems to back that up.

I stand to be corrected if someone can quote from the http://www.ameli.fr/  site where Logan's idea is stated.

If I am right it tips the balence of the argument back the other way if you might have to meet 20% of a serious operation and aftercare