Consumer expert Adélaïde Robert has outlined strategies for French households to select cost-effective top-up health insurance as premiums rise across the country. Speaking on the television show Bonjour ! Avec vous, she explained how policyholders can assess their actual coverage needs and calculate whether their plan is financially worthwhile.
In France, 95 percent of households hold a complementary health insurance policy, known as a mutuelle, to cover expenses left unpaid by the national state healthcare system. Consumers currently choose among approximately 400 providers, including commercial insurance companies and non-profit mutual protection institutions.
The French healthcare structure relies on Assurance Maladie, the state health insurance agency, to cover basic medical costs. Because the state system rarely reimburses full treatment fees, most residents rely on top-up policies to pay for co-payments, hospital stays, prescription drugs, and specialist care. 60 Millions de consommateurs, where Robert leads the health and hygiene desk, is a major consumer testing and advocacy publication issued by France's National Consumer Institute.
Evaluating costs and coverage
To determine whether a policy is necessary, Robert recommended that consumers begin by examining their personal medical history on the official state healthcare portal. The Assurance Maladie site provides an online account service called ameli, which tracks individual healthcare consumption and medical claims.
Policyholders should compare their ameli statement against reimbursement summaries available on their health insurer's customer portal. Robert said determining profitability requires adding up all annual premium payments and comparing that total to the amount reimbursed by the policy over the year. She noted that consumers must also evaluate their out-of-pocket expenses, adding that paying a slightly higher monthly premium can sometimes be worthwhile if it yields substantially better reimbursement levels.
Rising costs for older policyholders
Health insurance contract rates rise significantly with age, creating specific financial pressures for senior citizens. Robert advised older people, particularly those on lower incomes, to maintain top-up insurance to protect against unexpected major medical risks.
She pointed out that a single day in hospital intensive care costs 3,500 euros. While Assurance Maladie covers 80 percent of that bill, the patient is still left with an out-of-pocket expense of 700 euros. For individuals over the age of 70, a mutuelle costs an average of 150 euros per month, while for those over 80, monthly premiums can reach 160 or 170 euros.
Robert stressed that paying these high sums is financially viable for seniors suffering from chronic illnesses or ongoing medical conditions. However, she observed that healthier older policyholders may end up paying far more in contributions than they ever receive back in reimbursements.
Couples and retirement transitions
To optimize costs, couples facing a significant age gap can take out joint contracts strategically. Robert recommended listing the partner with higher medical risks as the primary policyholder first, ensuring that any age-based discount applies to the person carrying the higher risk profile.
Conversely, Robert warned retirees against joining the workplace insurance plan of a spouse who is still actively employed. She explained that coverage in collective corporate contracts is specifically tailored for active workers rather than the distinct healthcare needs of retired individuals.
French employers are legally required to fund at least 50 percent of their employees' health insurance premiums. When a worker retires, French law guarantees the right to retain the same coverage and pricing tier during their first year of retirement. However, Robert explained that the actual cost to the individual increases because the retiree must pay both their original employee contribution and the portion previously covered by their employer.
Finding savings and alternatives
To help seniors cut expenses, several French towns and regions offer group municipal contracts designed specifically around the healthcare requirements of older residents. Additionally, Robert highlighted that many mutuelles provide unexpected support services, such as home meal delivery following a hospital stay when a patient is temporarily unable to cook.
She advised policyholders to thoroughly read their contract terms to understand all included rights, particularly regarding coverage for alternative medicine services.
When choosing or changing providers, Robert cautioned against using commercial comparison websites, noting that they typically screen only a limited subset of available market contracts. She recommended carrying out a comprehensive comparison across multiple types of providers, including mutual societies, insurance companies, and protection institutions.
Finally, Robert urged consumers to check whether they qualify for Complémentaire santé solidaire, known as C2S. This state-funded social protection scheme provides free or low-cost complementary health coverage to French residents living on modest incomes.
