An Expat Discussion of CSS vs Mutuelle

A note from the authors: In these articles, we (Molli — MS and Gracie — GB) have a conversation about a topic that’s familiar to both of us. In addition to providing information, our aim is to explore it from two different angles and give you a more in-depth view of the complexities of French life and the expat experience.  To get the most benefit, make sure you read our previous articles explaining CSS and mutuelles.

GB: Since moving to France, I’ve been both impressed and mystified by the French healthcare system. For a long time, I assumed everyone’s carte vitale was a magical debit card that paid all their medical expenses. Eventually, I learned that this isn’t the case and that many French people also have a mutuelle which acts as additional health insurance. My American perspective is to assume health care plans are linked to employers, so I figured a mutuelle had to come from a full-time job at a French company, and since I arrived in France on a specifically non-working visa, none of these options felt accessible to me. What were your first impressions of the French healthcare system, Molli? Did you have someone to help you avoid my misconceptions?

MS: I had a similar perspective as you! I think that in the U.S. there’s this big narrative around the fact that yes, health care is free in most other countries, but that it means low-quality care, long wait times, and old-fashioned hospitals and healthcare centers. I was also shocked to find out that the “free” health care so bragged about here isn’t actually free.

The first time I had to go to the doctor or hospital was when I was still an au pair. I cut my thumb on some broken glass and when the cut got infected my host dad took me to the hospital. I was pleasantly surprised at the normal wait times, friendly doctor, and standard hospital equipment that I was used to seeing in the US Yet another stereotype bit the dust that day. 

That said, one stereotype did come true that day, and it was the fact that health care here is extremely affordable albeit not free. You definitely don’t have to worry about going bankrupt if you end up in the emergency room and you don’t have a carte vitale, which I didn’t at the time. I was on some special au pair insurance that my host family had set me up with. If you’re wondering what a carte vitale is, think of it as a healthcare card similar to the insurance cards in the US. You use it at the doctor’s office, pharmacy when you pick up prescription drugs, and at the hospital. It also has your French social security number on it, as well as your name and picture.

I actually didn’t get my first carte vitale until I opened my auto-entreprise three years after I had been living in France. Interestingly enough, I should have been given one automatically when I began the intensive French language program I began after I decided to stop nannying, as all students are part of France’s social security system (which includes the carte vitale). But, in true French bureaucratic fashion, halfway into the school year I still wasn’t issued one. Luckily, I decided to start my auto-entreprise while I was still a student. 

I also had never heard of the concept of a mutuelle, and naively thought that I could go to any sort of doctor or specialist for free. I have since learned that if you have to go to the dentist, eye doctor, or physical therapist and you don’t have this extra coverage, things can get really expensive. Gracie, do you have extra coverage now that you understand the system better? And, speaking of which, when and how did you start to wrap your head around how everything works?

GB: Yes, I have extra coverage through complementaire sante sociale (CSS) in addition to a carte vitale. Having both of those together means the French government pays for most of my healthcare which makes me feel amazing and lucky. That said, it did take about a year and a half of filing paperwork and waiting to get the whole thing in place. And to qualify for a CSS, you have to be making very little money so I’m not sure if it will be a permanent solution, especially since you have to reapply each year. As with all French bureaucracy, they don’t make it easy. 

I started to wrap my head around how everything works after being in France for about two years.  I’d always assumed that I had to be a French citizen or have a more permanent visa (at the time all I had was a long-term visitor visa), but that wasn’t correct. France is actually fairly lenient about including immigrants in its healthcare system, and all you have to do is prove that you’re living in France in a “stable and regular manner.” This means you do not have to be born in France, married in France, or even working in France to register. It does mean you do have to have spent at least three months in the country and have a valid titre de séjour

This was one of those classic –– why didn’t anyone tell me this –– revelations. From there, I learned more from the assurance maladie office which told me I could apply for a permanent number and a carte vitale after I was PACSed and had a VPF visa. My primary care physician was also extremely helpful and advised me to apply for the CSS in the first place.

What about you — were there any specific moments or people who illuminated this process for you? And once you were in the French system, what made you decide to get additional coverage?

MS: It seems like I’ve had to just figure out everything as I go ever since I arrived in France. In all seriousness, when I was an au pair, my host family was very helpful, but almost too helpful because my host parents took care of almost everything for me, including a lot of paperwork. Once I became a student and was no longer living under their wing, a lot of things came as a shock and there was a massive learning curve!

I was really hesitant to get a mutuelle because up until very recently I had the mentality of “I’m healthy, I’m young, I’ll never have to go to the hospital, and I don’t want to spend the money on something I’ll never use.” And, until I was 26 and still under my parent’s insurance back in the States, I saved my yearly dentist and eye doctor appointments for when I went home to visit. 

My French mother-in-law actually pushed me to finally get a mutuelle. Since I’m turning 30 this year, it was about time, and ultimately I’m happy I took the plunge into the world of paying for my own healthcare. I pay around 30 € per month, and most of my prescription drugs are covered as well as the dentist and the ophthalmologist (I wear glasses and contacts). I have to admit, there’s something so sweet about going to the pharmacy and picking up medicine for free!

My last question for you about the CSS is, do you have the same coverage as someone like me who has a mutuelle? Or, are there things that I have access to and you don’t? 

GB: I’m pretty sure my CSS has the same coverage as a mutuelle, if not more. Although I haven’t taken it to every possible doctor, the documentation says it reimburses most glasses, prosthetics, and hearing aids, as well as all visits to the doctor, dentist, and hospital. I wear insoles and have been meaning to see my podiatrist about those, and I’m assuming that’s covered as well. I also have lofty ambitions to work with a kinesiologist and would love it if that was reimbursed since I know it’s only partially covered by the normal medical system. 

My admittedly American approach is to show up to any doctor, assume it will cost hundreds of euros, and be pleasantly surprised that it’s significantly cheaper than in the US. That said, the medical system here is much more transparent about costs –– all doctors post their fees on their website and in their offices, and they will explicitly tell you how much a procedure is and if you’ll be covered when discussing it with you. My dentist wanted to x-ray my teeth and told me it would only be partially reimbursed –– the x-rays cost 50 € and I’d get back 60%. The total cost was laughably small, especially since I used to pay $300 to have my teeth cleaned. That said, I’m grateful she had the conversation with me and wish the American medical system had the same transparency.

We hope this has been a helpful discussion of our experience with the French medical system. Feel free to comment with any questions or health insurance adventures of your own.

Photo by Marcelo Leal on Unsplash

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3 thoughts on “An Expat Discussion of CSS vs Mutuelle

  1. This is super informative! I still have a carte vitale from when I was a full time student then profession libérale which formally ended in December 2018 when I didn’t renew my PL because I returned to the US. I cancelled my mutuel at that time. My CV still works i found out when I went to a pharmacy there in July 2021 for a covid test. I’ll be requesting your assistance to apply for a long term carte de séjour next year, which I know requires insurance coverage. I’ve been paying tax every year on rental income of my Paris apartment since then until I return. Any idea if can state on my application that u have a CV for insurance?

  2. Pingback: Profession Liberale Visa: Part 2 (90 Days Later) | The American in Paris

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