Health Insurance in W Europe

W

Whisper9999

Recycles dryer sheets
Joined
Jul 5, 2004
Messages
173
Let's say I want to semi-retire in five years to somewhere in Western Europe (France, Spain, etc.). And let's say I'm living off income from investments and part-time self-employment.

Does anyone know if there is a reasonable way to get health insurance over there that isn't exhorbitant? doesn't have exclusions and riders?

Also, I would need family coverage.

Any help or tips would be much appreciated...

(And, yes, I know Western Europe is not the cheapest place to retire. I actually only want to live there 3-6 months out of the year...)
 
If you are going to be based in the USA and spend 3 - 6 months a year in Europe I would first ask your USA insurance company, you may already be covered and any extension may be very affordable. Our existing US policy covers us for Europe - I checked with them before we came over for this 6 month visit that we are currently doing.

Before I asked my Insurance company I also inquired with Amex Travel, and a travel policy over several months was very reasonable.
 
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Alan said:
If you are going to be based in the USA and spend 3 - 6 months a year in Europe I would first ask your USA insurance company, you may already be covered and any extension may be very affordable. Our existing US policy covers us for Europe - I checked with them before we came over for this 6 month visit that we are currently doing.

Before I asked them I also inquired with Amex Travel and a travel policy over several months was very reasonable.
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Thx but that's my question: I won't be working for my current company at that time. I will be "self-employed" (part-time) and am wondering if there are health insurance options over there for people such as myself (and my family)?
 
I agree with Alan. If it's not a permanent move, I would start by looking stateside. Our current health insurance covers us abroad.

Edit: I just saw your second post. I know there are insurance options for people who are not EU citizens, but I don't know enough about them to be of much help. A few companies you might want to look at: Bupa, GMC services, ACS, and Indigo (Allianz). They specialize in "expat" health insurance.
 
FD said:
I agree with Alan. If it's not a permanent move, I would start by looking stateside. Our current health insurance covers us abroad.

Edit: I just saw your second post. I know there are insurance options for people who are not EU citizens, but I don't know enough about them to be of much help. A few companies you might want to look at: Bupa, GMC services, ACS, and Indigo (Allianz). They specialize in "expat" health insurance.
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Thx. That's just what I was looking for. Didn't know where to get started and which were good insurers.

Any other tips are much appreciated...
 
We live in France for 3 months in the summer and a few trips during the year. Our US insurance with United Health Care covers us. The only problem is filing the claims. Be ready for things like explaining to UHC that France doesn't use the same diagnosis codes that the US does! It can be a pain but they ultimately pay up. The real question is if you are seriously injured how would get home. You could get stuck overseas. Just a risk to be aware. Don't do any skateboarding while you are away.
 
FD said:
I bookmarked this article a while ago and forgot all about it:
http://www.parisfranceguide.com:81/index.php?module=pagemaster&PAGE_user_op=view_page&PAGE_id=33

Those types of expat insurance policies may only offer limited coverage in the US so be careful if you come back home for a visit.
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Yeah, I was kind of wondering how that would work. Also, it seems like you could go over there, get sick there, and then be uninsurable when you come back.

Btw, the link didn't open up for me...
 
Whisper9999 said:
Yeah, I was kind of wondering how that would work. Also, it seems like you could go over there, get sick there, and then be uninsurable when you come back.

Btw, the link didn't open up for me...
Click to expand...

The link works for me in both Safari and Firefox. Dunno what's going on.

Alternative:
Go to http://www.parisfranceguide.com
Click on "health" in the "read it" menu on the left
Read the "health insurance" article
 
If you are legitimately self-employed in France, you will very likely be required to pay employer deductions. The bad news is that these can be a big percentage of your gross revenues. The good news is that they don't need to be a big part of your overall income (depending on how much is from investments vs employment) and they will give you access to French medical care. This pays for all but $10 of a doctor's visit, and all but $10/day or so of a hospital stay. (French people typically get extra coverage for these last few bucks, which are typically waaaaay less that Americans' co-pays.)
 
BigNick said:
If you are legitimately self-employed in France, you will very likely be required to pay employer deductions. The bad news is that these can be a big percentage of your gross revenues. The good news is that they don't need to be a big part of your overall income (depending on how much is from investments vs employment) and they will give you access to French medical care. This pays for all but $10 of a doctor's visit, and all but $10/day or so of a hospital stay. (French people typically get extra coverage for these last few bucks, which are typically waaaaay less that Americans' co-pays.)
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Really?? Well, that's very interesting to say the least. So if you pay into the system, you get health care even if you are outside the country. That's downright remarkable...

So what is their underwriting like? Will they accept you even if you have "preexisting conditions"? (I don't have any major health issues - I was just curious how they handle these situations.)
 
Whisper9999 said:
Really?? Well, that's very interesting to say the least. So if you pay into the system, you get health care even if you are outside the country. That's downright remarkable...

So what is their underwriting like? Will they accept you even if you have "preexisting conditions"? (I don't have any major health issues - I was just curious how they handle these situations.)
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Well, if you pay into the system, you do get coverage even outside the country. BUT, they will reimburse only on the basis of French healthcare costs. So if you live in a country like the US where healthcare is very expensive, then it might not pay for much. That's why I do not currently pay into the French healthcare system (even though I qualify). It would be expensive and it would not provide nearly enough coverage in the US. There is no underwriting to speak of but, if you join (or re-join) the system, pre-existing conditions are not covered for the first 90 days (IIRC).
 
FD said:
Well, if you pay into the system, you do get coverage even outside the country. BUT, they will reimburse only on the basis of French healthcare costs. So if you live in a country like the US where healthcare is very expensive, then it might not pay for much. That's why I do not currently pay into the French healthcare system (even though I qualify). It would be expensive and it would not provide nearly enough coverage in the US. There is no underwriting to speak of but, if you join (or re-join) the system, pre-existing conditions are not covered for the first 90 days (IIRC).
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So it's really only worth it if you are going to live there nearly year round?

And even then, of course, it's very expensive...
 
Whisper9999 said:
So it's really only worth it if you are going to live there nearly year round?

And even then, of course, it's very expensive...
Click to expand...

It would be worth it if you were to live permanently in France or another country with similar or lower health care costs (most countries in the world).

As for the cost, it would still be lower than what you would pay in the US. If you live outside of France, the premiums are determined based on your age and income and the cap is currently around 235 euros per month. So not that expensive, except if you are in the US where the 235 euros per month would buy you very little coverage.
 
FD said:
It would be worth it if you were to live permanently in France or another country with similar or lower health care costs (most countries in the world).

As for the cost, it would still be lower than what you would pay in the US. If you live outside of France, the premiums are determined based on your age and income and the cap is currently around 235 euros per month. So not that expensive, except if you are in the US where the 235 euros per month would buy you very little coverage.
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Oh I see. Very interesting, but I do have a q about what you wrote: "As for the cost, it would still be lower than what you would pay in the US". I read somewhere that it is about 40% of your salary. So is it salary-based or premium based?

And I would really like to hear why you say it is cheaper than the U.S.? Are you saying that most people when they compare the cost of health insurance in the U.S. with the cost of health care in France it's actually cheaper in France?

If so, then why don't I hear more about retiring to France? Well, actually, I guess I should word that probably a little differently: isn't France one of the best places to "retire" if you're not really going to ever retire?

In my case, I don't think I'll ever retire as I will always have a "job" doing what I love. In other words, I will have some money coming in from doing my passion so to speak. Isn't France ideal for that kind of scenario?
 
Whisper9999 said:
Oh I see. Very interesting, but I do have a q about what you wrote: "As for the cost, it would still be lower than what you would pay in the US". I read somewhere that it is about 40% of your salary. So is it salary-based or premium based?
Click to expand...
For an average middle-class full-time earner, 40% represents the total tax and deductions take across their entire salary, in more or less every European country. It's difficult to say exactly how much of that is health care premiums, because the costs are hidden across various things, but in any case you can't opt out of any of them.

Once you have the coverage, though, the treatment is not far short of US levels and the co-pays are negligible. And everyone has the same level of coverage. Heart by-pass ? Cancer ? Transplant ? You're covered.

Whisper9999 said:
And I would really like to hear why you say it is cheaper than the U.S.? Are you saying that most people when they compare the cost of health insurance in the U.S. with the cost of health care in France it's actually cheaper in France?
Click to expand...
It's cheaper in that /1/ you pay less in premiums (even within the complexities mentioned above), /2/ co-pays are less, /3/ the scheme pays out less because doctor's fees are capped, /4/ the scheme pays out less because the French government negotiates prices for medicines that are way lower than the US (one of the biggest tragedies of the US system is that with the amount which the US government spends on healthcare, it should be negotiating tougher conditions with the drug companies), and /5/ because everyone has coverage, everyone goes to a doctor rather than the ER.

By the way, if you're just visiting and don't have insurance, a doctor's visit currently costs about $35 and getting a prescription filled for a course of antibiotics is about $15. I recommend Americans who are visiting Europe to bring their prescriptions with them and get them re-filled over here; even with the dollar in its current state this can make quite a difference.
 
BigNick said:
For an average middle-class full-time earner, 40% represents the total tax and deductions take across their entire salary, in more or less every European country. It's difficult to say exactly how much of that is health care premiums, because the costs are hidden across various things, but in any case you can't opt out of any of them.

Once you have the coverage, though, the treatment is not far short of US levels and the co-pays are negligible. And everyone has the same level of coverage. Heart by-pass ? Cancer ? Transplant ? You're covered.


It's cheaper in that /1/ you pay less in premiums (even within the complexities mentioned above), /2/ co-pays are less, /3/ the scheme pays out less because doctor's fees are capped, /4/ the scheme pays out less because the French government negotiates prices for medicines that are way lower than the US (one of the biggest tragedies of the US system is that with the amount which the US government spends on healthcare, it should be negotiating tougher conditions with the drug companies), and /5/ because everyone has coverage, everyone goes to a doctor rather than the ER.

By the way, if you're just visiting and don't have insurance, a doctor's visit currently costs about $35 and getting a prescription filled for a course of antibiotics is about $15. I recommend Americans who are visiting Europe to bring their prescriptions with them and get them re-filled over here; even with the dollar in its current state this can make quite a difference.
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Thx for the time to give me all this info - I appreciate it. So, basically, if you don't mind paying all those taxes, then all the extra dollars you'd pay into Medicare goes away. So for some that would be a big savings. Or it would save from the premium to fill in the gaps of your medical coverage or HSA premiums or whatever.

Well, that'll give me something to think about!
 
Whisper9999 said:
Oh I see. Very interesting, but I do have a q about what you wrote: "As for the cost, it would still be lower than what you would pay in the US". I read somewhere that it is about 40% of your salary. So is it salary-based or premium based?

And I would really like to hear why you say it is cheaper than the U.S.? Are you saying that most people when they compare the cost of health insurance in the U.S. with the cost of health care in France it's actually cheaper in France?

If so, then why don't I hear more about retiring to France?
Click to expand...


This is in fact a very complex question. There are several "regimes" of social security in France. How you pay for your healthcare and how much you pay for it depend in large part on the "regime" under which you fall. There are different regimes for salaried people, independent contractors, students, retirees, expats, etc...

As an expat, I would have to pay quarterly "premiums" based on age and income. As a student, I paid an annual "premium" as well. But people who have an income in France pay a "social tax" on that income. That tax pays for a host of things, including the national healthcare system, the national retirement system, and various other social programs (I don't know how much of it actually goes to pay for healthcare per se). The current rate is approximately 8% of salaried compensation, 7% of pension income and 12% of other passive income. It's not dissimilar to the Payroll Tax in the US. Of course, like in the US, that's in addition to any potential income tax, sales tax (VAT) and local taxes.

Big Nick addressed the cost question, but I wanted to add that another advantage of the French system is that you are guaranteed to be covered and there is a cap on how much you have to pay for that coverage (either a maximum premium or a maximum percentage of your income depending on your regime). In the US you have little control over your premiums (you can shop around, but if you have certain pre-existing conditions, you may be SOL). In France, you don't have such uncertainty.

Plenty of people retire in France (British people retire there en masse in fact). I also know quite a few Americans who have done so as well (of course the weak dollar has been a disincentive over the past few years). Also, the cost of living in France is pretty high and people generally retire abroad to spend less, so France might not be on their radar.
 
FD said:
This is in fact a very complex question. There are several "regimes" of social security in France. How you pay for your healthcare and how much you pay for it depend in large part on the "regime" under which you fall. There are different regimes for salaried people, independent contractors, students, retirees, expats, etc...

......

Plenty of people retire in France (British people retire there en masse in fact). I also know quite a few Americans who have done so as well (of course the weak dollar has been a disincentive over the past few years). Also, the cost of living in France is pretty high and people generally retire abroad to spend less, so France might not be on their radar.
Click to expand...

Gotcha. Well, I've read a little on the regimes, etc. So it's really quite confusing. I guess that you have to pay the taxes you mentioned and then you have social taxes on top of that, right?

Anyway, that leads to my next q: how do you find a reasonable estimate for what your taxes are, assuming of course that you know what regime you fall under?

I guess what I'm asking is that if you knew your regime, a rough idea of your income and the sources, is there somewhere you could go to a rough idea as to the amount of taxes you would pay?

Also, and this may be a complex q, what is the VAT over there? It's just a certain percentage of everything you buy right? Do you get out of it if you make an online purchase?
 
Whisper9999 said:
Gotcha. Well, I've read a little on the regimes, etc. So it's really quite confusing. I guess that you have to pay the taxes you mentioned and then you have social taxes on top of that, right?

Anyway, that leads to my next q: how do you find a reasonable estimate for what your taxes are, assuming of course that you know what regime you fall under?

I guess what I'm asking is that if you knew your regime, a rough idea of your income and the sources, is there somewhere you could go to a rough idea as to the amount of taxes you would pay?

Also, and this may be a complex q, what is the VAT over there? It's just a certain percentage of everything you buy right? Do you get out of it if you make an online purchase?
Click to expand...

Well, the regime stuff is confusing even for me.

Basically you pay 4 types of taxes like in the US: income tax, social tax (kinda like payroll taxes but levied on all incomes), VAT, and property taxes. If you are one of the lucky few, you may also have to pay the wealth tax (for people with a net worth over 1.3M euros).

Income tax: Like in the US, there are many opportunities to decrease your taxable income. Like in the US, figuring out your tax bill is quite daunting. As such, it is very difficult to estimate how much your taxable income will be and how much you will pay in income taxes without filling out the official form. The final number depends on how you make your money and what investment you own. Real estate for example is very tax-advantageous in France. Stocks and bonds, not so much.

The VAT is currently 19.6%. You pay that rate on anything you buy online or offline (though, there again, there are loopholes: the VAT on food and medication is much lower).

If you work in France, you will fall under the "regime general" for healthcare and retirement. In that case, you get coverage by paying the social tax on your income (see previous post for rates). If you don't plan on working while in France and if you have never contributed to the "regime general", you will likely be looking at the "couverture maladie universelle" or CMU regime (for all legal residents of France who have been in the country for at least 3 months).

Here is the website:
La CMU de base

You will probably qualify only for the "CMU de base" (meaning that, like most French people, you will have to buy a supplemental insurance policy for better coverage). The CMU regime is income-based. You pay 0% on the first 9,029 euros of taxable income, then 8% of the taxable income beyond that amount. You pay the CMU every quarter.

See here:
Couverture maladie universelle : cotisation - Service-public.fr
 
FD said:
Well, the regime stuff is confusing even for me.

Basically you pay 4 types of taxes like in the US: income tax, social tax (kinda like payroll taxes but levied on all incomes), VAT, and property taxes. If you are one of the lucky few, you may also have to pay the wealth tax (for people with a net worth over 1.3M euros).

Income tax: Like in the US, there are many opportunities to decrease your taxable income. Like in the US, figuring out your tax bill is quite daunting. As such, it is very difficult to estimate how much your taxable income will be and how much you will pay in income taxes without filling out the official form. The final number depends on how you make your money and what investment you own. Real estate for example is very tax-advantageous in France. Stocks and bonds, not so much.

The VAT is currently 19.6%. You pay that rate on anything you buy online or offline (though, there again, there are loopholes: the VAT on food and medication is much lower).

If you work in France, you will fall under the "regime general" for healthcare and retirement. In that case, you get coverage by paying the social tax on your income (see previous post for rates). If you don't plan on working while in France and if you have never contributed to the "regime general", you will likely be looking at the "couverture maladie universelle" or CMU regime (for all legal residents of France who have been in the country for at least 3 months).

Here is the website:
La CMU de base

You will probably qualify only for the "CMU de base" (meaning that, like most French people, you will have to buy a supplemental insurance policy for better coverage). The CMU regime is income-based. You pay 0% on the first 9,029 euros of taxable income, then 8% of the taxable income beyond that amount. You pay the CMU every quarter.

See here:
Couverture maladie universelle : cotisation - Service-public.fr
Click to expand...

Again, thank you so much for all the info! Very kind...
 
Most people don't worry about VAT on a day-to-day basis as the price you see is generally the amount you pay, unless the advertising is aimed at a business. So a car might be €19999 including VAT, which would be something weird like €16327 excluding VAT. On the other hand, a small delivery van might be advertised at €12999 excluding VAT, because the business which buys it will be deducting the cost from the VAT which they pay.

In much of Europe (but not France, although things are evolving) people don't really notice their income tax either, because it's deducted every month(*) from your payslip. So you have the strange situation that Americans and French people complain about income tax because they get a specific bill for it, whereas Brits, Dutch, Germans, etc pay waaaaaay more but don't see a post hoc demand for money, so they just treat it as part of the daily grind.
 
AARP Article on Group Health Insurance for France

AARP International: An American in Paris

By Thomas Rose
AARO Insurance Committee

Ever get the urge to work abroad? Or take early retirement and live in a foreign country? If the travel bug has bit you and your dream is to retire in Europe, listen up! The glossy fliers may tempt you but sooner or later you'll have to face the problem of providing health care for yourself as an American abroad.

While a short article can't do justice to a subject evolving as rapidly in Europe as in the US, a brief tour in France will illustrate the constraints applicable to Americans who wish to work, reside or retire in France.......see link
 
Safe Harbour said:
... The real question is if you are seriously injured how would get home. You could get stuck overseas. Just a risk to be aware.
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How does $100,000 of medical evacuation & repatriation (return to home country) insurance for $35 a year sound? Can be used only on trips more than 50 miles away from your permanent residence. Offered by D.A.N., the Divers Alert Network. One does not have to be a diver to join, nor do the medical reasons for the evacuation or repatriation have to be dive related. DAN is a non-profit organization. My diver friends speak highly of it.

Member benefits are here.
 
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