A healthy relationship
As the Brexit process now officially begins, Robin Gauldie examines how healthcare cover for British expats in France might be affected and the options available to them
How Brexit could affect your access to the French healthcare system
Expat Britons will, after Brexit, have to budget for a policy that covers their medical costs in full
If you already live in France or are planning to join the ranks of Anglophone expats, it’s never been more important, now that Article 50 has finally been triggered and the UK’s withdrawal from the EU begins, to make sure you have the right health insurance policy.
Until now, expats who have made France their permanent residence for five years, or who have reached retirement age, have been able to join France’s healthcare system, which is rated among the world’s best – better, some claim, than Britain’s beleaguered NHS.
Food critic, author and programmemaker Jonathan Meades, who has lived in France since 2006 (first near Bordeaux, now in Marseille) was rushed into a French hospital for cardiac surgery last year.
“If I had been in England, with Jeremy Hunt’s current blood lust, I’ve no doubt I’d be dead,” he says in a recent interview in The Observer.
Despite cost-saving measures introduced by successive French governments in the last decade, access to France’s Couverture Maladie Universelle (CMU) system, generally rated the best option for expats, has until now been relatively easy.
“There are no medical questions, no exclusion of pre-existing conditions, no age limits, no claims deductible and no delay for urgent necessary treatment,” notes Exclusive Healthcare, which specialises in health insurance for Anglophone residents in France, on its website.
It also notes that: “In many countries private full cover insurance is regarded as better than the local NHS and many people consider it is necessary. In France this is definitely not the case; in comparison private full cover medical insurance hardly exists.”
That is about to change, at least as far as British residents are concerned. Currently, patients are expected to contribute around 30% of the cost of their treatment, so most people buy a top-up health policy to cover the gap between medical bills and the French national health service’s reimbursement to healthcare providers.
However expat Britons will, after Brexit, have to budget for a policy that covers their medical costs in full. That will be expensive, and for those with pre-existing conditions, it may be difficult or even impossible. A typical top-up policy can currently be bought for around €800-€1,000.
“Standard premiums for a 62-year-old buying a fully underwritten health policy will range from €2,290 to €4,977, but the maximum limit and the guarantees are quite low,” says one Francebased insurance expert. “For a higher limit and better guarantees the premium would be from €6,702 to €8,412.”
Since 2007, new arrivals planning to live permanently in France but not yet eligible for the French system have been required to prove that they have personal medical insurance or are covered by British National Insurance contributions, so that the French healthcare system can recoup from the UK the costs of treating them.
PUMA (Protection Universelle Maladie – universal illness protection), introduced in 2016, equalised the rights of EU and non-EU citizens to apply for France’s health insurance card, the carte vitale. That made life easier for British and other EU residents, who previously had to be resident for a period of five years before they were eligible.
As with every other aspect of Brexit, it’s too early to know exactly what the future may hold for British residents in France. In particular, it is unclear whether they will still be eligible to join the French system, or to have their medical costs in France paid by the UK.
However, maintenance of the reciprocal status quo, under which the French health system (like that of other EU countries) reclaims its share of the cost of treating British residents from Britain, looks to be very unlikely.
“The health issue has been mishandled by politicians who just forgot about it,” says Charles Wilson, president and managing director of Exclusive Healthcare and president of the management board of the Institut Hospitalier Franco-Britannique.
Younger clients and those with a clean bill of health are unlikely to have problems finding an insurance policy to cover medical expenses currently provided under the French national system, says Wilson, who has himself been resident in France for many years. However, for many, the days of quick, no-questions-asked acceptance by an insurer are numbered.
“For those over 65, an insurer will have you, after a medical examination, at a price per existing condition. That price is dependent on your aggregated level of health.”
A record of treatment such as hip replacement surgery is unlikely to be an issue for an insurer, but Wilson warns that anyone who has had any form of cancer will pay an extra loading, adding greatly to the cost of their policy, or may even be refused cover. From the insurer’s point of view, this is understandable.
“Hospitalisation can be disastrously expensive. If you have a serious bout of cancer you can run up bills of €150,000 or more,” Wilson points out.
That said, the cost of a visit to a French doctor averages only €23. Common prescription remedies are usually relatively affordable, and Britons may find it makes sense to buy a cheaper policy that excludes minor treatment but provides cover for hospitalisation and more major surgery. Such policies already exist.
“We have designed a policy for people who just need cover for possible hospital bills,” Wilson says.
WILL THE EHIC STAY OR GO?
While full-time residents should already be considering their healthcare options, second-home owners who for now enjoy access to the French system while in France using the European Health Insurance Card (EHIC) will also need to make sure they have private medical cover post-Brexit. With the end of reciprocal healthcare, insurers will no longer be able to move British patients into French state hospitals at no cost to themselves, but will have to pay for hospitalisation and treatment. Inevitably, that will mean higher premiums and higher policy excesses, say insurers.
Kate Huet, managing director of International Travel and Healthcare, a British insurance provider, speculates that some EU countries could opt to honour cards with longer validity until their expiry date. In that case, she warns, “there could be a rush to acquire a card” in the months before Britain’s final departure from the EU in 2019 – so renewing your five-year EHIC next year could be a smart move.
“Without the EHIC, I’m worried that some people could have large medical bills they’ll struggle to pay, unless the UK makes another provision,” says Philip Wright, managing director of the European division of International Medical Group, a worldwide private healthcare insurer.
So far, there’s no indication that the UK government is likely to do that, or has even begun to think about it.
In March, days before the departure process was triggered, Brexit minister David Davis breezily admitted that he hadn’t thought about the problem. Questioned by the House of Commons Brexit Select Committee, Davis said it was “probably right” that Britons would no longer be able to use the EHIC after withdrawal from the EU.
Some UK sources say there is no need for Britons to lose the EHIC. Alan Wardle, public affairs director of the travel association, Abta, says: “Abta disagrees with David Davis that UK citizens will have to lose the EHIC health treatment card. Brexit shouldn’t have to mean that we lose reciprocal medical care rights with other European countries: the EHIC card is currently valid in Switzerland, which is not a member of the EU.”
But Davis’s comments show that preserving the EHIC will not be a priority as Brexit negotiations get under way. At best, something similar might be revived by a bilateral agreement between Britain and France at some future date.
While around 12.1 million Britons visit France each year, only around 4.61 million French tourists head the other way, so arguably we need the EHIC more than they do, weakening Britain’s negotiating position on reciprocal healthcare arrangements for visitors.
Charles Wilson, perhaps tongue-incheek, suggests that, in extremis, Brits living in France could still make a dash to the UK for emergency treatment under the National Health Service and worry about paying later.
“If you walk into a hospital anywhere in Britain they are not going to turn you away or demand cash payment before an operation,” he says, somewhat optimistically.
That would make them, in effect, ‘health tourists’ in their former homeland. And in January, the Home Office launched a pilot scheme to restrict free treatment of patients who cannot prove they are resident in Britain. According to a spokesperson for the NHS improvement scheme, specialist ‘cost recovery support teams’ will advise on identifying and recovering costs from non-eligible patients, who would presumably include full-time British expats.
Two years ago, the UK Department of Health warned that British expats living outside the EEA (which includes the EU) who returned to the UK to be treated by the NHS would be clobbered with bills of 150% of the cost of treatment unless they had adequate medical insurance.
Robin Gauldie is a freelance travel and business journalist and a regular contributor to International Travel & Health Insurance Journal and International Hospitals & Medical Tourism. When not travelling, he divides his time between a village house in Aude in Occitanie and a home in Edinburgh.