Health insurance: doubling medical deductibles, how does it work?

Health insurance: doubling medical deductibles, how does it work?


It’s time to save money. And they must make it possible to avoid at least 800 million euros per year in expenses for Health Insurance, whose accounts still showed a deficit of 11.1 billion euros last year. Since this Sunday came into force doubling of medical deductibles on boxes of medicine, paramedical procedures and medical transport, before the next increase in fixed contributions on medical procedures.

These two measures should lead to a additional cost of at least 17 euros per year for an average patient, mentioned the former Minister of Health Aurélien Rousseau last fall. Here’s what’s changing.

What are the new medical deductible amounts payable by you?

From now on, you will have to put 1 euro out of your pocket per box of medicine and per paramedical procedure (compared to 0.50 euros until now) and 4 euros per medical transport (compared to 2 euros). The daily medical excess limit, that is to say the maximum amount that can be charged to you, also doubles, to 4 euros per day for paramedical procedures and 8 euros per day for medical transport. There is no daily limit on medications.

This amount cannot be reimbursed by complementary health insurance within the framework of a responsible contract (i.e. in almost all cases). On the other hand, the annual medical deductible ceiling is ultimately neither removed nor increased: you will not pay more than 50 euros per year in total, whatever your consumption. Under 18s, women on maternity leave and beneficiaries of Supplementary Solidarity Health and state medical aid are exempt from medical deductibles.

How will you pay?

Medical deductibles are automatically deducted from reimbursements made by Health Insurance. In the case of third-party payment, that is to say if you do not pay for your medication or care, “the medical excess will be deducted later from any next sum paid (compensation, consultations, care, radiological examinations, nursing procedures, transport…) for you or one of your children”, specifies the site

The Primary Health Insurance Fund on which you depend may also request payment from you if you are unable to receive reimbursement. Payment can be made via the online debt payment service.

How do you know if you’ve reached the ceiling?

On your Ameli account, in the “My payments” section, your reimbursement statements are available, which shows the amount of each deductible taken. In the “Flat-rate contributions and deductibles” tab, you can consult, for a given year, the total medical deductibles paid and that of the flat-rate contributions (on consultations). Each of these two contributions has its own annual ceiling of 50 euros.

What will be the increase in flat-rate contributions for medical procedures?

The decree establishing the increase in these fixed contributions to medical consultations and analyzes and radiology examinations was also published in mid-February. But this has still not come into force, which should be the case on May 15, the Ministry of Health clarified to our colleagues at Capital. Until now set at 1 euro, it will double as mentioned for months by the government… But it could well triple. Because the text provides that, from now on, the amount of the fixed contribution cannot, without being less than 2 euros, exceed 3 euros. It is the council of health insurance funds (Uncam) which must set it in the coming weeks. Enough to portend a final (bad) surprise for policyholders in this matter.


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