Over the summer the government published four decrees designed to reduce the share of costs reimbursed directly by Assurance Maladie (state health insurer) and transfer more onto complementary insurers and, in some cases, patients themselves.
The areas affected are dental care, medical transport, medical devices and certain medicines.
For dental care, the patient's share is to rise from a previous range of 35-45% to 50-60%, meaning that Assurance Maladie could cover between 40% and 50% of the relevant costs. Certain protections remain, including full coverage for those with major/long-term illness (Affection de Longue Durée -ALD). In addition, people who choose dental treatments covered by the 100% Santé scheme will continue to receive those treatments with the full cost covered by Assurance Maladie and their complementary insurance.
For certain medical devices, the decree raises the relevant ranges of the patient’s share from 40-50% to 50-60%, and from 35-45% to 50-60%, depending on the category. The decree specifically maintains 100% coverage for certain essential equipment, including major prosthetic and orthotic equipment and wheelchairs, and does not create additional costs for people with ALD or those covered by complementary health insurance for low-income households.
For medical transport, the patient's participation will move from a range of 45-55% to 50-60%. A separate change, taking effect on 1st Oct 2026, will also limit the circumstances in which people with long-term illnesses can be exempt from paying this part of their healthcare costs.
The government has also changed the treatment of medicines with lower medical benefit. Under the published decree, the patient's participation for medicines in the relevant categories will rise to 85-95% for medicines with moderate medical benefit and to 93-97% for medicines with low medical benefit. In practical terms, this creates possible Assurance Maladie reimbursement ranges of 5-15% and 3-7%, respectively. Medicines classified with high medical benefit keep their standard reimbursement rate, normally around 65%, some at 100% for ALD patients.
All of these changes take effect from 1st Jan 2027.
The government originally proposed increasing the annual ceiling on patient contributions to €200 from €100. That proposal has now been abandoned.
These contributions are fixed amounts deducted from what the state health system reimburses. They are currently €2 for consultations or medical acts by a doctor, for certain radiology examinations and laboratory tests, and €1 per medicine, €1 per paramedical treatment, and €4 per medical transport.
Instead, the government plans to raise the two separate annual ceilings (franchises médicales and participations forfaitaires) from €50 to €70 each, giving a combined maximum of €140 per year, rather than €200. The ceiling only bites once you've accumulated enough small deductions. The ceilings have not been increased since they were introduced in 2005, but are now to be index-linked. A decree has yet to be published on this proposal.
The changes come against the backdrop of a rapidly deteriorating position for the health insurance budget, with a projected deficit of nearly €14 billion this year.
Not surprisingly, the changes have met with substantial opposition from the complementary health insurers, who will assume responsibility for the costs (for those who hold a complementary policy).
La Mutualité française (the national federation representing France's mutual health insurers (mutuelles) estimates that the transfers will amount to between €1.5 billion.
In practical terms, this means that even though complementary health policyholders may never notice a change in what they pay at the point of care the effects reflected in their annual premium renewal.
For patients who do not hold a complementary health insurance policy, it will mean a higher proportion of health costs will have to be met directly by them, although the impact will be marginal.
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