FRENCH VISA AND HEALTH INSURANCE FOR AMERICANS

The most expensive item in an American family's budget may be health insurance. But many Americans have no understanding of the true cost of their insurance because it's included in their employment package. Folks simply don't think about how much their employer may be reducing their salaries when factoring in insurance costs.

Before I retired, my employer paid for my health insurance but I had to pay to insure my wife. The cost, taken out of my every paycheck, came to about $6,000 annually. And even with insurance, there were co-pays and other out of pocket expenses. We were reasonably healthy (and still are, knock wood), but we each take a few common prescription medications - for blood pressure and cholesterol and the like, nothing exotic or costly. Even so, with regular visits to the doctor, periodic lab work, the drugs, and the occasional illness or injury, we normally spent an additional several thousand dollars annually in the States over and above the cost of the insurance.

The French do not recognize the American public health insurance plan for retired seniors known as Medicare. There is no reciprocal agreement between our governments. This becomes a problem for Americans when applying for a long-stay visa leading to a permanent residency in France. We must demonstrate that we won't be a burden on the French social system and therefore, before the French embassy or consulate that covers our particular region of the United States will approve our visa request, we must demonstrate among other things that we have a certain level of health insurance. Coverage must equal at least 30,000 euros without a deductible and must include repatriation. A coverage letter (and not just an insurance card) must be presented at the time of application in the US naming the insured(s), length of coverage, amount of coverage, and so on.

Rules change periodically. I am not a professional in the field. This post simply reflects my personal experiences. Research for yourself. Ask questions.

You can buy two types of health insurance to meet the requirements for a long-stay visa. Full coverage health insurance, similar to that which most folks have in the States, or travel insurance.

A number of internationally recognized companies offer full service health insurance for expat Americans in France. AXA, Cigna, Bupa, and BC/BS are well known companies offering plans to Americans but there are a raft of others. Their plans are structured similar to the way that plans are structured in the States with different levels of coverage, different deductibles and co-pays, and different riders and optional benefits. Health status will be questioned and certain pre-existing conditions and prescriptions may be excluded. Coverage may exclude the USA/North America or be world-wide. There may be age limitations. Evaluating plans is not simple stuff...not quite rocket science but not easily understood at first glance. Apples to oranges to pecans in many cases.

Travel insurance from companies like UnitedHealthcare Global and Seven Corners is simple by comparison. You don't pay very much money and you don't get very much coverage. Because it's travel insurance, lost luggage and trip interruption may be covered. But you are moving to France, not spending two weeks on a barge on the Loire, so that's not a very big deal. What can be a big deal is that pre-existing conditions are almost never covered. Your everyday meds are not covered. Regular checkups are not covered. Fall down the stairs and break your leg? Covered. Get caught in the rain and contract pneumonia? Covered. But for most folks who are not accident prone and who have the good sense to stay inside when it's raining, travel insurance will seldom come into play. You'll be paying full retail for your healthcare without much of a backstop.

The cost differential between full-service insurance and travel insurance is significant. For one year of coverage, a couple that we know who are just past retirement age has recently been quoted $3,000 for travel insurance for their first year in France, $25,000 for full-service. Not a typo. $25,000 for two people for health insurance for one year. After the sticker shock wears off, how do you make your choice?

Here's how we helped our friends choose.

1. We took a list of their prescription meds to our local pharmacy in France and asked for the cost of a one month's supply of all of the meds on the list. At full retail without insurance, the extensive list came to about $200 per month - $2,400 per year.

2. I recently had a minor surgical procedure in France. Nothing life threatening but I had an MRI, spent one night in the hospital, had lab work done, had to pay a surgeon and an anesthesiologist, had an EKG and other tests, and had a follow-up visit with the surgeon for a minor in-office procedure without anesthesia. Total at retail? Under $3,000.

3. If I'm not mistaken, at the first of the year the full price for a simple visit to a general practitioner to have prescriptions renewed and a quick checkup will rise to about $27.50. Visits to specialists run from about $100 to $150. As an example, a recent series of visits to a podiatrist for my wife to be fitted for shoe inserts cost us about $115. That amount fully included the cost of the inserts plus an initial visit to measure for the them, a second visit to fit them, a third visit to check on an area of chafing, and a fourth visit to fit some extra padding.

In the end, our friends agreed that there was no reason to pay $25,000 when the cost of care is so reasonable here. If a new illness was discovered during their initial year, not a pre-existing condition, the travel insurance would cover them. Otherwise, it seemed that saving over $20,000 would more than provide a buffer for the actual cost of care that they were likely to incur that travel insurance would not cover.

So our friends bought travel insurance from a reputable company and will apply for residency as soon as they arrive. Once granted residency, they will apply for their cartes vitale. But that's a story for another day.

I repeat, rules change periodically. I am not a professional in the field. This post simply reflects my personal experiences. Research for yourself. Ask questions.