Don’t Count Your Chickens Before They Hatch: a Look at the Proposed Healthcare Amendment

A couple weeks ago an article ran in The Local by journalist Genevieve Mansfield titled “French MP’s target American retirees for new health charge.”

While there is truth in the statement, the title alone might lead you to jump to conclusions. The article started a big discussion among all of our close advisors —tax attorneys and advisors, certified accountants, immigration attorneys, financial advisors, etc.—not to mention comments and questions from many in our audience. We saw Facebook groups and other online bloggers rise to the occasion, and it’s for this reason I’m writing about it now myself…to put your minds at ease.

We tell our clients that when they get a “Carte de Séjour Visiteur” from the French government, it will give them the RIGHT to the French healthcare system…which is true. France explicitly considers access to healthcare to be a fundamental right, not a privilege—and that right applies not only to citizens, but also to legal residents. After 90 days of living in France, a new French resident is entitled to apply with “Protection Universelle Maladie” (PUMA) through their local CPAM office to get the same kind of coverage any French person has, even though they never paid into the system.

So, what’s all the fuss? France needs money to support this fabulous system, so they’re looking for it in the nooks and crannies. An amendment, NOT YET VOTED on, is before the parliament proposing that “foreign, non-EU-EU/EEA nationals holding the ‘visitor’ residency status be required to pay a specific contribution, under conditions set by decree, in order to open and maintain rights to healthcare.” An explanation of the amendment specifically mentioned American retirees.

Of course it did. Americans come to France with plenty of money. They also end up contributing healthily to the inheritance tax pool if they stay in France, become tax resident and die here, leaving a good portion of their wealth to the French government…so what’s a little healthcare, when the big pot of gold is in the inheritance taxes?

I work in France and pay high social security taxes (URSSAF)—to the tune of about 45% of my earnings. In the U.S., that equates to FICA’s 15.3%—so it’s almost three times the amount…but I have three times the benefit, too. It has never bothered me that I pay this large sum to the government in exchange for such wonderful healthcare and have never begrudged retirees moving here and having the same advantage I have. Just the opposite, in fact. I agree with France that healthcare should be a RIGHT, not a privilege and that EVERYONE has access to good and inexpensive healthcare, thanks to the people who work in France and pay social security taxes.

I have never met an American retiree who moved to France and paid for access to French healthcare. By law, they are expected to, but the system till now isn’t set up for it. There is also the France-US tax treaty to take into consideration.

In a previous interview by The Local, Jonathan Hadida, from Hadida Tax Advisors—with whom we work very closely and fully trust to advise our clients—told The Local, “At the present time, it appears that URSSAF has been treating US pensions/social security akin to the French/European/Swiss pensions.”

Don’t count your chickens before they hatch. Even if the amendment passes, how will it be implemented? And even then, how on earth will they go about assessing it? And then, if they can assess it, how expensive will it be?

Considering that healthcare costs in the US are 10 times what they are in France, one might imagine that the assessment, should it actually happen, be one-tenth of what your current healthcare bill is in the US. This is nothing to lose sleep over and it’s certainly NOT a reason to give up your idea to move to France. Au contraire—it’s even more of a reason to move to France!

Here’s more information and how you register to be on the French healthcare system. Do it now, before anything changes!:

Who qualifies for PUMA?

• Anyone who has lived in France for more than three months with the intention of living there for at least six months.
• Those who are working in France and have their contributions automatically deducted from their salary.
• Those not working but whose spouse/civil partner earns above a certain threshold (9,655€).
• Those not working and whose household taxable income is below a certain threshold (9,655€).
• Individuals covered by an S1 or A1 form, such as certain UK pensioners in France.

Note: PUMA is not entirely free: Some residents are required to pay the “Cotisation Subsidiaire Maladie” (CSM), an annual tax based on income.

During the first three months of residency, you are not automatically covered by PUMA. You will need to obtain private health insurance to cover costs during this period. To obtain a visa, the immigration authorities will want to see one full year of coverage!

Register through your local CPAM office: You can apply to register for PUMA at your local Caisse Primaire d’Assurance Maladie (CPAM).

Register online: Online registration options are also available on the Ameli website.

Wait for documents: After registration, you’ll receive a temporary social security number and then an “attestation de droits à l’assurance maladie” (proof of right to health insurance), which you can use for medical care.

Apply for a Carte Vitale: Once you have your social security number and document, you can apply for a “carte vitale” (health insurance card).

Note: One of our advisors was pleased to announce that he will be meeting with the député who put forth the provision very soon to talk about PUMA contributions and other important matters.

Here’s what he wrote:

“On the PUMA side of things, it sounds like the general consensus amongst American retirees is that we want what is fair, and that we’re willing to pay our fair share. That we show up at the point of our life when we need the most medical intervention, and that it’s free and paid for by the taxpayers of a different country, and never receive a bill, isn’t fair. It has always been a loophole in the system. I think it’s just for France to have us pay our fair share. The discussion will be with regards to what is a reasonable amount, if it is in fact a standard amount, and I do plan on talking with the député who drafted the amendment about this, in my meeting with him on Dec. 2nd.”

Meanwhile, don’t count your chickens before they hatch…

But do count your turkeys! Our Thanksgiving Dinner in Nice is fully booked with 100 soon-to-be happy diners! I’m sorry to be missing it myself…but hope not to next year!

Happy Thanksgiving to all!

A la prochaine…