The medical deductible is a compulsory deduction from the Health Insurance on the reimbursement of medical expenses. Are you concerned? How much are these charges? Can health insurance reimburse this deductible? We tell you everything.
WHAT IS THE MEDICAL DEDUCTIBLE?
Simply the medical deductible
When reimbursing Social Security, a fixed amount is deducted from these three items:
prescribed medications,
medical and paramedical acts, during a course of care, whether coordinated or not,
medical transport.
This is called the medical deductible.
This levy, in place since 2008, has a dual purpose:
participate in the bailout of the famous "safety hole",
to empower the French to avoid non-essential health expenses.
Good to know: the medical deductible and the flat-rate contribution are two very different things. The second is a compulsory deduction of €1 on any medical act, whether it is a consultation with a health professional, radiology examinations, or medical analysis.
Am I affected by this franchise?
Only a few categories of patients are not affected by the medical deductible. It's about :
members of the CMU,
minors,
pregnancies and maternity (within a range from the 6th month of pregnancy to the 12th day following delivery).
WHAT ARE THE AMOUNTS OF THE MEDICAL DEDUCTIBLE?
The amount per health benefit
Health Insurance provides a grid of fixed deductible amounts depending on the service.
Health benefit Deductible amount
Paramedical act 50 cents
Medicine box (single) 50 cents
Consultation with a general practitioner 1€
Medical transport 2€
Hospitalization (clinic, public hospital) 18 €
Hospitalization (psychiatry) 13€
Is the medical deductible capped?
Yes, the accumulation of medical deductibles cannot exceed two types of ceilings.
A daily cap applies:
paramedical acts, for which Social Security can charge a maximum of €2 per day,
medical transport, for which the maximum levy is €4.
An annual ceiling is set at €50 per year per patient, all health services combined.
HOW IS THE MEDICAL DEDUCTIBLE CHARGED?
What are the means of payment for medical deductibles?
If you do not benefit from third-party payment, you pay the fees for your consultation with a health professional or medicine in a pharmacy. Social Security then deducts the appropriate medical deductible directly from the total amount of your reimbursement.
If you benefit from third-party payment, you do not pay the health costs generated by treatment. In this case, the deductible cannot be deducted directly. It is then later reimbursed for another health expense.
But if all of your health expenses have been covered by the third-party payer, at no time can the deductible be collected on one or more reimbursements. Your health insurance fund then sends you a letter notifying you of the amount you must pay directly.
Is the medical deductible reimbursed by your mutual health insurance?
As policyholders are not reimbursed for the medical deductible by Social Security, can they be reimbursed by their complementary health insurance?
Not if it is a “responsible contract”. This type of mutual is indeed subject to constraints and reimbursement ceilings. The medical deductible cannot in any case be included in its reimbursements.
If your contract is not said to be responsible, the medical deductible may very well be covered by your mutual insurance company, if your guarantees provide for it. This remains relatively rare, the deductible not being part of the co-payment. So be sure to check the terms of your current contract.
Good to know :
The co-payment is the sum remaining payable by the patient once the reimbursements from Medicare have been deducted. This advance of costs may be reimbursed in part or in full by the insured's mutual insurance company, depending on the guarantees contracted. The latter can, for example, reimburse doctors' overruns or the percentage of the price of medicines not covered by Social Security.
In short, this compulsory Social Security deduction remains your responsibility most of the time. With capped daily and annual amounts, this deduction remains reasonable and aims to empower patients.
However, if you wish to be reimbursed for this medical deductible, it is up to you to find a non-responsible mutual insurance contract offering it.
THE MEDICAL FRANCHISE: WHAT IS IT?
The medical deductible is a compulsory deduction from the Health Insurance on the reimbursement of medical expenses. Are you concerned? How much are these charges? Can health insurance reimburse this deductible? We tell you everything.
WHAT IS THE MEDICAL DEDUCTIBLE?
Simply the medical deductible
When reimbursing Social Security, a fixed amount is deducted from these three items:
prescribed medications,
medical and paramedical acts, during a course of care, whether coordinated or not,
medical transport.
This is called the medical deductible.
This levy, in place since 2008, has a dual purpose:
participate in the bailout of the famous "safety hole",
to empower the French to avoid non-essential health expenses.
Good to know: the medical deductible and the flat-rate contribution are two very different things. The second is a compulsory deduction of €1 on any medical act, whether it is a consultation with a health professional, radiology examinations, or medical analysis.
Am I affected by this franchise?
Only a few categories of patients are not affected by the medical deductible. It's about :
members of the CMU,
minors,
pregnancies and maternity (within a range from the 6th month of pregnancy to the 12th day following delivery).
WHAT ARE THE AMOUNTS OF THE MEDICAL DEDUCTIBLE?
The amount per health benefit
Health Insurance provides a grid of fixed deductible amounts depending on the service.
Health benefit Deductible amount
Paramedical act 50 cents
Medicine box (single) 50 cents
Consultation with a general practitioner 1€
Medical transport 2€
Hospitalization (clinic, public hospital) 18 €
Hospitalization (psychiatry) 13€
Is the medical deductible capped?
Yes, the accumulation of medical deductibles cannot exceed two types of ceilings.
A daily cap applies:
paramedical acts, for which Social Security can charge a maximum of €2 per day,
medical transport, for which the maximum levy is €4.
An annual ceiling is set at €50 per year per patient, all health services combined.
HOW IS THE MEDICAL DEDUCTIBLE CHARGED?
What are the means of payment for medical deductibles?
If you do not benefit from third-party payment, you pay the fees for your consultation with a health professional or medicine in a pharmacy. Social Security then deducts the appropriate medical deductible directly from the total amount of your reimbursement.
If you benefit from third-party payment, you do not pay the health costs generated by treatment. In this case, the deductible cannot be deducted directly. It is then later reimbursed for another health expense.
But if all of your health expenses have been covered by the third-party payer, at no time can the deductible be collected on one or more reimbursements. Your health insurance fund then sends you a letter notifying you of the amount you must pay directly.
Is the medical deductible reimbursed by your mutual health insurance?
As policyholders are not reimbursed for the medical deductible by Social Security, can they be reimbursed by their complementary health insurance?
Not if it is a “responsible contract”. This type of mutual is indeed subject to constraints and reimbursement ceilings. The medical deductible cannot in any case be included in its reimbursements.
If your contract is not said to be responsible, the medical deductible may very well be covered by your mutual insurance company, if your guarantees provide for it. This remains relatively rare, the deductible not being part of the co-payment. So be sure to check the terms of your current contract.
Good to know :
The co-payment is the sum remaining payable by the patient once the reimbursements from Medicare have been deducted. This advance of costs may be reimbursed in part or in full by the insured's mutual insurance company, depending on the guarantees contracted. The latter can, for example, reimburse doctors' overruns or the percentage of the price of medicines not covered by Social Security.
In short, this compulsory Social Security deduction remains your responsibility most of the time. With capped daily and annual amounts, this deduction remains reasonable and aims to empower patients.
However, if you wish to be reimbursed for this medical deductible, it is up to you to find a non-responsible mutual insurance contract offering it.
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