most people who have a top-up healthcare policy – a mutuelle – can obtain glasses and certain dental prosthetics free of charge from this year.
This is due to the new 100% Santé scheme, an election promise of President Macron which aims to rectify a situation where many people are put off buying glasses or getting dental work because of the high cost.
The changes do not benefit people who have very high insurance cover for these health areas, but this is not the case for the majority of less expensive policies.
Outside the 100% Santé system, for example, glasses in France are reimbursed for adults at 60% of a fixed state tariff of €2.84 for the frame, plus €2.29-€24.54 per lens depending on strength.
A person with a mutuelle that reimburses only up to 100% of the state tariff could therefore be left having to pay hundreds of euros.
The government estimates that a person with an “average” mutuelle would previously have paid around €65 after reimbursement (compared to zero with 100 Santé) out of a typical €290 cost for a pair of glasses.
Similarly, the basic state tariffs used as a basis for reimbursement for dental prosthetics such as crowns and bridges are, outside the new scheme, often hundreds of euros less than the actual costs usually charged.
People can still opt for glasses or prostheses that are outside the scheme – and pay for them – if they want a certain brand, but the government says they do not need to do so to have good quality material.
This is providing their mutuelle is of a “responsible” kind and compatible with the scheme, but this applies to 95% of mutuelles in France.
The 100% Santé will be extended to hearing aids from 2021 but hearing aid shops are already meant to offer a range at moderate, capped costs.
All opticians’ shops must now stock a range of 100% Santé glasses.
They must offer a choice of at least 17 frames for adults and 10 for children, and two colours, at a fixed price of no more than €30.
Some go much further, such as Direct Optic – with actual shops as well as selling online – which states it has a choice of 300 100% Santé frames.
A range of lenses must also be available for different prescriptions and of good quality, including slender, toughened lenses with anti-scratch and anti-reflective treatments.
For those who buy their glasses in models outside the 100% Santé, however, the reimbursement may now be more limited than before.
“Responsible” mutuelles should now not reimburse the frame at more than €100, as opposed to a cap of €150 before the reform.
It will be possible to combine a 100% Santé frame and ordinary lenses, or vice versa.
If you opt for the 100% Santé range, depending on whether the shop is accredited with the health network to which your mutuelle belongs, you might have nothing to pay upfront – known as le tiers payant.
Otherwise, you have to pay, then obtain a reimbursement from your mutuelle. This also applies if buying glasses from an online optician.
The manager of an Optic 2000 optician’s shop in Ile-de-France told RTL radio the new range is nothing like the old “lunettes Sécu” he wore as a child. British people may remember “NHS glasses”, which were also known for being functional but ugly.
“These look a lot nicer, they’re perfectly acceptable and very suitable to wear,” he said.
Contact lenses are not included in the new scheme.
The 100% Santé applies to crowns and bridges.
To be covered under it, the fittings may include metal in less visible parts of the mouth and white ceramic at the front.
“Moveable” prosthetics, ie. dentures, will be included from next year.
You should ask your dentist for a formal estimate for the work you want done – un devis – which should indicate on it a range of options, whether under the 100% scheme or otherwise.
Prosthetics work can now come under three headings: 100% Santé; at moderate rates within set ceilings; or at a free market price if you want the most sophisticated models.
Before the reform, an adult having a ceramic crown fitted paid on average €550, with €195 of that non-reimbursed.
Now the costs under the 100% Santé will be capped at €500 and fully reimbursed.
Dentists are offering the same services as before, but with some standard procedures now offered under the 100% Santé.
This differs from glasses manufacturers, who have come up with dedicated 100% Santé ranges.
Philippe Denoyelle, president of the Dental Union, said: “We’ll be fitting exactly the same products, with the same quality as before.”