The number of people without a mutuelle top-up health insurance policy is reported to be on the rise again.
Governments have made efforts to tackle the problem for years and progress was considerable.
The last big survey, in 2019, showed a record low of 3.6% of the population – 2.5 million people – without top-up insurance. Most were from low-income groups.
Comparable figures from 1996 showed 14% of the population were without a policy.
More recent statistics are not yet available. They will be collected in 2025 as part of a six-yearly review of Europe’s health services.
Read more: Top-up health insurance firms confirm big price rises in France
French people surprised at mutuelle cost once they retire
However, rising premiums have led to several press reports speculating that people are leaving these policies.
This is despite legislation requiring all salaried workers, including those in small firms, to have a mutuelle.
Many French people have expressed surprise at the cost of mutuelles once they retire.
Couples in their 60s now pay an average €250 a month for top-up health insurance, which rises to €300 for the over-70s, according to a recent survey by online broker Meilleurtaux.
Work-linked health insurance plans are much less costly than individual ones, as at least 50% of the price is usually borne by employers.
Bosses are also able to join collectives to negotiate prices down by buying in bulk.
Read more: Top-up health insurance increasingly expensive for over-60s in France
Insurance companies absorbed €1.5billion in additional costs
In autumn, insurance trade bodies published a joint statement as parliament debated the health budget, warning that mutuelle fees will have to rise.
They claimed that in 2023 they had seen a 4% increase in payouts, and had already absorbed €1.5billion in additional costs without pushing up prices.
“Complementary health insurance providers are aware of the major role they play in providing healthcare for French people, but they cannot run at a deficit,” the statement said.
Across the sector as a whole, increases were estimated at between 8% and 12.5% in 2024, although the then-Health Minister Aurélien Rousseau criticised these projections as “untenable”.
In December, he called for a more limited increase in premiums of 4% to 5%. Mr Rousseau has since resigned over the new immigration legislation.
The government drive to extend top-up health insurance, and other measures such as tiers payant (where most doctors’ bills, prescription medicines and treatments, some dental work and hospital bills are settled without the patient paying anything) means that not having a policy now raises eyebrows in surgeries and pharmacies.
Read more: Claiming free or cheaper top-up French health insurance to get easier
Gamble on staying healthy
Nevertheless, some people are prepared to gamble on staying healthy – not least because standard assurance maladie officially covers, on average, 76.8% of costs, according to 2019 Health Ministry figures.
For those with affectionsde longue durée (long-term illnesses), this rises to 100%.
In practical terms, it means that people with conditions such as cancer, multiple sclerosis or diabetes, or who are recovering from the long-term effects of stroke have little left to pay unless they want additional comforts, such as a private hospital room or TV.
Costs can add up
Where injuries or accidents come into play, however, cancelling top-up insurance can be a false economy and can quickly drain savings accounts.
In France, doctors rarely have in-house facilities, so a twisted knee, for example, will involve an appointment with a general physician, an X-ray, either at a hospital or an independent centre under the doctor’s prescription, and another appointment with the physician to discuss the results and decide if physiotherapy or prescription medicines might help.
It all adds up, and the twisted knee can end up costing €50 or more without a mutuelle.
Those requiring hospital stays – for example, to operate on a broken bone – can face much higher bills.
While the state health system pays 80% of the costs of basic hospital fees, it does not cover the fixed €20 per day for meals and board, nor the charge of €24 for some medical procedures costing more than €120.
Extra fees, known as dépassements d’honoraires, above and beyond the standard fixed state rates, are also sometimes demanded by surgeons and anaesthetists.
These are often opaque or not fully explained on admittance, so even with a good mutuelle, a bill of €200 for day surgery is common.
Some mutuelle providers now offer cover just for hospital expenses, with premiums of around €80 to €120 a month.
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