Older people with low incomes can benefit from aid to enable them to finance their health expenses. This financial support concerns expenses reimbursed by health insurance, but also those covered by complementary mutual insurance companies. The details of these aids and explanations
Elderly people with low incomes can benefit from two kinds of aid from the Health Insurance to meet their health expenses.
With complementary universal health coverage (CMU-C), which is free, elderly people with low resources benefit from 100% coverage of their care without having to pay the costs in advance. These may be health expenses incurred at the doctor's office, at the pharmacy, in a medical analysis laboratory, at the hospital, at the dentist's, etc. This coverage also concerns the part of health expenses not reimbursed by Social Security (excess for glasses and glasses, for dental and hearing aids, etc.) and the daily flat rate due in the event of hospitalization. With the CMU-C, elderly people with modest incomes also do not pay the flat-rate contribution of 1 euro normally payable by all those insured by social security.
To benefit from the CMU-C, it is mandatory to enroll in a coordinated care course prescribed by a declared attending physician.
Three conditions must be met to be able to benefit from the CMU-C:you must have resided in France for more than 3 months; be in a regular situation on French territory and have a modest income.
The annual resources (salaries, allowances, pensions, rents, etc.) taken into account to benefit from the CMU-C are those of the 12 calendar months preceding the application. They must not be higher in metropolitan France than 8810 euros for a single person, 13215 euros for 2 people, etc. The CMU-C also applies to the beneficiary's spouse or partner.
The request for CMU-C is possible online via the personal account of each Social Security insured. It is then sent to the primary health insurance fund of residence or attachment for processing, which then has 2 months to submit its response.
The CMU-C can be managed by the beneficiary's health insurance fund or by an authorized complementary organization which must be registered on the list of organizations participating in the complementary CMU. Their list by department is available on the cmu.fr website.
The request for CMU-C must be renewed every year.
Assistance for complementary health care (ACS) is intended for people who have low incomes but who exceed the ceiling allowing them to benefit from CMU-C. The ACS allows the person concerned to receive financial assistance to acquire additional health cover, and therefore help them pay their health expenses. This aid also entitles you to other health benefits:medical tariffs without exceeding fees as part of a course of care; exemption from the financial contribution of 1 euro due in connection with health expenses; exemption from medical deductibles and third-party payment.
The ACS is subject to means and residence conditions. Regarding resources, to be able to benefit from this aid, the elderly person must not have an annual income that exceeds 11,894 euros if they live alone, or 17,840 euros for 2 people. Note that these ceilings are increased in the overseas departments and territories, except in Mayotte where the ACS is not applicable.
The residence condition requires living in France for more than 3 months. But this period is not required for the elderly who receive certain allowances such as the Allowance for the elderly (Apa) or the Allowance for disabled adults (AAH).
People aged 60 and over with low incomes receive an aid of 550 euros per year from the ACS to help them pay for complementary health insurance. This amount is paid in the form of a check certificate to be given to the complementary body. Please note that the ACS mainly finances so-called approved complementary health contracts, that is to say, selected by the State for their quality/price ratio. The list of contracts concerned is available on the ameli.fr website.
The request for ACS is made to the insured's health insurance organization by sending a form (Cerfa n°12504*07 or S3711h), accompanied by supporting documents, in particular concerning resources.
The health insurance organization has 2 months to announce its decision. Without a response within this period, the request is considered accepted. The ACS is granted for a period of 1 year, after which it is necessary to renew the request. Elderly people who benefit from the Solidarity allowance (Aspa) are entitled to the automatic renewal of the ACS.
Complementary health insurance governed by the Code de la mutualité has, as part of their social policy, aid systems (social action funds) to help low-income elderly people cover their health expenses on an ad hoc basis. This aid makes it possible, for example, to help pay for an out-of-pocket payment for expensive medical care or it can take the form of a financial contribution which covers a contribution to complementary health insurance.
This aid is subject to resource conditions defined independently by each complementary health organization.
