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Understanding 100% health in 6 questions

Understanding 100% health in 6 questions

Eyeglasses, dental prostheses, hearing aids… These medical devices are expensive and the rest is particularly important. To help the French people stay in good health, the government has decided to implement the 100% health reform. Why such a measure? What changes for your health budget? We enlighten you on the subject.

1. The 100% health reform:what is it?
Announced in June 2018, the 100% health plan (or remains at zero charge) provides access to baskets of dental, optical and hearing equipment that meet quality criteria and are fully reimbursed. Professionals (opticians, dentists, etc.) will then have to respect selling prices (POS), which is the opposite of today where they are free to charge the prices they want. Social Security, for its part, is increasing its reimbursements for this equipment. Result:zero out-of-pocket costs for patients who sometimes gave up treatment for financial reasons.

Rest at medium charge:the numbers

According to the Ministry of Solidarity and Health, in 2018, the average remaining charge for:A hearing aid =€850/ear; Optical equipment (single lenses) =€65; A ceramic crown =195 €.

2. Who is the reform for?
Any insured person who has taken out a responsible supplementary health policy in a company or individually will be able to benefit from 100% health baskets for optical, dental and audiology items. All without increasing the average cost of mutuals.

Complementary responsible health:definition

A responsible complementary health contract complies with specifications drawn up by the public authorities. This provides for minimum guarantees and reimbursement prohibitions. At the same time, maximum guarantees beyond which the insurer cannot reimburse have been put in place. These rules allow a reduction in taxation.

3. What changes for my health budget?
In optics
• Opticians must offer a minimum of 17 adult frames and 10 children's frames in 2 different colours, for a maximum of €30.
• The reform concerns all corrections. The lenses will all include mandatory treatments (thinned glass, anti-scratch, anti-reflective, anti-UV).
• It will be possible to choose lenses that meet the conditions of the reform and a 100% healthy non-basket frame.
In dental
• 46% of prosthetic procedures will be fully reimbursed.
• Coverage of fixed or mobile, metal or ceramic prostheses, depending on the location of the tooth to be treated.
En audiology
• Full coverage of high-quality equipment (aesthetic appearance, technical performance).
• Doubling of the basis for reimbursement of hearing aids by Social Security (up to €1,400 (for children under 20).

4. When will the 100% health reform come into effect?
The rest at zero charge will gradually come into effect. Optics and certain prosthetic dental care will open the ball, with full coverage from January 1, 2020. Finally, hearing aids will be fully reimbursed from January 1, 2021.

5. How to benefit from the 100% health reform?
It's very simple. When choosing your glasses or your hearing aid, the health professional will have the obligation to offer you an offer with a zero charge and to draw up an estimate mentioning it. The dental surgeon, for his part, must draw up a detailed estimate of the acts and treatments envisaged. If he offers equipment at free fees, he must, as far as possible, offer you a therapeutic alternative with zero or controlled remainder.

6. And if I have taken out an additional supplement, will it still be useful?
The answer is yes. On the one hand, because the 100% health reform only concerns optical, audio and dental care. Other items such as hospitalization or alternative medicine do not benefit from a zero charge. On the other hand, because there will always be excess fees and benefits not covered by Social Security, including on the 3 positions affected by the reform. Taking out an additional supplement will always be a good way to be fully covered.

Wearing glasses, a hearing aid or having to get a tooth done should soon no longer cost you a penny! The 100% health reform is a real breath of fresh air for the French who have given up care for lack of means.