Moving to the U.S. is an exciting adventure, but the American healthcare system can quickly turn the dream into a financial headache. Between $5,000deductibles and medical inflation, how do you insure yourself without breaking the bank?
In our recent webinar, Eric Pavie (Director of CFE) and Jean-Christophe Pandolfi (Founder of Santexpat) deciphered winning strategies for the French in the USA.
Culture shock: Patient in France, “Client” in the USA
In the United States, healthcare is an industry. As Jean-Christophe Pandolfi points out:
“In the United States, healthcare is highly financialized. You might ask yourself: is the doctor advising me this protocol in my vital interest or for his wallet? That’s why we offer services like second opinions to reassure our expatriates.”
A simple consultation can cost between $150 and $300, while a delivery can cost between $10,000 and $50,000. Without solid coverage, medical contingencies can quickly turn into personal bankruptcy.
A variable-geometry pricing system
Unlike France, where a consultation costs the same everywhere, American rates are free. For the same procedure, the bill can vary from simple to triple, depending on the establishment. An MRI, for example, can cost $1,100 in New York, compared with around €100 in France. Without the “shield” ofappropriate insurance, you are exposed to Surprise Billing, where unforeseen anaesthetist or laboratory fees are added after the fact.
| Type of care | Average cost in France | Average cost in the United States | Out-of-pocket expenses (without US insurance) |
| Generalist consultation | 26,50 € | 150 $à 300$ | 100% of the amount until the deductible is reached |
| MRI / Scanner | ~100 € (Sécu rate) | 1 100 $à 3 500$ | High “Surprise Billing” risk |
| Delivery (vaginal) | ~€2,500 (paid in full) | 10 000 $à 20 000$ | Up to $15,000, depending on your deductible |
| Day of hospitalization | ~1,300 (80% reimbursement) | 5 000 $à 15 000$ | Very high if the hospital is “Out-of-Network”. |
| Emergency call (Ambulance) | Free (SAMU/Fire brigade) | 800 $à 2 500$ | Often not covered by basic insurance |
The lexicon of financial responsibility
Becoming a customer also means managing your own financial risks via three pillars unknown in France:
- Deductible: The amount (often between $3,000 and $6,000) you must pay in full before the insurance begins to pay out.
- Copayment & Coinsurance: Your out-of-pocket expenses for each procedure, even after you’ve paid your deductible.
- In-Network: In the USA, being insured is not enough. You need to check that your doctor belongs to your insurer’s network, otherwise your reimbursements will be drastically reduced.
Medical excellence… but “defensive” medicine
American medical technology may be the best in the world, but it’s also the most “aggressive”. To protect themselves from legal action, doctors sometimes multiply the number of additional tests required. This medical consumerism makes it essential to be accompanied by an expert like Santexpat: our role is to check the consistency of estimates and negotiate invoices via Cost Containment, so that you remain an informed customer and not a financial target.
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CFE : More than an option, a universal “safety net
Many expatriates mistakenly believe that CFE is useless when faced with the exorbitant cost of American healthcare. Yet CFE is much more than just insurance: it’s the social security system for French expatriates.
Created in 1978, CFE is a private organization with a public service mission, under the supervision of the Ministries of Health and Budget. Its mission? To enable expatriates to retain the benefits of the French social protection system, whatever their country of residence. As Eric Pavie reminds us
“CFE is the only organization that does not select on entry. We insure every French person, with no medical questionnaire and no age barrier, guaranteeing a universal base.”
Why is CFE your best ally in the USA?
Although it covers only a portion of actual expenses in the U.S., CFE offers coverage that no local insurance company can provide:
- No exclusions: Unlike American insurers who may scrutinize your medical history, CFE covers you regardless of your medical history (no selection on file).
- Continuity of rights: the key to your mobility. By joining, you avoid gaps in coverage. When you return home for good, you’ll rejoin the French system immediately, without the three-month waiting period usually imposed on French nationals returning from abroad.
- The Carte Vitale abroad: By maintaining your affiliation to the French system via the CFE, you keep an active Carte Vitale. It can be used during your temporary stays in France (vacations, scheduled treatment), enabling you to benefit from third-party payment in pharmacies and simplified reimbursements.
The Winning Combo : Why combine CFE and complementary health insurance?
In the U.S., CFE alone covers only around 20% of actual expenses. That’s where Santexpat comes in. Contrary to popular belief, adding the two together is often more economical than private insurance alone.
Jean-Christophe Pandolfi explains the mechanics:
“Every other time, it costs less to take out a CFE + Complementary policy. Why is this? Because the insurer, by sharing the risk with CFE, reduces its costs. This enables us to offer premium increases of only 4 to 6%, whereas American contracts are subject to increases of 15 to 25% a year.”
The concrete benefits of the combo :
- Premium stability: By delegating part of the reimbursement to the CFE (particularly for heavy treatment), the supplementary insurer reduces its exposure. Your premiums are more manageable over time.
- Guichet Unique: Thanks to agreements between CFE and Santexpat, you submit your applications only once. Coordination is automatic.
- Peace of mind in the event of serious treatment: If you choose to return to France for a serious pathology (cancer, surgery), the combo guarantees you total care in your medical and family “comfort zone”.
Mastering American specificities: Cost Containment
In the USA, the bill often depends on negotiation. Santexpat not only reimburses, but also acts as a price shield. Thanks to our cost containment service, every hospital bill is checked and negotiated.
“We check that invoices are in line with the pathology and local cost in your region. A treatment in New York doesn’t cost the same as in Texas,” explains Jean-Christophe Pandolfi.
Services that make all the difference :
- Access to major networks: United Healthcare, Aetna, Blue Cross Blue Shield (third-party payment included).
- Expertise Maternité: Specific support (Centre Neuf Mois) to avoid delivery bills of up to $50,000.
- Second medical opinion: The possibility of having your diagnosis reviewed by French experts, to avoid American “over-medicalization”.
Retirement: Don’t sacrifice your future
Expatriation need not be a parenthesis in your career. The CFE allows you to continue contributing to the basic French pension scheme on the same income scale as in France.
“It’s a shame to come back to France with a considerably reduced pension because you didn’t take the precaution of contributing for a few years abroad,” warns Eric Pavie.
What to check before you leave :
- The waiting period: Join CFE within 3 months of your arrival for immediate coverage.
- Tax compliance: Santexpat provides the forms (1095) required for your IRS (US tax) returns in states such as California.
- 24/7 assistance: Thanks to AgoraExpat’s presence in New York, you have a French contact in your time zone.
The American system is efficient, but merciless to the unprepared. As Jean-Christophe Pandolfi sums up: “You shouldn’t go to the USA without taking precautions. Health problems can happen to anyone, even the youngest. “Need a personalized diagnosis? Compare CFE + complementary health insurance solutions for the USA on Santexpat.fr
