Expatriating to the United States is an exciting adventure, but the American healthcare system is also the most expensive in the world. Understanding how it works, the cost of care and the insurance solutions available is essential to avoid unpleasant surprises. Here’s expert advice for French expatriates.
During our recent webinar with the American Chamber of Commerce, experts from CFE, Santexpat and HealthCase shared their advice. They explained how to protect your health in the United States. They also gave tips on how to protect your wallet.
How much does healthcare cost in the United States? Comparison with France
By way of introduction, Xavier drew a stark conclusion. The United States spends over $4.5 trillion a year on healthcare. In France, the figure is just 400 million. While 92% of Americans are insured, the out-of-pocket expenses can be devastating.
Unlike France, where healthcare rates are regulated by the State, the United States has a “Free Market Healthcare” system. Each hospital, laboratory and specialist sets its own prices.
- Routine consultation: expect to pay an average of €150 for a 15-minute consultation with a Primary Care Physician (GP), where the French standard rate is €26.50.
- The surgical procedure: a hip replacement, quoted by Xavier at €20,000, can even reach €40,000 in certain private establishments in Manhattan if you are “out of network”. In France, the full cost (including hospitalization) rarely exceeds €8,000, which is fully reimbursed.
In New York, the financial risk is major. As Xavier points out:
“Having an emergency health problem in New York City is a major financial risk if you don’t have insurance, because the immediate bill is very high.”
What is the “Out-of-Pocket Maximum” in the American healthcare system?
Even with insurance, 92% of Americans are exposed to the “Out-of-Pocket Max”. This is the maximum amount you have to pay out-of-pocket before insurance will cover everything.
- In France: The remaining cost (ticket modérateur) is often just a few euros.
- In the USA: It is not uncommon to have an annual out-of-pocket expense capped at $9,450 for an individual or $18,900 for a family (the Affordable Care Act’s legal ceilings for 2024). It is this “reste à charge” that causes the majority of personal bankruptcies in the United States.
Expert Zoom: Obesity, a public health issue in the USA
In addition to these exchanges, it is interesting to note that 35% of American adults are obese, compared with an average of 19% in wealthy countries. This statistic, cited during the webinar, explains the prevalence of chronic illnesses (diabetes, hypertension) that drive up local insurance premiums. Choosing flexible international coverage often helps to manage these risks over the long term.
PPO Network: how to reduce the cost of healthcare in the United States
To avoid paying the “Chargemaster” (the list price, often inflated by 300 to 600% compared with the real cost), it’s imperative to use a PPO (Preferred Provider Organization) network.
HealthCase provides access to giant networks such as Aetna, UnitedHealthcare and Multiplan, comprising over a million professionals and 7,000 hospitals. The advantage is twofold:
- Negotiated rates: When you join the network, you automatically benefit from wholesale discounts negotiated by these insurers.
- Direct Billing: This is the crucial point. By presenting a recognized local insurance card, the insurer pays the hospital directly. This saves you from having to advance sums that can be as high as the price of an apartment.
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CFE: social security for French expatriates
For many French people in the USA, the Caisse des Français de l’Étranger (CFE ) is much more than just a reimbursement fund: it’s the assurance that they’ll never be “out of the system”. RachidaKaci, CFE Marketing Director, reminded the audience that this private organization with a public service mission is the guarantor of the French social model, even 6,000 km from Paris.
Why CFE is essential for expatriates in the United States
In the U.S., signing up for local private insurance can be an obstacle course, especially if you have a medical history. CFE breaks down these barriers:
- Zero medical questionnaire: No matter what your current state of health, you’re accepted.
- No age limit: Unlike private insurers, who drastically increase their rates or cease coverage after age 65 or 70.
- Immediate continuity: If you join within three months of leaving France, there is no waiting period. You’re covered from day one.
How does the CFE refund work?
CFE operates in the same way as the French social security system. Reimbursements are based on the French convention rates.
Example: For a consultation with a GP in New York at a cost of €150, the CFE will apply the French rate (around €26.50) and reimburse 70% of this amount, i.e. around €18.
This amount may seem derisory compared with American prices. Yet the CFE plays an essential role. As Jean-Christophe from Santexpat points out, it serves as a basis for reducing the cost of your complementary health insurance.
The strategic advantage: Returning to France and the Carte Vitale
This is undoubtedly the strongest argument for expatriates: maintaining ties with France.
- Scheduled care: For major, costly operations in the USA (surgery, complex dental care), CFE allows you to return to France for treatment at French rates.
- Total transparency: Thanks to technological agreements, CFE allows you to keep or create your Carte Vitale. During your vacations or stays in France, you can use your card at the doctor’s or chemist’s as if you’d never left. Third-party payment applies, and you don’t have to pay the basic part of the bill in advance.
As Rachida Kaci sums it up perfectly:
“CFE stands for universality, for health insurance for all. Our role is to insure all French people, wherever they are in the world, without excluding any country.”
It is this notion of solidarity and continuity that makes the CFE a sensible choice, particularly in a country where health is treated as a luxury financial product.
Expatriate health insurance: why supplement CFE
Jean-Christophe Pandolfi, CEO of Santexpat, explained why combining CFE with supplementary insurance is often the most economical solution.
“CFE top-up rates are often lower than the ‘first euro’, as the insurer is reassured to share the risk of major hospitalization with the Caisse des Français de l’étranger.”
Santexpat does not limit itself to reimbursements. The company offers practical services for expatriates. You can access teleconsultation in French and maternity support via WhatsApp. Thanks to their recent union with Agora Expat in New York, you can also benefit from local healthcare networks.
How to prepare your health coverage before leaving for the United States
Whether you’re on VIE, an entrepreneur or retired, one rule applies. Always leave with appropriate health coverage. The American system doesn’t allow for improvisation.
The excellence of French social protection can be exported, as long as you choose the right partners. Combine the solidarity-based foundation of CFE, the digital and human expertise of Santexpat and the power of HealthCase’s healthcare networks. You reduce a major risk to a simple administrative formality. Need personalized advice for your departure?
