PUMa Countdown
Entering the French Healthcare System
In a few weeks I’ll have been back in France for 3 months, making me eligible to apply to participate in the PUMa health scheme. PUMa is the acronym for Protection Universelle Maladie; the system that guarantees access to healthcare in France for everyone who legally resides in the country (for 3 months or longer). I’ve been getting my application documents in order and have downloaded the PUMa application.
I had a meeting last week at OFII the French office of immigration and integration (l’Office Français de l’Immigration et de l’Intégration). The meeting was a basic health screening and the office was easy to get to using the (free) tram. They pricked my finger and tested my blood for hepatitis and checked my blood sugar. They asked about my past surgeries, current medications, and parental health, and reviewed my vaccination records. They measured my height and weight and tested my blood pressure. At the end of the meeting I was given three copies of a letter, to be given to the prefecture, the PUMa administrator, and a copy for myself. I was told not to give the originals away to anyone except for the prefecture; everyone else gets only a copy!
This was actually my second appointment with OFII, I had another appointment about a year ago but we had decided not to apply to enter the healthcare system at that time. Oddly, Carolyn has not been called for an interview yet, neither last year nor this year.
I’m happy to report that my French has improved dramatically over the past year. At my previous meeting I had barely been able to communicate and relied on the nurse’s English skills (which were weak, but stronger than my French). On this visit I was able to communicate effectively, and it was SO encouraging; in that moment, my French language success made me happier than the negative Hepatitis A test!
All told the meeting itself took only about 30 minutes. The nurse who interviewed me was very kind and funny (she called me a “rocker” when she was unable to draw blood pricking the finger of my left hand because of the thick callouses on my fingertips from playing guitar). I was impressed with everyone I interacted with at the OFII building. To a person they were cheerful, helpful, and patient—dedicated to their mission of helping people integrate into French life/culture/bureaucracy.
In the waiting room there was a picture of President Macron and a large, colorful cutout of the OFII logo. I couldn’t help but think how very different this was from America: a bureaucracy staffed by cheerful, helpful people. I was in a clean building flooded with natural light, and proudly displaying a logo that literally depicts a rainbow of different people, and whose mission is to help immigrants get healthcare and integrate successfully into a new culture. Of course, this struck me because at the time of my appointment the US government was shut down over the issue of whether as a country we were going to help make health care affordable for everyone (spoiler alert: we are not). One of the parts of the government that didn’t shut down was the army of ICE thugs terrorizing American cities as they attempt to round up and deport immigrants.
I’ve been noticing healthcare stories lately:
We had dinner last night with an American couple, one of them had broken a leg in Paris and was impressed by the treatment she received. They had to pay a big bill before the hospital released her. Fortunately, they were reimbursed by a combination of medicare and a travel insurance policy.
We saw an American comedian who lives here now and who told the story of getting hit by a bus and being impared for months—she didn’t go into medical debt or lose her job, both plausible outcomes if she had been injured in the US.
And of course our own experiences paying out of pocket for basic care at the doctor, pharmacist, and dentist and being shocked that the costs (with no insurance) are often less than our co-pay (with insurance) back in the US.
One of the signs you are an American adult is that November stops being about Thanksgiving or black Friday and starts being about the open enrollment period for the ACA/healthcare exchange. We haven’t signed up for a new plan yet and our PUMa entry will complicate the decision making. We’d like to avoid paying premiums for coverage we can’t access for the 6-8 months of the year we are in France. I’ve been researching options but our situation is unusual enough that there’s no clear, easy answer. I have no idea whether we’ll end up buying expat insurance, signing up for evacuation insurance to return us to France if we’re gravely injured/ill in the US, or if we should buy a regular ACA plan and cancel it when we leave the country each year. One of our consultants suggested a meeting with a health care adviser and we’ll do that soon. I promise to let you know what we decide!
à la prochain!
Roberto & Carolyn
I have a vivid memory of going through a horrific cattle call health screening in Paris in 2002 that was for non-EU migrants. French ladies screaming orders at everyone in French to take off our shirts, being marched around bare chested in front of everyone, roughly questioned “vous etes enceinte?” ARE YOU PREGNANT” at the last second before being ex rayed for TB. The wonen who didn’t understand the question were roughly patted about the belly and asked PAS DE BEBE? ( no baby in there?). Then handed films of our lungs and told to take them across town to some other office within the day or no dice. It was wild. Glad things have improved (or maybe it’s just París?).
Yes please send your recommendations and experience with a healthcare advisor. My retirement is 2 yrs. out and will have 5 years self-insured until I'm eligible for MediCare.
My sister, who lives in Germany, pays for private insurance with a cohort of other legal professionals. She recently lost her job and was freaking out about losing that private option if she didn't find another job above the salary requirement. She made it sound like the state insurance in Germany was awful and has told me many stories of how grateful she was to have her private insurance when giving birth to her two kids and when she had issues. Would love to hear your thoughts!