5 questions about…
1. What is Medicare?
State Health Assistance (AME) is a social assistance paid for by the State, which responds to an ethical and humanitarian principle as well as a public health objective and adequate spending. It is not a migration policy tool. It allows, since 1um January 2000, to foreigners in an irregular situation to access the French health system under conditions.
The system was reformed by the Finance Law for 2020 (art. 264) and a decree of 30 October 2020 integrated it. Its terms of access have been tightened, in particular to combat fraud.
Due to the health crisis, the entry into force of these new provisions, initially scheduled for 1um January 2021, it was postponed to 1um June 2021. This system comprises on the one hand the common law AME, which offers relatively comprehensive health coverage, and on the other hand urgent and vital care, which makes it possible to compensate in the aftermath expenses incurred by hospitals for assistance to foreigners in an irregular situation not eligible for the AME. It is granted for one year from the date of submission of the application. Its renewal is annual. It is not applicable to Mayotte. The AME represents 0.6% of public health expenditure in France.
2. Who is eligible for Medicare?
The precarious foreigner can benefit from the AME when he resides in France illegally – without a residence permit – continuously for at least three months from the expiry of the visa or residence permit. His resources, of any kind, must not exceed 9,571 euros a year for a single person (10,653 euros in overseas departments). The person with whom they live as a couple by marriage, PACS or cohabitation, their children up to 16 years of age or up to 20 if they continue their studies, benefit from the AME.
Social security institutions can access the database relating to foreigners applying for a visa in France, called Visabio, in order to verify the irregularity of their presence in France.
The first application for AME is submitted by the applicant to a health insurance institution which reviews it on behalf of the state. The right to the AME is also open to persons not habitually residing in France and who are present on the territory on a regular basis as regards the right of residence if their state of health justifies it and by ministerial decision taken on a humanitarian and individual.
Persons detained on French territory can also benefit from the AME, whether or not they reside in France, if their state of health justifies it.
Minor children benefit immediately from the AME even if the condition of presence of more than three months in France is not satisfied.
The asylum seeker does not benefit from the AME, but from universal health protection (Puma) after three months of residence in France. During these three months, he is treated by the emergency care system.
3. What rights does the benefit of state medical assistance offer?
The AME entitles you to 100% coverage of medical and hospital care, in the event of illness and maternity, in particular prostheses and dental care, optical appliances, medical expenses related to pregnancy, medical transport, etc.
Coverage is limited to the social security rates, i.e. the rate on the basis of which the calculation for the reimbursement of a medical procedure by the health insurance is made. Within this limit, the beneficiary does not anticipate expenses. The medical expenses of minors remain 100% covered in all cases.
Certain treatments and planned non-emergency care are covered only after a period of nine months from admission to AME for any new beneficiary or for one who has not benefited from AME for more than one year (CASF, art. R.251 -3 ). Holders of State Health Care are not required to follow the coordinated care path.
4. What benefits are excluded from state medical assistance?
Some benefits are excluded from state medical assistance. No reimbursement by the Health Insurance in this sense is therefore possible for the technical procedures, visits, medicines and products necessary for the provision of health care for procreation, medicines with low medical benefit reimbursed at 15% and spa treatments. These services are entirely paid for by the adult AME beneficiary.
5. Who are the actors in Medicare?
A National Fund for Medicare is responsible for financial matters. Social services and non-profit associations or organizations recognized by the prefect of the department can help the foreigner in an irregular situation to apply for AME at the CPAM extension.
Access to care is guaranteed unconditionally and free of charge in hospitals and care access centers (PASS) but is not fully guaranteed in community medicine due to refusal of treatment.
At an administrative level, the files deposited in a service center authorized by the health insurance institution, at a health institution or a RIDE, are educated by the CPAMs according to strict rules. The AME admission card must be presented to the consulted healthcare professionals. In the absence of a response within two months, the AME is rejected.
CASF: art. L.251-1 to L.251-3, L.252-1 to L.252-5, L.253-1 to L.253-4, L.254-1 to L.254-2, R. 251-1 to D.253-4