Glasses, dentures and hearing aids will be fully reimbursed by the Social Security and complementary health from 2020.
The decree was published Saturday, January 12 in the Official Journal . From 2020, some glasses, dental crowns and hearing aids will be fully reimbursed by Social Security and complementary health. This is the implementation of the reform on “zero charge rest” , adopted in December by the National Assembly in the framework of the law governing the budget of the Social Security for 2019.
Why such a measure? When will it be possible to benefit? On what types of equipment? We take stock.
Why such a reform?
Emmanuel Macron had made it a flagship measure of his presidential campaign, speaking of “essential social conquest”: by the end of the five-year period, certain glasses, dental prostheses and hearing aids will have to be covered 100% by Social Security and the complementary health, so without any rest to pay for the patients.
According to a CSA survey conducted for Cofidis and published in October by Le Parisien-Aujourd’hui in France , nearly one in three French people gave up treatment in the last 12 months, dental care and optical care leading the list of acts considered to be too expensive.
In 2018, the remainder for patients is 43% on dental prostheses, 22% on optical offer, 53% on hearing aids.
The measure was passed by Parliament as part of the Social Security budget for 2019. According to the decree published Saturday , full reimbursement applies ” to contracts entered into or renewed on or after 1st January 2020 to the provisions the optical and dental and as of 1st January 2021 for the provisions relating to hearing aids. ”
Since 1st January 2019, insured must already be eligible for baskets deals getting better refunded up to a total repayment by 2021.
A reform monitoring committee has been set up.
Which glasses are 100% refunded?
The reform sets the ceiling for average corrective lenses and their mount to 420 euros . The ceiling is set at 800 euros for eyeglasses equipped with progressive lenses and their mounts, and as of 1 st January 2020. Their renewal is limited to one pair every two years .
“In any case, the support of a mount is limited to 100 euros,” says the decree.
The optician must offer 17 models for adults and ten for children, each in two colors. Glasses should be anti-reflective, hardened and thinned.
However, the insured will have the opportunity to “blend the offer”, by choosing glasses without any dependents and a setting corresponding to his tastes outside the basket “100% health”, indicates the official presentation file (read below). below).
Which dental prostheses?
In 2018, the average price of a ceramic crown amounts to 550 euros , including 195 euros payable by the patient.
The “zero charge remainder” will cover monolithic ceramic and metal-ceramic prostheses on visible teeth, metal crowns any location, transient crowns, all-metal and metal-ceramic bridges any localization and removable dentures based on resin.
Patients may also opt for less reimbursed care but with capped rates.
In addition, new types of care will be covered by health insurance, especially for children aged 3 years.
According to the decree, the remaining zero charge on dentures will be introduced from 2021.
And for hearing aids?
The number of people suffering from hearing difficulties is estimated at 6 million in France. Of these, about half are likely to be paired.
Today the expenses assumed by the insured after taking over by the health insurance are particularly high. They are estimated on average at 850 euros per ear, a total cost of equipment of 1700 euros . This amount will be fully supported by 2020.
All device types should be concerned with the remainder at zero charge with at least 12 tuning channels and 4 years warranty. The prices of the basket will gradually decrease from 2019, which should reduce by 200 euros the rest to the insured.
As for optics and dentistry, there will be more upmarket models, at prices set freely and which will be reimbursed for only a part, depending on complementary health.
Towards an increase in rates for mutuals?
The Minister of Health, Agnès Buzyn had accused some mutuals in December of “sabotaging” the reform . She reminded the complementary health of their “commitments”, especially that of not using the reform to justify an increase in their tariffs .
A study by the consulting firm Santiane health insurance, published by Le Parisien on October 22nd, said that the increase in refunds to arrive at the remainder zero load would necessarily push additional health to raise their rates. The firm predicted an average rate increase of 6.8% and up to 9.4% for retirees, heavy users of dental prostheses and hearing aids.
Questioned in the Senate on the 25th October, Prime Minister Edouard Philippe reassured:
“The conditions of discussion with industry, mutuals and health insurance have led to an agreement after which three quarters of the cost of this reform will be covered by health insurance and a quarter by mutuals.”
More information about the official dossier of presentation of the project “100% health”.