Arousing many fantasies, State Medical Aid (AME) allows foreigners in an irregular situation in France to have access to a basket of treatments covered by social security. But contrary to popular belief, the state does not pay the full cost of care, but only part of it. What cure is it? Who pays ? InfoMigrants takes stock.
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The State Medical Aid (AME) now allows foreigners living in France in an irregular and precarious situation to benefit from free access to a “basket of care” at no cost.
Its implementation benefits everyone: migrants arriving in France illegally often have a fragile state of health. The existence of AME allows them to be treated but also to protect the entire population by limiting the risks of spreading diseases.
State medical assistance has existed since the 3rd Republic. “It was created in 1893 before social security,” explains Didier Maille, coordinator of the Comède social center (Committee for the health of exiles) in Paris. It was then called “Free Medical Assistance”. For years it has concerned undocumented immigrants but also unemployed French people, the poorest of the population. Everyone could benefit from free access to care “.
Only in 1999, during a reform, were some of the beneficiaries excluded from the AME for other medical coverage. “French citizens benefited from another health insurance scheme. Only undocumented migrants remained. This therefore created a magnifying effect on this population,” explains Didier Maille.
What treatments are AME beneficiaries entitled to?
According to Didier Maille’s formula, the beneficiaries of the AME have access to “a basket of care almost equal to that of a socially insured but reduced by a certain number of benefits”.
In concrete terms, this means that, since the 2000s, AME beneficiaries have no longer been able to take advantage of “spa treatments, accommodation costs for disabled children and adolescents, oral examinations for children, medically assisted (PMA)”. These treatments remain entirely the responsibility of the patient.
Aside from this listing, the AME recipient can access all other treatments (general medicine, dentist, ophthalmologist, etc.), like any social insured.
The treatments included “in the AME basket” are 100% covered.
Why is it wrong to say that migrants are better off than the poorest French people?
Taking care of the treatments 100% does not mean paying them back 100%. This is where the AME can arouse certain fantasies.
The AME applies 100% of the social security rate. “It’s very different,” Didier Maille insists.
Explanations. “An undocumented migrant needs a dental crown. The dentist’s bill is 600 euros. The AME applies 100% of the pension share estimated at 54 euros. This means that the state pays all of the 54 euros, but nothing else. . The patient remains stationary has to pay 546 euros “, explains Didier Maille.
“People are often confused. The AME does not pay 100% of the cost, it pays 100% of the social security rate.”
Precarious French citizens also benefit from social security but also from the Complémentaire santé solidire (formerly CMU). “They benefit from a more advantageous coverage. Because the social security reimburses part of the expense and the supplementary one takes care of part or all of the rest.”
Undocumented migrants who benefit from AME do not have complementary health insurance, nor mutual insurance. “Undocumented migrants are therefore no better treated than modest French people.”
The AME level of support is insufficient to cover the actual costs of a prosthesis or a pair of glasses. “It’s a real problem for children’s glasses, for example. Two single lenses from children’s glasses must cost around € 200. If the 100% social security rate is € 60. How will parents find the rest of the sum? “, continues Didier Maille.
“It must be taken into account that there are two levels of payment: the one that pays the basic insurance (100% of the social security rate) and the excess taxes charged by some health professionals, and that remains the responsibility of the beneficiary of the AME”.
If an AME beneficiary goes to a general practitioner, does he not advance the costs?
“If an undocumented person finds a doctor who applies the social security rate, or a consultation for 25 euros, the AME will cover the 25 euros – which is equivalent to the 100% rate of social security. There is no moderation ticket, “explains Didier Maille. This means that the undocumented person has no money to advance.
But beware: the AME beneficiary must still find a doctor who applies the social security rate, without exceeding the fees. In this case, the remainder to be paid is borne by the AME beneficiary.
As for women: Can they access a gynecological examination (smear) to prevent cervical cancer?
Yes. As noted above, the AME beneficiary has access to the same care basket as the socially insured (with the exceptions mentioned above).
A woman with an AME card can go to a gynecologist and will receive 100% coverage. But, as with any treatment, you will need to ask your doctor what your price is to find out if there is an excess rate and calculate what your remaining charge will be.
Is the beneficiary of the AME a social security like any other?
No. The beneficiaries of the AME are not “socially insured” but “beneficiaries of state social assistance”, they cannot access:
-A vital card
– To a social security number
– To the periodic free health check of the Social Security
The AME is granted for a period of one year, the renewal is not automatic. And it must be done two months before the due date. Better to do this in advance because, in some departments, file processing times are very long and can take up to 6 months. According to Didier Maille, only one in two beneficiaries has access to it, or around 380,000 people (including children).