Mutual insurance for seniors: the budgets to plan to be well reimbursed, according to your profile

The older you are, the more you pay. This is the principle on which the price system of the complementary health insurance organizations (Ocam) is based. According to the working document of the High Council for the Future of Health Insurance (HCAM), drawn up last year, the annual premiums paid by French people aged 25 to 45 to benefit from additional health cost an average of 830 euros. This is 44% less than the population aged 66 to 75, whose annual bill is close to 1,500 euros.

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At the time of retirement, seniors thus experience that employer participation gradually disappears if they were employees. The transition from a collective agreement to an individual one leads to a sharp price increase. Especially since insurance companies rely on these types of contracts to balance their accounts. HCAAM recalls that individual contracts sold by insurance companies are profitable, while collective coverage is loss-making.

7 health supplements on the test bench

Despite this, the balance owed to elders, that is, the money they have left to pay out of pocket after reimbursement from health insurance and their mutual insurance, remains high. Thus, according to HCAAM, in 2012 this proportion still reached an average of 3.8% for all households. But the older you get, the greater this proportion. It thus rises to 4.5% for those whose oldest individual is between 60 and 69 years old, and finally reaches 6.1% among those whose oldest individual is between 70 and 79 years old.

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For all these reasons, Capital has decided to test the offers of seven mutual insurance companies and brokers specializing in health, using the comparison Comparadise. The rates were examined on 2 December for the following three profiles: a 55-year-old active person, a 62-year-old young pensioner and a 75-year-old pensioner. The first two have intermediate guarantees, while the third requires more regular care and therefore a contract with high protection.

To highlight regional differences, we simulated prices in two medium-sized cities: Dijon and Vannes. The percentages shown in the tables below correspond to the reimbursement basis for social security and also include the reimbursement from health insurance and supplementary health insurance. If some reciprocals are missing from one profile to another, it is because they do not meet the coverage requirement that we have set.

Our 55-year-old asset profile must contribute between 54 and 66 euros per month to benefit from correct guarantees. At a very competitive price, Malakoff Humanis offers him a very good guarantee of hospitalization. For 8 euros more, it is MMA that offers him the most complete guarantees, especially in dental and optical, but excluding reimbursement of alternative medicine (psychologists, osteo). Note that the AcommeAssure and MMA brokers lower their prices significantly in Vannes. Partly because the guarantees can vary slightly, but also because the size of the premiums depends on the geographical areas. The criteria that the supplementary insurance companies take into account are, in particular, the consumption of medicine as well as excesses of fees per region.

For our 62-year-old pensioner, the prices offered are only slightly higher (than who?) They are very homogeneous, around 65 euros in Dijon. For optical care, it is better to turn to Kovers, which offers a package of 250 euros every two years. For hospitalizations and dentists, it is better to favor Malakoff. Reimbursement for routine care is finally higher at Cocoon.

Our last profile, a 75-year-old pensioner, has to have high guarantees… and therefore has to pay a high price. A budget of between 102 euros and 154 euros can be expected for Dijon, and slightly less in Vannes, because Mutuelle Intégrance significantly lowers its prices there. It is also this organization that exhibits the strongest guarantees in all the positions examined. The broker April, on the other hand, can boast of an excellent ratio between quality and price. At a price significantly lower than the competition, its guarantees are comparable or even better than Cocoon, Kovers or Malakoffs. Only downside: he doesn’t include alternative medicine in his contract.