Why choose a good health insurance? The advantages not to be overlooked

A health mutual, or complementary health insurance, covers the portion of medical expenses not reimbursed by the mandatory health insurance. This out-of-pocket cost includes the co-payment, excess fees, and certain treatments that are only partially covered by Social Security. The choice of contract directly determines the level of financial protection against healthcare expenses.

Transfer of costs to mutuals: what changes in 2027

Several decrees published in the Official Journal on August 22, 2026, organize a rebalancing of reimbursements between health insurance and complementary plans starting January 1, 2027. This transfer affects common expense items: dental care, medical devices (optical, hearing aids), medical transport, and certain medications.

For dental care, the portion covered by complementary plans increases from 40% to 50% of the co-payment. For medical devices listed in the LPP (glasses, hearing aids, telemonitoring devices), the insured’s or their mutual’s contribution is raised to a range of 50% to 60% instead of 40% to 50%.

Medical transport outside of ALD sees the mandatory coverage rate by complementary plans increase from 45% to 50%. For medications with low or moderate medical service rendered, co-payments increase significantly: from 85% to 95% for low SMR, and from 70% to 85% for moderate SMR.

This movement means that a contract with too low guarantees will leave a heavier bill than before, making it relevant to learn more about AllP Santé before comparing available offers.

Co-payment and excess fees: understanding the out-of-pocket cost

The co-payment represents the difference between the basic rate of Social Security and the amount actually reimbursed. For a consultation with a general practitioner, health insurance reimburses part of the conventional rate. The remainder, without complementary coverage, comes directly from the patient’s budget.

Excess fees add an additional layer. A practitioner in sector 2 charges above the Social Security rate, sometimes double. The mutual intervenes according to the level of coverage subscribed, expressed as a percentage of the Social Security reimbursement base (BRSS): 100%, 200%, or even 300%.

Areas where the coverage gap is most felt

• Optics: frames and progressive lenses regularly exceed the limits of the “100% Health” basket, especially for complex corrections. A mutual with enhanced optical guarantees limits the net expense.
• Dentistry: prostheses, implants, and crowns outside the regulated basket generate out-of-pocket costs that can reach several hundred euros per procedure.
• Audiology: class II hearing aids (outside 100% Health) remain among the most expensive equipment, with an average renewal every four years.

A well-calibrated contract on these three areas absorbs the majority of unexpected expenses.

Prevention guarantees and services included in the contract

Beyond pure reimbursement, a health mutual often includes preventive services: packages for health check-ups, smoking cessation, vaccinations not reimbursed by Social Security, or dietary sessions. These services do not appear on the classic guarantee table but reduce healthcare expenses in the medium term.

Teleconsultation is now part of most recent contracts. Access to a doctor remotely, without upfront costs, speeds up care for common pathologies and avoids emergency consultations.

Assistance and complementary services

Some contracts offer home assistance after hospitalization, psychological support, or a network of partner care providers with negotiated rates. These services reduce the actual cost of the contract by decreasing ancillary costs not directly covered by the guarantee table.

Checking for the presence of these services before subscribing allows for an assessment of the overall value of an offer, beyond just the monthly premium price.

Concrete criteria for choosing a suitable health mutual

Comparing mutuals based solely on the monthly price often leads to poor choices. The ratio between the premium and the actual level of reimbursement for the most used items remains the determining criterion.

• Identify recurring expense items (specialist consultations, optics, dental) and check the associated reimbursement limits in each offer.
• Check the waiting periods: some contracts impose several months of waiting before covering dental care or hospitalization.
• Examine the partner care network, which guarantees negotiated rates with opticians, dentists, and audioprosthetists, and reduces out-of-pocket costs without additional premium costs.
• Check the portability of the contract: in case of a change in professional situation, some mutuals allow for the retention of acquired guarantees without interruption of coverage.

The price of a mutual is judged by what it actually reimburses, not by its displayed premium. With the cost transfer planned for 2027, this careful reading of the contract becomes even more necessary to avoid surprises on items that have previously been better covered by health insurance.

The decrees of August 2026 mark a turning point in the distribution of healthcare expenses in France. Adapting complementary coverage to this new situation, by examining each guarantee offered item by item, remains the most reliable way to manage one’s health budget in the coming years.