Patients will be used to absorb the social hole. According to the drafts of decrees that BFM Business has obtained, the government counts not only to double the annual ceilings of medical franchises and participations of flat rates … but also their amounts, as well as the daily ceilings.
As a reminder, medical franchises and flat participations are these small sums, discreetly deduced by the safety of their reimbursements of prescription medications, their consultations in a doctor, a physiotherapist or a nurse, or even radiological exams, analysis of medical biology and their paths in health transport.
They are not reimbursed by complementary health insurance, within the framework of the “responsible” contract, which corresponds to 98% of the subscribed offers. In other words, even if you do not adjust them directly to the pharmacy counter or in your doctor’s office, these flat franchises and participations are your responsibility. However, certain categories of patients are exempt from him, such as minors, pregnant women (from the first day of the sixth month of pregnancy until day 12 after childbirth), health beneficiaries of complementary solidarity (C2), state medical aid (soul) and invalids of war.
2 euros the medication box
If the decrees appear in the official magazine as they have been sent for the advice of the National Health Insurance Fund (CNAM) and the National Union of Health Insurance Caisses (UNCAM), then the SERI would be, as of January 1, 2026, deduct two euros of medical franchise instead of one euro currently per box of medicines.
The same for the attention provided by a medical assistant as masseuse-fisiotherapists or nurses: these will also be two euros instead of one euro today. The deductible doctors also apply to the reimbursements of Trangers in Health Transport: they will rise from 4 to 8 euros per trip.
Doliprane can no longer be reimbursed by security
When carrying the deductible doctor to drugs to two euros, the rest of the patients will be de facto greater. Especially because the prices of medications are generally low, it is not excluded that the amount of the franchise exceeds the theoretically reimbursed sum reimbursed by Social Security.
Take the example of Doliprane. The price of a box, including, amounts to 2.09 euros in pharmacies. If your doctor has prescribed this medication, it is reimbursed to 65% for health insurance, or 1.35 euros. Complementary medical care covers the rest, namely 35% of the price, which amounts to 73 cents.
But safety deduces a deductible by the part that is supposed to reimburse you. Currently, he withdraws a euro, therefore, he reimburses in the end only 35 cents, just 16% of the price of Doliprane.
However, if the deductible increases to two euros, it will exceed the amount that the health insurance must attend theoretically (1.35 euros). Result: Security will eliminate the amount that is supposed to reimburse you. In other words, we can consider that health insurance will no longer reimburse the Doliprane and that only its mutual will be in charge of a small part of its price. And this case will refer to many daily drugs, whose prices have been reduced over time.
Up to 5 euros the rest payable to a general practitioner
With respect to the participations of flat rates, the drafts of decrees consulted by BFM Business also plan to double their amounts. Therefore, health insurance will deduce at least 4 euros and to the maximum 5 euros, instead of 2 euros of reimbursements of your consultations with a doctor or general specialist.
It will be the same for the holdings of flat rates deduced from the reimbursements of the radiology exams and the medical biology analysis.
However, the government is more likely to opt for a global summation to 4 euros. In fact, it is used that the Social Security Code provides a minimum and maximum for these sums deduced from the refunds of medical consultations, radios and medical biology analysis. This is not the case of the franchises mentioned above, for which a fixed amount is directly recorded.
On the other hand, if the medical franchises are planned from January 1, 2026, an entry into force has not yet been specified in the draft decrees about the participations of flat rates. It is simply written that the increase in its amounts will enter into force the day after the publication of the corresponding decree.
In any case, your remains payable after a medical consultation will necessarily be higher. Take an appointment from your general practitioner. The last invoice of 30 euros, which is covered in 70% for health insurance (21 euros) and 30% for complementary health (9 euros).
Currently, the section is 2 euros from your care, which makes you actually reimburse to 19 euros. By increasing the participation of a flat price to 4 euros, or even 5 euros, Social Security will reimburse only 17 or 16 euros. Where your responsibility is currently being 2 euros, therefore, it will increase to 4 euros minimum, 5 euros at most. And it will be the same for consultations with a specialized doctor, but that is without counting excessive rates that are not always covered by mutuals.
Up to 16 euros per day, 200 euros per year
However, medical franchises and global sum participations cannot be deduced from reimbursements indefinitely. Current regulations include daily ceilings that vary from 4 to 8 euros per day.
If medications are not affected, a daily roof of 4 euros applies to consultations with a physiotherapist or a nurse. Packaging participations and medical franchises have a limit of 8 euros per day for consultations with a doctor, radiology exams, medical biology analysis and health transport trips. Beyond these amounts, health insurance no longer deduces franchises and flat rate participations of its reimbursements.
According to one of the drafts of decrees that BFM Business has consulted, the Government plans to double the daily ceiling of deducting the care of care given by medical aid (physiotherapist, nurse, etc.), and 16 euros per day the roof of the medical franchises deduced from health transport.
A priori, it is not questioned to duplicate the daily ceiling of flat participations in consultations in a doctor, radios and blood analysis.
Finally, annual ceilings are also planned. They correspond to the accumulation of the medical franchises deducted on the one hand, and the accumulation of the flat rates participations for the other.
Currently, medical franchises and flat rates participations are respectively limited to 50 euros per year, or 100 euros per year in total.
This means that, for example, that he spent 50 euros in franchises, the Doliprane box mentioned above is well reimbursed of 1.35 euros for security, not just 35 cents. And so, with the complement brought by the mutual, you will no longer have any dependent on this medicine.
However, as François Bayrou announced during the presentation of its public finance recovery plan on July 15, one of the decrees projects consulted by BFM Business also plans to double the annual ceilings of medical franchises and fixed participations. Therefore, it will be necessary to have paid 100 euros in deductibles in medicines, health transport and consultations with a physiotherapist or a nurse, and 100 euros in global sum shares in an appointment with a doctor, radios and medical analysis so as not to see their reimbursements cut by safety. Or 200 euros per year in total.
700 million or 2 billion euros in savings?
According to the encryptions communicated by the Social Security Directorate (DSS) to a source close to the archive, the expected savings of the duplication of franchises and flat participations and their roofs would amount to 700 million euros in a full year.
But echoes advance a much greater amount: no less than 2 billion euros in a year. “I don’t know if they are 2 billion, I had 700 million euros,” said Dominique Corona, Undersecretary General of the ANSA and a member of the CNM Council on Friday, August 8 at the RMC microphone.
In addition, the daily amounts and ceilings of medical franchises and participations of flat rates had already doubled in 2024. And at that time, the DSS had estimated at 800 million euros the potential to save these increases. For the number 2 of the ANSA, reiterating these measures just over a year after it would only be a “without money solidarity to punish patients.”
Source: BFM TV
