Complementary Health Solidarity (CSS) offers low-cost or free health insurance to individuals with limited financial means, covering various healthcare services. Despite its benefits, many eligible individuals remain unaware or face challenges in accessing it, resulting in a significant underutilization rate. CSS beneficiaries tend to be younger than the general population, with a notable concentration in certain regions. As of April 2024, specific income thresholds determine eligibility for free or paid CSS options.
Understanding Complementary Health Solidarity (CSS)
Complementary health insurance, commonly referred to as mutual insurance, plays a significant role by reimbursing expenses not covered by Social Security. However, the costs associated with these policies can be quite steep. Fortunately, the Complementary Health Solidarity (CSS) program provides an opportunity for individuals with limited financial means to access health coverage either for free or at a reduced cost. Unfortunately, many eligible individuals fail to take advantage of this benefit due to financial constraints, lack of knowledge, or bureaucratic hurdles.
As of the end of 2023, 7.44 million people in France, or 11% of the population (excluding Mayotte, where CSS is unavailable), were recipients of the CSS. This includes 5.82 million who benefit from the program free of charge and 1.62 million who have a paid version. The CSS was introduced in 2019, replacing the previous universal complementary health coverage (CMU-C) and the aid for paying for complementary health (ACS).
The CSS covers a range of healthcare services, including visits to doctors, hospital stays, eyewear, hearing aids, and dental prosthetics under the 100% health plan. Notably, beneficiaries are exempt from any flat-rate participation or deductibles on medications and cannot incur additional fees.
Challenges in Utilizing CSS
Recent data from the Directorate for Research, Studies, Evaluation and Statistics (Drees) highlights an alarming trend: despite a slight increase in the number of CSS beneficiaries between 2022 and 2023, a significant portion of those eligible still do not utilize the service. The non-use rate was 44% in 2021, a figure that has remained stagnant since 2020.
Several factors contribute to this underutilization. Many individuals are unaware of the CSS or find the application process too complex. Additionally, even the modest financial contributions required can be a burden for low-income households. A staggering 78% of individuals living below the poverty line were eligible for CSS in 2021, yet only 47% of them actually utilized the program, as highlighted in the Drees study.
Demographics of CSS Beneficiaries
Interestingly, the demographic profile of CSS beneficiaries reveals that they tend to be younger than the general population. In 2023, 71% of free CSS recipients were under 40 years old, with 43% being under 20. In contrast, only 8% were aged 60 or older. Across the entire population, only 24% are under 20 and 28% are 60 or older.
This younger demographic is partly influenced by the minimum pension amount, which as of January 1, 2023, was set at 961.08 euros per month. This amount often exceeds the eligibility threshold for free CSS for many potential beneficiaries. In the case of paid CSS, the age distribution is more balanced, with 31% of beneficiaries being 60 years or older and 46% under 40, reflecting national averages.
The study also indicates that CSS beneficiaries aged 15 and above are more likely to live alone compared to their peers, with 26% living independently versus just 17% in the broader population. Additionally, one in every two CSS beneficiaries is part of a household receiving Active Social Income (RSA).
Geographically, the prevalence of CSS varies significantly across regions. While 11% of the overall French population is enrolled in CSS (8.6% for free contracts and 2.4% for paid contracts), certain areas show markedly higher rates. For instance, only 3.1% of individuals in South Corsica benefit from free CSS, while this figure skyrockets to 15.8% in Seine-Saint-Denis. Notably, all overseas departments report over 20% of their populations benefiting from free CSS, with Réunion boasting the highest at 34.6%.
To qualify for free CSS, as of April 1, 2024, individuals must have a monthly income of less than 847 euros if they are single without children in mainland France (943 euros in the DROM). For incomes above this threshold but below 1,144 euros (1,273 euros in the DROM), individuals may still access paid CSS options.