How does Luxembourg’s healthcare system work, and what does this mean for dual citizens’ coverage?
Healthcare in Luxembourg
Luxembourg has been rated by Business Insider as having the best healthcare system in the world. Although these rankings can be subjective, it is true that Luxembourg has one of the best healthcare systems in the world and in Europe. And there are good reasons. Depending on the source, between 95.2-99% of the resident population is covered by Health Insurance. In 2017, only 1.4% of medical expenses were borne by Luxembourg households (i.e. the lowest rate among developed countries – specifically, OECD countries).
As a dual citizen, there is a lot that you need to know about healthcare in Luxembourg.
As a dual citizen, is my healthcare in Luxembourg free?
Anyone in Luxembourg is entitled to receive emergency treatment, including dual citizens. However, this treatment is not free for anyone.
On the other hand, when it comes to preventative, day-to-day care and generally being on the healthcare system, you are not a part of the system by virtue of being a dual citizen.
When you become a dual citizen, you receive a social security number. Normally, when a foreigner moves to Luxembourg, they become insured in Luxembourg after receiving the social security number. However, this is not the case for you. When a Luxembourg citizen is born in Luxembourg, they automatically receive a social security number. Similarly, you also receive one when you become a citizen. However, you receive a social security number that is effectively “not active” if you are not directly contributing to the social security system. In Luxembourg, as across Europe, the social security system is the healthcare system and more. This includes sick leave, maternity leave, and other benefits.
Because your social security number is not active without working in Luxembourg, you cannot request a European Health Insurance Card (EHIC).
So, how does Luxembourg’s healthcare system work?
Luxembourg has an entirely public healthcare system run by the Government. The State runs all 18 of Luxembourg’s hospitals. None of them are private. 15% of the Luxembourgish government’s annual budget goes to healthcare expenditures. Additionally, Luxembourg is the country that spends the most per resident healthcare (over $8,000 per year on average).
The healthcare system and all hospitals are overseen by the National Health Fund or CNS (Caisse Nationale de Santé). The system is based on three concepts: compulsory health insurance, free choice of provider for patients, and compulsory provider compliance with the fixed set of fees and services.
Who gets coverage?
In Luxembourg, all employees and self-employed people must make social security contributions. This in turn entitles them and their dependent family members to the healthcare system. All minors and dependent children under the age of 30, residing in Luxembourg and not personally insured, may be co-insured with a parent who is personally registered with health insurance. Coverage includes most of the treatments provided by family doctors (general practitioners) or specialists, any laboratory test, prescriptions, and hospitalization. When you start working in Luxembourg, your employer (or potentially you if you are self-employed) will declare your employment to the Joint Centre of Social Security (Centre Commun de la Sécurité Sociale or CCSS).
If you want to move to Luxembourg for retirement and never contributed to the CNS, you will need to show proof of foreign or private health insurance.
How does payment work?
Workers in Luxembourg contribute on average 5.44% of their salary in Social Security payment. This maxes out at €6,225.00 per year. Employers also make a contribution. This provides for their healthcare coverage. The government pays directly for maternity-related costs.
Once you are in the system, payment for healthcare service works on reimbursement. Residents pay an invoice upfront and then send it into the CNS for reimbursement. Reimbursement comes via bank transfer within three weeks of filing. For certain types of healthcare, the CNS settles costs directly with the provider. These include pharmaceutical costs, hospital costs (but not the doctors you see at the hospital), physiotherapist costs, and laboratory costs, among others. In this case, you only pay the portion of the costs not covered by the CNS.
Generally speaking, the CNS covers between 80-90% of overall healthcare costs whether via reimbursement or direct payment. The out-of-pocket cost is usually among the lowest in Europe. Residents have to pay between 10-20% of family doctor costs, up to 20% of prescription costs (60% for non-essential medication), and around €22 a night for hospital stays.
Although the CNS or national system pays the majority of healthcare costs, up to 75% of people in Luxembourg take out private insurance. Private insurance covers the portion of your medical fees that aren’t covered by the CNS. Additionally, it offers extended coverage for such things as hospitalization, eye care, dental treatment, and medical services outside Luxembourg. Many employers also offer supplementary health cover to their employees as an employment benefit.
Seeing Your Preferred Provider
An important concept in Luxembourg’s healthcare system is the freedom to choose your provider. You can do so as long as they are on the CNS’s approved list. Outside of emergency situations, you need a doctor’s referral for hospital admission. Many specialists are located within hospitals. It is possible to make appointments directly with specialists at a hospital. Waiting times to see a specialist may vary and can take a few weeks. However, in general, Luxembourg has a favorable speed of treatment compared to other countries.
Many dual citizens think that they will receive free healthcare in Luxembourg once they obtain citizenship. We now know that while the cost of healthcare in Luxembourg is always much lower than in the USA, it is not free. Workers need to contribute from their salary for insurance purposes. They must also pay for the individual product or service. Dual citizens receive a social security number, but this does not mean that they are locally insured. Additionally, it is not possible to obtain an EHIC without contributing to the Social Security system in Luxembourg. People thinking about retiring in Luxembourg who never lived there before will need to provide their own insurance.
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