May 15, 2019
A Guide to Healthcare in France for American Expats
"You really should take out la mutuelle," the receptionist at my health insurance provider insisted, trying to convince me to sign up for extra health insurance coverage.
She pulled out a reimbursement form and gestured to it. "Look at this--this guy would've paid 700 euros for his hospital visit if he hadn't had la mutuelle."
I smiled politely and said thanks, but no thanks. I laughed and thought to myself: I'm American--you can't scare me with high healthcare costs!
It was wry humor that was unfortunately true. Last year, I paid $360 out-of-pocket for a two-mile (3km) ambulance ride in Boston where I received zero treatment; it was basically just a 10-minute taxi ride. The pre-insurance bill was $1800. My friend called the paramedics since I had peeled my finger with a veggie peeler, and we weren't sure if it needed stitches. I was luckily fine, and only received a tetanus booster, antibiotic ointment, gauze, and 3 Tylenol pills at the emergency room. That bill was $200 after insurance.
Fortunately, I haven't had to go to the ER in France (so far), and healthcare is generally a lot more affordable. Since it's France though, there are also a lot more rules and administrative steps that might be confusing to an American expat.
Here's what I've learned this year about French healthcare, so hopefully you can navigate the system more smoothly!
Overview of French Health Insurance
La securité sociale (la sécu) and la mutuelle
The first two terms you need to know are la securité sociale (la sécu) and la mutuelle. La sécu is the state-provided health insurance guaranteed to all employees in France. It covers about 70% of your medical costs* (I'll go into detail on the asterisk later). La mutuelle is the extra insurance many people take out to cover the remaining 30%. The cost of la mutuelle varies in function with your salary--the more you make, the more it costs. As an English lectrice (university teaching assistant), I made around the minimum wage of 1200€/month, and la mutuelle would've cost me 28€/month.
To receive the benefits of la sécu, you need to enroll with a health insurance provider. I chose MGEN, which is apparently the largest provider in France. I made an appointment and brought all necessary documents. I remember needing a copy of my work contract, bank information, and a copy of my passport. At some point, you will also be required to send in a copy of your translated birth certificate. When you make your appointment, be sure to ask what exactly you should bring.
Doctor's Visits
It is relatively cheap to see the doctor in France. Without insurance, the set rate for a general practitioner is 25 euros. With la sécu, you get back 16,50€ (your health insurance provider takes a 1€ fee from your 70% of 25€).
Note, however, that you MUST declare a primary care physician to get back 16,50€, otherwise you only get 6,50€. Ask for a déclaration du médecin traitant when you sign up for la sécu. Fill it out, ask the doctor of your choice to sign it, and turn it in as soon as possible.
Other Medical Specialists: Dentists, Eye Doctors, Physical Therapists
I haven't seen other types of doctors, but I did at one point consider seeing a physical therapist for a rolled ankle. Other medical specialists also have set rates, and they should be more affordable than they are in the US. La sécu may not reimburse these visits as well, however, so be sure to ask your insurance provider. I didn't go to the dentist or eye doctor in France since I just got those appointments done on trips back to the States. I have heard that neither of these appointments are very well covered by la sécu.
Also know that there may be unusual rules to make appointments with medical specialists. I was told that to see a physical therapist, I first had to see my general practitioner to get a referral. It seemed like too much work (and money) to have to visit two doctors when I just wanted to see one, so I never went.
When I had food poisoning: nausea, diarrhea, fever--the works!
Prescriptions
Prescription medicine is VERY cheap in France compared to the U.S. (around 3€ per medication before insurance). That said, you also aren't well-reimbursed for prescriptions with la sécu. For about 10€ worth of prescriptions, I usually got only 3€ back. Each prescription comes with a code that indicates the percentage you can expect to be reimbursed:
PHN: 0%
PH2: 15%
PH4: 35%
PH7: 65%
For women, I also want to note that reproductive care is more affordable in France. According to this article, birth control is 2-15€ for a month's supply. Plan B is also much cheaper, costing around 7€ instead of the $30+ in the U.S.
Pharmacies
You'll notice that there are pharmacies everywhere in France--sometimes within 100m of each other! This makes getting prescription or over-the-counter medication a lot more convenient.
Note, however, that non-prescription medication is a lot more expensive than prescription meds. I've paid almost 30€ for an aloe gel and herbal supplement a pharmacist suggested for my itching symptoms, 6€ for 14 ibuprofen pills (yikes!), and 10€ for a pack of probiotics that ended up giving me side effects. I would not buy any extra over-the-counter medications that a pharmacist suggests. When in doubt, just visit your doctor to get recommendations, as it will likely be cheaper after reimbursements than just going to the pharmacy for suggestions. Pharmacists in France are actually known for being sales-y, so don't buy into their gimmicks!
Carte Vitale / Reimbursement
Getting reimbursed is really easy and automatic, if you have a carte vitale. This is basically a health insurance card that you can swipe at the doctor's office and pharmacy to get your insurance discounts automatically.
I received a letter from MGEN about the card two months after enrolling in la sécu. The letter asked me to mail in a copy of my translated birth certificate, residency permit, copy of my passport, and an ID photo so I could get my carte vitale. While they ask for a certified translation, I did my own, and it was accepted. You should, however, get an apostille in your home state before leaving to authenticate your birth certificate. An apostille is basically a piece of paper that declares that your official document is real. After sending in all this information, I got a second letter three months later, asking me to confirm my personal details by mail for my card.
Unfortunately, administrative processes take forever in France, so I only got my card 8 months after arriving. Since I didn't have a carte vitale for most of the year, I had to instead get a feuille de soins (photos 2 and 5) that I physically gave to MGEN so they could reimburse me through direct deposit. For prescription reimbursement, you need to attach a copy of the prescription to the feuille de soins (see below photo). The whole reimbursement process generally took one month.
May 10, 2019
Triathlon Training for a Marathon: My Experience
My first marathon in 2016; was elated to finish after battling injury for so long!
I realize that my training is unusual, not very logical, and probably makes a lot of running experts cringe.
The first potential issue is of course the low mileage. For the month of March, my 20-miler was almost 1/3 of my monthly mileage--which really isn't supposed to happen. Some coaches even say that long runs should only be 20-30% of your weekly mileage (though this seems extreme to me, as you'd have to be doing 67-100 mile weeks to do a 20 mile run). The reasoning behind the rule is that it can be unsafe to attempt longer distances if you don't have the right training volume. My training has probably been somewhat of an exception since I'm still exercising on the days I don't run (those training for an Ironman also tend to have longer runs that are a high percentage of their weekly mileage).
That said, many claim that weekly mileage matters in developing speed. Running coach and 2:28 marathoner Josh Sambrook explains that the two most important factors in predicting marathon performance are weekly mileage and pace of those miles. These impact is lessened, however, if you're aiming for above 3:30 marathons; this is when cross-training and other nuances can make a bigger difference. There's a cool race predictor tool that Josh introduces in his interview--I found it to be accurate within a couple minutes of my Paris performance when I entered my Barcelona Half Marathon time, my average weekly mileage, and average pace. (He claims that it's pretty consistent--so even if it's not totally accurate, you can usually adjust by the difference each time to get an accurate prediction).
During our two-week Easter break, I jetted off to Eastern Europe for the first time. While I've wanted to go to more "mainstream" destinations for a while, like Portugal and southern Spain, I figured I should hit my less accessible destinations first. After all, Portugal is much closer to the US than Croatia, and sometimes flying from Boston to Portugal is faster than flying from Paris! (especially for the Azores).
The photos of Croatia, Bosnia & Herzegovina, and Montenegro seemed stunning, so I decided to visit all three countries while I was in the area. They're luckily right next to each other, which made getting around easier. I flew into Zagreb, Croatia from Paris, and ended my trip in Kotor, Montenegro, which made it easy to fly out of Dubrovnik, Croatia (the airport is only 1.5 hours away).
Here's a quick recap of my trip, and a sample itinerary if you're planning to visit these countries as well.
14 Days in Croatia, Bosnia & Herzegovina, and Montenegro
St. Mark's Church
This is one of the more iconic spots in the city, as the tiled roof is very eye-catching. The church is only open at Mass, so I just came to see the roof.
Where to eat: Poljana, a state-owned restaurant that was surprisingly affordable, and had vegan options!
What to do: hike/walk (no swimming, as it's a UNESCO World Heritage site)
Where to stay: Hotel Bellevue (50+ euros/night, depending on season)
Both these photos are from the lower lakes near Entrance 1 of the park, the arguably more impressive part. The water is such a stunning turquoise and the falls are unreal. I started with the upper lakes (the smaller falls, but still charming) and visited the lower lakes on the second day.
3. Split, Croatia (2 nights)
Where to eat: was not particularly impressed by any of the food I ate. Prices also definitely got more expensive here.
What to do: Diocletian's Palace, Marjan Park, Green Market, Bacvice Beach
Where to stay: Cosy Rooms in the Center of Split (24 euros/night); run by the sweetest family
Diocletian's Palace
The main grounds are free and are well-integrated into the city, so I passed by several times. If you want to visit the underground part, you have to pay (I didn't go, so I can't tell you if it would be worth it).
Bacvice Beach
This was a lovely place for a freezing dip (apparently it was unseasonably cold for mid-April). I appreciated the step ladders that made getting in and out of the ocean much easier.
4. Mostar, Bosnia & Herzegovina (2 nights)
Where to eat: Food House, a restaurant off the main pedestrian street with vegan options. The veggie plate is AMAZING and very generous.
What to do: visit old town, Karađoz Bey mosque (great view of Stari Most, thefamous bridge), trip to Blagaj Tekija
Where to stay: Full View Apartment (10 euros/night); also run by the sweetest family--the mother kept bringing me complimentary homemade food, and took me on a trip to the iconic Blagaj Tekija!
Stari Most, view from Karađoz Bey mosque
Stari Most is probably the best-known landmark in Mostar. Adrenaline junkies might take a dip in the river by diving from the bridge, though it's generally seen as an unsafe jump. Locals might ask for donations from tourists before taking the plunge themselves, though.
Mostar had an unexpected Turkish influence, hence all the lamps, intricate dishware, and eye-catching tea sets. I really wanted to buy a lamp and tea set, but they were a little too bulky and fragile for my luggage haha. Souvenir shops overrun the old town, so you'll definitely have a ton of options. Word has it that you can try some gentle bargaining with the sellers, though I didn't realize until I left.
5. Dubrovnik, Croatia (2 nights)
Where to eat: I didn't eat out in Dubrovnik
What to do: it was rainy, so I didn't do much; I did hike up Mount Srd, but I don't think it's worth the effort, or the cable car price. People rave about Lokrum (island nearby) and Mlini (fishing town) though. I also really liked eating donuts in Cavtat, a fishing town near the airport. If you're a Game of Thrones fan, there's plenty GOT-themed tours as this is a filming location.
Where to stay: near the main bus station, or closer to the Old Town. I stayed in an Airbnb, but wouldn't recommend it for its location.
One of the most striking characteristics of Dubrovnik were the bustling alleyways. I would've loved to stop for a meal in one, though I suppose it's probably a tourist trap...
6. Kotor, Montenegro (3 nights)
Where to eat: Hoste Kotor, a tapas place in the Old Town with veggie options; the owner is happy to accommodate
What to do: hike the city walls, speedboat tour to Our Lady of the Rocks and Blue Cave, day trip to Budva (beach town)
Where to stay: I stayed in an Airbnb, but I'd also recommend staying closer to the Old Town. I was worried about noise, but apparently it quiets down a lot at night (at least in April)
I would definitely recommend the hike up the city walls, but 8 euros entry is a little pricey. There's apparently a free entrance, so try to find that instead. The views are very worth the climb, and there are cute sunbathing cats along the way.
What to Know Before You Go:
I got around primarily by bus, though I also caught a ride with other tourists once and took a taxi to and from airports. If you're going in a group, I would recommend renting a car, as the buses can be long and uncomfortable on the winding roads. If you do take the bus, know that you have to pay extra for any luggage stored underneath the bus (around 7 kunas or 1 euro per item).
These countries are on different currencies--Croatia, while a member of the EU, is on the kuna. Bosnia & Herzegovina is on the Bosnian mark, but I got away with using euros in the Old Town, or my card when paying at restaurants. Montenegro, while not in the EU, is on the euro. Most places will take card, but you'll want cash for market purchases and hold luggage fare on buses.
It may be difficult to find tasty and filling food as a vegan. I was not particularly impressed by most of the food I had, and it may be partially because a lot of traditional food is meat- or cheese-based. Be prepared to do some scouting!
There is a tourist tax in Montenegro. If you stay in a hotel, the tax (1 euro/night) should be included. If you stay in an Airbnb or Booking.com apartment, you'll pay your host; make sure your host has you registered, as this is apparently checked at the border. This may not be as strict as online forums make it seem, but I definitely was panicking at one point.
Smoking is even more common than it is in Western Europe. People may even smoke in their apartments, so be sure to ask your hosts about their rules if you're sensitive to cigarette smoke.
There are cats everywhere. Most of them are "stray," but people will give them food, so many look well-nourished. They're apparently very friendly in general, and don't mind a tummy rub or even being picked up.
Locals generally speak English and are very friendly and willing to help. My hosts were very attentive and sweet, a couple of them even welcoming me and taking care of me as if I were part of the family. And when I looked lost in Split, an elderly man asked if I needed help. That said, I did encounter one teenager in Montenegro who told me and an Irish friend I'd made to "get out" and that living in the Balkans was miserable compared to visiting. Be aware of your privilege as a tourist, and know that not everyone is excited about tourism.
Have you ever visited any of these spots? Let me know what you thought, or if there's a gem that I missed!
April 19, 2019 Paris, France
Race Review: Paris Marathon 2019 + Breaking 4 Hours!
I wasn't sure what to expect this race. Less than two weeks before, I struggled to fall asleep several days in a row, clocking as little as 4 hours of shut-eye one night. During this period of sleep deprivation fog, I also went on a hiking trip. I was supposed to be tapering, not traipsing up and down mountains and making my legs sore.
I sometimes put a lot of pressure on myself to perform in races--I become so stressed about getting enough sleep and rest that I actually keep myself tossing and turning for hours. I'm constantly reminding myself that I run because I love it--and if I'm making myself miserable, it's time to step back.
Eventually, I found some peace the week before the race. I was going to have fun and do my best, whatever that was.
Here's how the race went down, and my thoughts on how the event was run:
Paris Marathon Expo:
I arrived at the expo mid-afternoon on Saturday, the day before the race. It was at Porte de Versailles, a convention center on the outskirts of the 15th arrondissement. Despite there being 60,000 registrants, it took only a couple minutes for me to get my bib. I'd say there were at least 12 bib pickup stands, each organized by estimated start time and number, which divided up the traffic efficiently.
From there on, I grabbed the free race backpack and got my required bracelet (to show that we were real participants on the day of the race, and hadn't copied a bib or something). The bracelet was one of those wristbands that don't loosen once on, so don't tighten it too much if you're reading this for future editions of the race.
There was no free t-shirt at the expo, as you would get a finisher's t-shirt at the end of the race. The event t-shirts being sold at the expo were really well-designed though, and I almost wish I had gotten one since the finisher's t-shirt was very garish (you'll see what I mean later).
There were a TON of running-related vendors, but not a whole lot of free food/samples (the real priority haha). I snagged a couple free cookie packs and a key chain, but that was really it. There was a food court, which is probably why there wasn't a lot of free food.
Note: since this is a French race, a physical/medical exam is required to participate. You can upload your medical certificate on the Time To portal beforehand (which I did), so you don't have to worry about bringing it to the expo.
Thanks Henry for the above two photos!
Start Line of the Paris Marathon:
The race starts on the Champs Elysées, the major street leading to the Arc de Triomphe. I set up a meeting spot with a friend who came from Boston to run the race--we picked Le Duplex, a night club (lol) on Avenue Victor Hugo near the Arc de Triomphe. It was right past the bag drop/finish line area, and it was a great meeting spot since the part of the bar above ground was this black shell--so very noticeable, and good shelter from the wind/cold.
The weather for the 2019 Paris Marathon was actually very chilly for mid-April. It was only in the mid-30s at the start, and warmed up to maybe the high 40s/low 50s by the end. I was not very excited about the cold, but it really was ideal racing weather--once warmed up, your body wouldn't need to expend energy trying to stay cool (though my arms were numb for the first 4 miles).
My friend Henry and I made our way to our 3:45 corral (while we were pretty sure we weren't going to run 3:45, the 4:00 corral started half an hour later at 9:30, which is pretty late). The corrals close 15-20 minutes before the start, so be sure to come early. They are very strict about these closures, and we saw hordes of late runners jump the fence to reach the 3:30 corral (some even took the fence apart!).
There are porta potties in the corrals, but the lines get massive as early as 30 minutes before the start. They also run out of toilet paper, as I was delighted to discover :( Get in line as early as possible, and maybe bring yourself some TP!
The atmosphere is pretty energizing though, with music blasting through the speakers, and lots of friendly runners around. The race also donates any clothes left at the start, so I wore some old leggings and a sweatshirt that I later let go of.
I look pained, but I promise I'm having a good time!
From the official website
Paris Marathon 2019 Course:
I'd heard that this race wasn't the easiest, so I was bracing myself for a tough course. I was pleasantly surprised though--here's why:
- The course is relatively flat; my Garmin recorded 528ft elevation gain and 489ft elevation loss. It's not the flattest course ever, but it's not really hilly either. There are some inclines, but they're not really noticeable until mile 15 on, where you have to run down and up a few road tunnels.
- There are both mile and kilometer markers (hooray for the Americans still stuck on the imperial system haha).
- You get to see many major Parisian sites: obviously Arc de Triomphe, but also Place de la Concorde, Palais Garnier, Place de la Bastille, and the Eiffel Tower, among others.
- The cobblestones are really not that bad. We're not talking the horribly uneven cobblestones in medieval villages; the ones along the course are flat, and I barely noticed them.
- There is a green line along most of the course that helps you avoid adding too much distance when turning. The closer you stick to it, the closer your total distance should be to 26.2.
- The course is all on the road; I mistakenly thought that the sections through the parks would be on dirt paths, but we stuck to the roads winding through them.
- Despite so many participants, there's usually enough room to run your pace.
I started off with the intention of running 9:30 miles, but ended up clocking some sub-9s. I didn't feel like I was overexerting myself, so I tried to keep a 9 minute pace or slightly quicker. Henry and I started together, but we split up within the first mile--he had run LA 3 weeks before and his goal was to enjoy the course.
I made it to the halfway point in 1:58:42, on track to run a sub 4-hour time (this was the goal in the back of my mind, but I wasn't sure that I could do it after the sleep deprivation, and I wasn't sure that I had done enough speed work). I was feeling relatively good, but I knew that the race wasn't over until it was over. For my first marathon, I ran the first half in 2 hours, but slowed down by 8 minutes in the second half. In my second marathon, I also had a positive split of 8 minutes.
I kept chugging along though, and didn't hit a wall until mile 21. Until that point, my pace had felt manageably challenging. The last 5 miles felt horrible. My calves and quads were on the verge of seizing up--I knew that if I pushed myself too hard, I'd end up with non-compliant legs. I could no longer keep the 9-minute pace, and really had to fight to keep moving.
You didn't run 21 miles on pace to lose your sub-4 marathon now. I repeated this to myself so that I wouldn't slow down too much. I'd wanted to run in under 4 hours since my first marathon, three years ago.
Nearing the finish line, I vaguely recall yelling. Probably some ugly "AHHHH" mixed with a massive grunt. It was one of those races that was satisfying because I know I couldn't have run faster; I know I gave it my all.
I crossed the finish line in 3:59:27 (9:08/mi or 5:40/km). It was a 9-minute PR, and my first PR in 3 years.
Paris Marathon Fuel Stations:
I was expecting a major feast at the finish line for such a big race. Unfortunately, there was really only water, fruit (apples, oranges, bananas, dried apricots), gingerbread (pain d'épices), pretzels, and Stimium recovery sticks (kind of like an energy gel). There were some street food vendors who took up the chance to reach a large, hungry client base though, and their prices were relatively cheap (I got a large order of fries for 3 euros).
Along the course, you could expect similar fare. There was always water, and usually some fruit; I didn't grab any solid food, so I couldn't tell you for sure. There were aid stations every 5km or so, but the first one wasn't until about 4 miles in. Like most races in France, there also weren't any energy gels or sports drinks at the fuel stops. I carried my CamelBak since the aid stations were infrequent and guzzled 1/3 of an Aptonia lemon isotone before the race (a drink like Gatorade). During the race, I consumed 1 Roctane Gu (miles 1-5), 2 Honey Stingers (miles 10-13 and 17-21), 1 pack of Stimium chews (miles 8-10), and 2 salt tablets (mile 7 and mile 15).
Reflection/Summary:
I loved this race--not only because I PR'ed, but also for how scenic the course was, and how well-run the event was. There was also a decent amount of spectators on the course, though it varied. It seemed to be either a sea of people, or only a sprinkling.
Of course, some points of improvement would be:
- The medal design was pretty basic this year compared to past years, and the shirt was Halloween colors.
- Would love to see energy gel, or at least sports drinks at the aid stations. Food at the finish could also be more generous/filling.
Performance-wise, I think it was my trail training that helped me finally run a sub-4 on this course. When I hit the hillier section along the Seine, I told myself that the inclines could be much worse. I also think that racing and training for the Barcelona Half Marathon 2 months before helped me get in a decent base of speedwork, even if I didn't PR then. I had followed a similar pattern for the Lyon Half Marathon in October 2018 by training to race a 5k over the summer. The 5k didn't go super well, but the track workouts I did were a strong foundation for a 1:45 finish in Lyon (my first sub-1:55 in 3 years!).
Based on my half marathon PR (1:44:03), race calculators say I should be capable of running faster marathons (around 3:40, though race predictors have never been super accurate for me). Still, I'm very happy with how the Paris Marathon went. Marathon training can be pretty volatile for me, as I've burned out in both previous training cycles. I only tasted similar fatigue once during this cycle, about 3 weeks out, and I took it easy from there.
I'm looking forward to chasing more PRs and challenges, but I'm happy to get some rest and travel for now. If you're looking for an international spring marathon in 2020, registration is already open for Paris. Entry starts at 90 euros and goes up to around 130 by the fall. I'm already feeling nostalgic about this race, and can heartily recommend it.
If you ran Paris too, I'd love to hear about your experience. If you ran another race that you think I should consider, I'm all ears too!
Run happy,
Why to Pick the Forerunner 235:
- The Forerunner 235 latches onto GPS signal immediately, while I've had to wait several minutes with the Vivoactive 3, especially if I've changed geographical location (like one country/state to another). After that initial GPS signal search, the Vivoactive 3 still takes 10-30 seconds to find signal.
- This watch comes with a recovery advisor, which recommends the amount of rest time you should take after a run, based on your effort. It's also equipped with a race predictor, which gives you projected race times based on your runs. I've heard that both these aren't entirely accurate, but I've also not tested them firsthand.
- There's talk that the Forerunner 245 will soon be released, so prices should drop on the 235 soon.
Why to Pick the Vivoactive 3:
- This watch feels more "modern," probably due to the touchscreen and sleeker design (the Forerunner 235 feels very plastic-y and bulky). The Garmin Vivoactive 3 Music was released in 2018, while the Forerunner 235 is from 2015, so the Vivoactive 3 is newer technology for about the same price. The prices are currently $219 vs. $245, respectively, though the price gap was even smaller at time of purchase. You can use camelcamelcamel to track price changes and get alerts if the price drops to your desired amount.
- The Vivoactive 3 Music has a music storage function, so you can connect Bluetooth headphones and keep your tunes with you on the run (you can even access Spotify Premium now!). If you don't listen to music while running, there is the non-music Vivoactive 3 that is currently cheaper than both the Vivoactive 3 Music and the Forerunner 235. I actually have never tested the music function as I don't own Bluetooth headphones, and I prefer to be lost in my thoughts while running haha. I got the music version primarily for aesthetic reasons, to be completely honest (if I'm gonna spend $200+ on a watch, I better like how it looks!). The non-music Vivoactive 3 has a metal bezel that I'm not particularly fond of.
- The heart rate monitor of the Forerunner 235 juts out and sticks into your wrist, which is uncomfortable if you're wearing the watch for an extended period of time. The Vivoactive 3 HR sensor doesn't protrude, so it's much easier to wear.
- The Vivoactive 3 can track more activities; I was particularly interested in the swimming stats (pace per 100m, average number of strokes, etc). Note that in swimming mode, heart rate is disabled. Also, the swimming function is currently pretty inaccurate. Despite changing pool distance settings, I've gotten total distance numbers more than twice as long as I've actually swum! Hopefully this function improves with updates though.
The Bottom Line:
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