Tired of paying for others? Why personalized mutual insurance is the future

In short: For three consecutive years, mutual insurance rates have exploded while reimbursements have dwindled. Exorbitant management fees, the inefficiency of a two-tier system, and unequal access widen the gaps. Faced with this situation, the personalized mutual insurance emerges as a pragmatic response: adapt coverage to each person’s real needs, reduce superfluous spending, and restore a more equitable cost management. It’s less a revolution than an obvious choice: being able to choose what you pay for, rather than financing services you’ll never need.

When paying more and more means receiving less and less

There is something absurd about what the health mutual market is showing us at the start of 2026. For three years running, contributions have risen — an increase of more than 7% in 2025 alone — while, at the same time, organizations are seriously considering reimbursing less. Glasses? Now every three years instead of two. Hearing aids? Extended to five years instead of four. And then there’s this almost surreal decision: the abandonment of reimbursement for menstrual underwear.

It’s as if a customer were asked to pay more for fewer pages in a book. Except here, the stakes aren’t cosmetic: these are treatments, health, fragments of daily life. This perverse mechanism raises the question: what is the real purpose of this system that the French have been financing for decades?

A complex system that costs at every level

Let’s look at the numbers without beating around the bush. Social Security covers 80% of health expenses; complementary insurers cover 13%, and households remain responsible for the remaining 7%. On paper, that looks like a distribution. In reality, it’s an expensive stacking where each layer adds its management fees.

Here is the paradox: the Health Insurance operates with 4% management costs, while complementary insurers demand between 16% and 23% depending on the year. How can such a glaring difference be justified? A public organization, with a universal base of members and standardized contracts, achieves an efficiency that the private, fragmented, and competitive sector cannot match. That means about €7 billion a year evaporate simply to maintain a bureaucracy that heals no one.

Money that should pay for care funds sailboats

But there is worse than management. There is what one could call “strategic padding.” Mutual insurers, subject to a legal constraint — never showing profits or deficits — have a perverse incentive: to cast a wide net. They inflate contributions at the start of the year to avoid the red. And when there is leftover money they cannot keep, where does it go?

Into advertising. Into marketing. Into naming racing yachts. While some families give up care for lack of means, mutual insurers invest in Vendée Globe visibility. There is something almost cynical about seeing money intended to protect the health of the French fund massive advertising campaigns. There are many mutual insurers, the market is saturated, loyalty is fragile: they therefore have to fight to exist. This competition, which should theoretically serve the user, mainly creates unproductive expenses.

Who actually pays for whom?

Inequality does not hide itself. According to the Institute for Research and Documentation in Health Economics, 4% of the population — some 2.6 million people — have no complementary insurance. Among them are 11% of the poorest retirees and 20% of the long-term unemployed. The most vulnerable remain without a safety net, while those who can pay finance a system that overprotects them and forces them to pay for services they will never use.

Individual responsibility then becomes an unfair burden: it’s no longer “paying for your health,” it’s “paying for others while hoping not to need it.” This is at the heart of what pushes toward a profound reform, toward a different logic.

Personalized mutual insurance: tailor the suit to fit

Faced with this dead end, a trend is emerging: the personalized mutual insurance. Not as a miracle solution, but as a logical reaction to the weaknesses of the current system. The idea is simple and radical: each person composes their coverage according to their real needs, health profile, age, and medical history.

Why force a young person without dental problems to finance crowns? Why make a retiree pay for spa treatments they’ll never take? Adapted coverage becomes the alternative to one-size-fits-all coverage. It’s a bit like old-fashioned bookbinding: rather than imposing a standard format, you shape the book according to the customer. You assess the paper, choose the leather, decide the color. Every detail matters, and nothing is superfluous.

Economy and anticipation: the two engines

This approach responds to a simple economy: avoiding the financing of unnecessary services reduces overall contributions. It also responds to a life logic: better anticipate health expenses. A mother of young children will not choose the same plan as a fifty-year-old man with a history of heart problems. This granularity is regained efficiency.

But it raises a central ethical question: can fair financing coexist with personalization? If the sickest pay more — because their risk profile is higher — aren’t we simply reproducing, in a more fragmented way, what we criticize about the current system? It’s the big dilemma: how to innovate without deepening inequalities?

Personalized premiums as a transition

Personalized premiums are a pragmatic first step. They allow insurers to adjust contributions according to transparent criteria — age, sex, employment status, medical history. It’s not full bespoke, but it’s better than one size fits all.

Several insurers are already exploring this model, recognizing that the future of insurance lies in better segmentation. The advantage: everyone pays closer to what they consume. The drawback: safeguards are needed to protect at-risk populations and prevent them from being excluded or overcharged. You can consult detailed information on mutual security and provident insurance to better understand these mechanisms.

When the State contemplates going without

Some thinkers and economists go further. What if complementary insurers should be purely and simply abolished? In 2021, the Court of Auditors judged the system “generally costly” and “sometimes unfair.” The High Council for the Future of Health Insurance raised the hypothesis of moving beyond mutuals. The occasion? The Covid crisis, which had force-opened the taps: 100% of vaccines, 100% of tests, 100% reimbursed, without passing through the mutual route.

At that time, a question became clearer: was this two-tier system really indispensable? Or simply entrenched in political and commercial routines?

The 100% Social Security model under debate

Technically, a shift to a 100% Social Security regime is possible. Contributions would increase slightly, but out-of-pocket costs would overall decrease for the majority of French people. Management fees would melt away: no more marketing, no more multi-level bureaucracy, no more administrative overlaps. It’s a purely mathematical logic.

But politically, it’s much more complex. Mutual insurers employ tens of thousands of people. The industry has established interests. And then there’s a matter of principle: should we really leave the State as the sole guarantor of our health coverage? This is where the personalized mutual insurance appears as a compromise: keep complementarity, but rethink it from the ground up.

The outlines of a new model

What the “health insurance” of tomorrow might be: transparent about its fees, modular according to real needs, fair without being uniform. Digital technologies help. We can now imagine algorithms that propose optimal coverage based on a person’s profile, without overloading or stripping it away.

We can also imagine stricter regulation of management fees, or even an obligation to provide minimum benefits to avoid a dismantling that would leave the most fragile unprotected. Consult information on 2026 aid and thresholds to see how the aid system is currently structured.

Toward shared responsibility

What would fundamentally change is the relationship to care. Instead of blindly paying for everything and feeling cheated when coverage shrinks, everyone would become an informed actor of their choices. I finance glasses because I need them, or I don’t. I opt for enhanced dental coverage because my mouth requires it. It’s not short-term profit; it’s enlightened individual responsibility, not imposed.

This requires education, transparency, and — paradoxically — a State that guarantees the framework, to prevent this “freedom” from reproducing inequalities. It’s fragile, but it’s the direction that a certain urgency traces in the face of the absurdity of the status quo.

Everyday mutual insurance, reinvented

In editorial rooms, we often talk about the difference between “writing to look good” and “writing to clarify.” Today, mutual insurance writes to look good — marketing, promises, margins. Tomorrow, it should write to clarify: say exactly what is covered, for whom, at what cost, without detours.

It’s a cultural change as much as a structural one. The mutual insurers that understand this mutation — that move from “we sell you protection” to “we help you choose your protection” — will be the ones that survive. The others will remain trapped in a model where prices must continually rise to stay visible.

A renewed collective stake

There is also an angle that mutual insurers, by nature, could cultivate more: their mutualist side. The real one. Not the marketing, the real thing. If a personalized mutual insurance allowed its members to really understand where their money goes, to vote on major directions, to share the savings made thanks to better management… it would no longer be insurance, it would be a form of collective engagement. A reconnecting, in the sense of linking people through a common project.

Maybe it’s naïve. But it’s less naïve than continuing to pay more and more for less and less, wondering where on earth that money goes.