Ticket modérateur (patient co-payment)
The ticket modérateur is the share of medical costs that stays with you after the Belgian compulsory health insurance has reimbursed its part. The amount depends on the type of care and on your social status. Capping mechanisms limit the annual total borne by a household, and the term appears on every reimbursement statement.
Why the mechanism exists
The co-payment is designed to make patients conscious of what care costs without obstructing access to necessary treatment. That is where the French name comes from: it moderates demand rather than blocking it.
The amount varies considerably by type of service and by whether the practitioner is contracted to the official tariffs. A non-contracted doctor may charge free fees, and the unreimbursed excess is added on top of the co-payment.
Preferential statuses reduce the co-payment for certain categories of beneficiary, and an annual capping mechanism limits the total a household bears in a year, calculated according to its income.
Frequently asked questions
How can I reduce my co-payment?
By consulting contracted practitioners, whose fees follow the official tariffs. Certain social statuses give entitlement to increased reimbursement, and the annual capping mechanism limits what a household pays over a year according to income.
Does hospital insurance cover the co-payment?
In hospital, generally yes within the limits of the policy. For ordinary outpatient care it depends on the guarantees taken out, so check the exact scope of the contract before relying on that cover.