France

To understand how the French health care system works one first has to take a look at the French health insurance system. This insurance is financed by both employer and employee contributions as well as by personal income tax and it allows 96% of the population to access entirely free health care. The insurance also gives French residents the right to choose between diverse health providers such as general practioners, specialists, public or private hospitals and be reimbursed at a fixed rate for different procedures. On top of the statehealth insurance, 80% of the French population also possesses private supplemental insurance often provided by the employer. This insurance covers extra costs above the fixed rates set by the state for specific treatments. Health insurance is provided by the government to three major groups of the population: salaried workers and their families, farmers, and artists and business professionals. The types of expenditures by the government include general practitioners' fees, specialists' fees, medical prescriptions, public hospitals, private clinics, nursing professionals and sanitary transportation.

The Ministry of Health organizes the French health system through central, regional and departmental services via two major organizations: General Health Management and Hospital and Healthcare Management.

France’s healthcare system offers some of the best standards in the world, though private health insurance is necessary in certain circumstances. Medical insurance in France has been a hot topic since the French healthcare system was overhauled in 2016.

This guide explains the public and private health insurance on offer in France, and how you can access treatment. It includes information on the following topics:

• The healthcare system and health insurance in France
• Who needs health insurance in France
• Public health insurance in France
• How to apply for public health insurance
• Private health insurance in France
• Health insurance costs and reimbursements
• Health insurance for unemployed and low earners
• The healthcare system and health insurance in France

French law stipulates that all residents of France must have health insurance. This can be through the public healthcare system or a private scheme.

In 2016, the government introduced of a new universal public healthcare system – Protection Maladie Universelle (PUMA). The scheme’s introduction means most expats are now eligible for state French health insurance (l’assurance maladie).

Individuals not covered by the PUMA or who want to increase their health coverage can instead opt for private health insurance policies.

Who needs health insurance in France?

Under the PUMA system, permanent residents receive state health insurance if they’ve lived in France for three consecutive months.

Major healthcare reforms have simplified the requirements for workers and residents in France, meaning unlimited healthcare access is now a right of all residents.

This applies regardless of age, medical history, and record of social security contributions (cotisations sociales).

Previously, French health insurance for foreigners was only offered if a number of conditions were met. Now, PUMA guarantees that legal residents keep their health insurance despite any changes in circumstances.

The new system saw France reach eighth place out of 89 countries in the 2019 Health Care Index, behind only Austria, Denmark and Spain in Europe. For more information, read our Guide to the French healthcare system.

Public health insurance in France

France operates a co-payment system for public healthcare, with the majority of medical costs reimbursed through your state health insurance.

The reimbursement varies depending on the service. For example, it’s usually in the region of 70% for visiting a doctor, dentist or specialist. Reimbursement for visiting a French hospital is around 80% of costs. For prescribed medications, it can be up to 100% of costs.

If you have a health card (Carte vitale), you won’t need to make upfront payments. However, patients without a card will have to pay the appropriate medical fees at the point of service. You’ll receive reimbursements in your bank account between five and 10 business days later.

Who does public health insurance in France cover?

Residents: anyone with stable and regular residency in France for at least three consecutive months per year can register for health insurance. Your family or principal home must be in France, and you must intend to live there for at least six months (183 days) a year.
Employees: employees working in France are eligible for health insurance through their social security contributions (cotisations sociales)
Self-employed freelancers and business owners: freelance sole traders (micro-entrepreneurs) and limited company business owners (Société à Responsibilité Limitée) can access medical insurance in France through the Régime Social des Indépendants (RSI) system.
Children: children are automatically eligible for healthcare insurance in France, regardless of their nationality.
Students: foreign students aren’t typically recognized as residents, so most students must acquire the required Students’ Social Security (Sécurité Sociale Etudiante), which covers health expenses while in France. Exceptions are available for EU/EEA citizens with EHIC cards, scholarship recipients, unemployed non-EEA citizens older than 28, and students studying in France for less than three months.
EU, EEA, and Swiss citizens: these citizens can typically use their European Union Health Insurance Card (EHIC) if they’re staying temporarily. However, health insurance is necessary for legal residents.
EEA and British retirees: these retirees who receive pensions from their home countries and reside in France can apply to French health insurance with a valid S1 form.
Unemployed people/workers with low incomes: jobless or low-income legal residents are eligible for French health insurance and can get subsidies through CMU-C.
What does public health insurance in France cover?

Doctors: under the state system, you’ll usually need to pay a flat fee of €25 when visiting a doctor. Insurance providers partially reimburse the costs afterwards.
Emergency care: A&E services are part of the state healthcare system, and all cities and large towns also have an emergency ambulance service.
Specialist care: specialists in France may charge higher fees than general doctors, but these will be set within the parameters of the standard state healthcare costs. To be reimbursed for a visit to a specialist, you’ll need to have been referred by your GP.
Medicines: pharmacies operate slightly differently to other elements of the healthcare system. Instead of paying the full amount and then seeking part reimbursement of your costs, you’ll only pay the amount not covered by the state when buying medicine in a pharmacy.
Dental care: the French state healthcare system covers visits to the dentist. However, dental care comes with its own tariffs and reimbursement rates. General dental treatments are reimbursed in the same way as other specialized care, but reimbursements for advanced procedures will typically be less due to the higher cost.
Maternity care: The majority of the costs associated with pregnancy and childbirth are covered by public healthcare. 70% of the costs of your first two scans are covered, then after six months all costs are fully covered. Find out more in our guide to having a baby in France.

How to apply for public health insurance

The first step to acquiring health insurance in France is to either join the social security system or visit your local CPAM (Caisse Primaire d’Assurance Maladie).

Employers typically register their employees with social security and arrange their healthcare formalities. However, it’s your responsibility to check this has been done. Self-employed workers apply via the Régime Social des Indépendants (RSI).

If you qualify under PUMA, visit your local CPAM or send your application by post. CPAM assesses your rights, but the social security authority determines if you contribute towards your healthcare costs. If you earn below a certain threshold, you qualify for free healthcare under CMU-C.

Firstly, you’ll need to present a CERFA form, proof of identity and residence, translated birth and marriage certificates, proof of three-months’ residence in France, banking details, evidence of income, and your declaration de medecin traitant (doctor registration). During registration, you can add beneficiaries or dependents.

After activating your health insurance, you may need to formally request your carte vitale. This can take a long time to be processed, but you can ask for a temporary insurance card (attestation de couverture sociale) to cover you while you wait.

You can update your carte vitale annually by inserting it in the green box at CPAM offices, hospitals, and pharmacies.

Registering with a doctor in France

Residents over 16 years old and covered by the state medical insurance are required to register with a family doctor (médecin traitant). This is to access the full reimbursement of their medical costs.

Failure to do so will lead to penalties of higher medical fees and lower reimbursement rates.

Anyone 16 years or younger can visit any GP without fear of financial penalty. Once you’ve registered, you will receive a Declaration de Médecin Traitant. For more information, read our guide to registering with French doctors.

Private health insurance in France

Many French residents top up their coverage with a private health insurance policy, known as a mutuelle. Mutuelles can sometimes cater to workers with specific professions, and some are specifically aimed at English speakers.

Employers often offer a place in a mutuelle as part of your benefits package.

Students can either choose coverage from their parents’ mutuelle or select their own.

The advantages of getting private health insurance coverage in France

State insurance typically doesn’t cover consultations with psychologists, osteopaths, chiropractors and certain specialists.

If you require any specialist treatment, private insurance offers the same treatment as you’d get at home.

Private care costs depend on the type of cover required and factors such as the age of the applicant; however, few mutuelles ask for your health details prior to approval.

Basic packages focus on hospital care and medicine, but may include limited dental coverage. So, you should always research and compare plans before moving in order to obtain the best insurance coverage for you.

How does private health insurance work?

Most French insurance companies reimburse the remaining 30% of your general healthcare costs, including emergency hospital treatment.

Many specialists are independent but receive public health funds from the state. The state sets the price of services. However, some carry a surplus charge that the individual must pay if their mutuelle doesn’t cover it.

Thus, some policies that refer to 100% coverage can appear misleading.

Reimbursements only refer to state-fixed tariffs, such as the standard charge for a consultation with a doctor. Surplus amounts aren’t covered by the mutuelle, and is therefore payable by the individual.

The process may seem complicated at first, so don’t be afraid to ask for advice. For prescriptions, private insurance may offer partial or total refunds.

French health insurance providers

Some of the largest French health insurance companies, or mutuelles, include:

• Allianz Care
• Cigna Global
• Health insurance contributions and reimbursements

Anyone working in France will have social contributions (cotisations sociales) automatically deducted from their salaries. This covers their state healthcare insurance in France.

There are a number of factors that influence costs, such as income and household. It averages out at around 8% of your net income above a minimum threshold set by the state.

Retirees and non-resident taxpayers typically pay less, however.

Visit CLEISS (Centre des liaisons Européennes et internationales de sécurité sociale) for the full list of French health insurance contribution rates as of 1 January 2019. The government amends the percentage of cotisations sociales deductions yearly.

Health insurance for unemployed and low earners

Unemployed workers and low earners are eligible for free complementary state-funded healthcare, known as CMU-complémentaire (CMU-C).

The current income thresholds per household for 2019 are set at the following levels:

Single-person household: €8,951
Two-person household: €13,426
Three-person household: €16,112
Four-person household: €18,129
Each additional person in a household with more than four people: €3,580 each.
Expats must first activate PUMA before qualifying for CMU-C. Afterwards, the state health insurance covers all medical and dental costs.

You won’t be asked for upfront payments after services have been rendered. You can apply for the CMU-C by filling in this form and submitting it to your local CPAM.

Healthcare vocabulary in French

Below are some medical terms in French to help you with setting up your health insurance in France as well as visiting a French doctor or hospital in France.

You can find more in our guide to medical terms in French, while this online voice pronunciation guide can help with your French pronunciation.

Insurance in French: assurance, une assurance médicale (medical insurance)
Healthcare in French: services de santé, soins de santé, soins médicaux (medical care)
Health in French: santé
Doctor in French: médécin
Hospital in French: hôpital
Ill in French: malade
Fever in French: la fièvre
I am cold in French: J’ai froid
Ambulance in French: une ambulance; J’ai besoin d’une ambulance (I need an ambulance)
Useful resources

L’Assurance Maladie‘s (AMELI) – the French government’s health insurance department