Complementary Solidarity Health Insurance (CSS) in France: 2026 Guide

The **Complémentaire Santé Solidaire (CSS)** is a French state-funded scheme that gives people with modest income access to complementary health cover either **free of charge** or for **less than €1 per day per person**. It replaced **CMU-C and ACS** on 1 November 2019 (Decree n°2019-621). Eligibility depends on a household income test, with two tiers; cover is comprehensive — including the 100% Santé basket — and renewals are decided yearly by your CPAM (or MSA for the agricultural scheme). In 2026 the thresholds were revalorised on 1 April. For more on insurance in France, see our complete guides.

> **Key takeaways**

> - **CSS = free or under €1/day per person** complementary health cover for modest-income households.

> - Replaced CMU-C and ACS in **November 2019** (Decree n°2019-621).

> - Two tiers: **CSS gratuite** (below the first threshold), **CSS avec participation** (between the two thresholds).

> - **2026 indicative thresholds**: ~€10,166 (single, free) / ~€13,724 (single, contributive). Thresholds rise with household size and are revalorised annually on 1 April (see ameli.fr).

> - Application via **ameli.fr** or your CPAM; decision within **2 months**.

> - Cover includes the **100% Santé basket** (optical, dental, audiology) and **third-party payment**.

> - Excludes most **extra fees** ("dépassements d'honoraires") and unconventional care.

> - Disputes: ameli.fr, Conciliateur de la CPAM, then the Médiateur de l'Assurance.

What is the Complémentaire Santé Solidaire?

The CSS is a **state-funded** complementary health insurance scheme managed by the Sécurité Sociale (CPAM, MSA or the equivalent fund). It pays the share of healthcare costs left to the patient after Assurance Maladie reimbursement — and, on top, it removes most out-of-pocket charges at the point of care thanks to the third-party payment system.

It was created by the 2019 Social Security financing law to merge the two former schemes:

• **CMU-C** (Couverture Maladie Universelle Complémentaire): free, very modest income.
• **ACS** (Aide au paiement d'une Complémentaire Santé): subsidy towards a private contract for slightly higher incomes.

Since 1 November 2019, both have been replaced by the single CSS, with a simpler two-tier structure.

The two tiers in 2026

CSS gratuite (free CSS)

For households with annual income below the first threshold. **No premium** is paid by the beneficiary; the State covers the full cost.

CSS avec participation (contributive CSS)

For households with annual income between the first and second thresholds. The beneficiary pays a **monthly contribution capped at less than €1 per day per person**, with the exact amount depending on age:

Figures are indicative — see the official ameli.fr page on CSS for the current schedule.

Income thresholds in 2026

Thresholds are **revalorised every year on 1 April** and depend on:

• The number of people in the household ("foyer").
• The geographical area (mainland France vs overseas — Mayotte excluded, separate scheme).

Mainland France — indicative 2026 ceilings

The official figures of the year are published by the Direction de la Sécurité Sociale and reflected on ameli.fr. The ranges above are indicative — always verify on ameli.fr before applying.

What income counts

The assessment covers **the last 12 calendar months** preceding the application. Counted income includes:

• Net taxable salaries and self-employment income.
• Unemployment benefits (France Travail).
• Pensions (retirement, disability, alimony received).
• Capital income (interest, dividends, rental income).
• Some social benefits (RSA, AAH partially).

What income does **not** count

• **Allocations familiales** (basic family benefits).
• **Allocation de rentrée scolaire** (back-to-school allowance).
• **APL / ALS / ALF** (housing assistance), up to a flat rate.
• **Bourses scolaires** (means-tested student grants).
• **Prime d'activité** in full.

What does CSS cover?

A high level of protection

CSS pays the full ticket modérateur on every consultation and procedure reimbursed by Assurance Maladie, plus the forfait journalier hospitalier in full. On top, beneficiaries access the **100% Santé basket** (optical, dental, audiology) at zero out-of-pocket cost. See our complete health insurance guide for the wider context.

Concrete cover

• **Doctor and specialist consultations** within the coordinated care pathway, **no extra fees** (the practitioner is not allowed to bill any "dépassement d'honoraires" to a CSS beneficiary in routine care).
• **Medicines** reimbursed by Sécurité Sociale at 100%.
• **Hospitalisation** (forfait journalier included), tests, radiology.
• **100% Santé optical** (frames + lenses, every 2 years, more often if correction changes).
• **100% Santé dental** (crowns, bridges, removable prostheses in the dedicated basket).
• **100% Santé hearing aids** (Class I — fully covered).
• **Third-party payment** ("tiers payant") — no advance to make.
• **Maternity** care and the package of preventive measures fully covered.

What it does **not** cover

• **Extra fees** outside emergencies or particular medical justification.
• **Non-conventionnée** care or non-reimbursable items (some cosmetic procedures, some alternative medicine sessions).
• **Private hospital rooms** except on medical necessity.
• **Items beyond the 100% Santé basket** (premium optical frames above the dedicated basket, prostheses outside the basket).

How to apply for CSS in 2026

Step 1 — Run a simulation

Use the official simulator on ameli.fr (general scheme) or msa.fr (agricultural scheme). You will see immediately whether you qualify and at which tier.

Step 2 — Compile your file

• The application form (Cerfa n°12504*09).
• Proof of income for the last 12 months (payslips, France Travail attestations, pension statements, tax notice).
• Proof of identity (carte d'identité, passport, titre de séjour).
• Proof of residence and household composition (livret de famille, last energy bill).

Step 3 — Submit it

• **Online**: your "ameli.fr" customer area, fully digital.
• **By post**: to your CPAM.
• **In person**: at any CPAM reception desk or France Services point.

Step 4 — Decision within 2 months

If granted, your rights start on the **first day of the month following the decision** (or the day after the previous CSS expires if you renew on time). The CPAM sends you a CSS attestation; some beneficiaries can also pick an alternative insurer from the regulated list of "organismes complémentaires" that manage CSS.

Duration, renewal and reporting

One year, renewable

CSS is granted for **12 months**. About **2 months before expiry**, the CPAM sends a renewal invitation. Renewal is not automatic — you must resubmit updated income proof.

Renewal made easier in some cases

For beneficiaries of the **RSA**, renewal is largely automatic since 2022 (data is shared between the CAF and the CPAM). For beneficiaries of the **ASPA** (minimum old-age pension), CSS gratuite is granted automatically.

Report a change in your situation

You must declare any significant change to your CPAM during the rights period:

• A return to work or a substantial pay rise.
• An inheritance or a windfall.
• A change in household composition (marriage, PACS, divorce, birth, death).

A change may shift you between tiers or end the entitlement.

Transitions: CMU-C and ACS beneficiaries

• If you had **CMU-C** before 1 November 2019, you were automatically moved to **CSS gratuite** at renewal.
• If you had **ACS**, you could request **CSS avec participation**, which is generally more protective than the former ACS contracts.

There is no longer any new CMU-C or ACS — only CSS.

What if your application is refused?

1. Ask your CPAM for the written reasons.
2. Contact the **Conciliateur de la CPAM** — free internal mediation.
3. File a "recours amiable" with the **Commission de Recours Amiable (CRA)** of your CPAM within 2 months of the decision.
4. If unsatisfied, take the case to the **Pôle social du tribunal judiciaire** (formerly TASS).
5. For practice issues or insurer-related disputes, contact the Médiateur de l'Assurance. For wider data-protection issues, the CNIL is the competent authority.

Conclusion

CSS is the safety net of the French complementary health system in 2026: free or near-free, with one of the most protective baskets on the market and full tiers payant. The single most common mistake is missing the renewal window — set a reminder a month before expiry. If your income sits just above the CSS avec participation ceiling, you may still qualify for other schemes (AME for non-residents in irregular situations, ASPA, ASS), which the CPAM social worker can guide you through.

Frequently Asked Questions

Who is eligible for CSS in France in 2026?

Anyone enrolled in the French health insurance system (Sécurité Sociale) whose household income over the last 12 months is below the relevant threshold. The threshold depends on household size and is revalorised every 1 April. Check current figures on ameli.fr.

Is CSS really free?

Yes for **CSS gratuite** (no premium at all). For **CSS avec participation**, the cost is capped at less than €1 per day per person, with an age-based schedule (around €8 to €30/month per person).

Does CSS replace my Sécurité Sociale?

No. CSS is **complementary**: Sécurité Sociale still reimburses its share, and CSS pays the patient's share, including the 100% Santé basket. The two work together.

Can a doctor charge me extra fees if I have CSS?

In standard care within the coordinated pathway, no. Doctors and specialists are not allowed to apply "dépassements d'honoraires" to CSS beneficiaries except in particular justified cases (e.g., out-of-pathway requests for a sector-2 specialist).

How long does it take to get a decision?

Up to **2 months**. If you have no answer after 2 months, the absence of answer is treated as a refusal under French administrative law; you can then file a recours amiable.

What if I just lost CSS because my income rose slightly?

Ask your CPAM about other schemes (Chèque énergie, APL recalculation, Conciliateur). You can also reapply when your situation evolves; the file is judged on the last 12 rolling months.

Can I choose my CSS insurer?

Yes. You can either keep your CPAM as manager of CSS, or pick a private insurer from the regulated list of "organismes complémentaires" approved to manage CSS. Cover and contribution are identical; choose based on service quality.

Related Articles

• Health Insurance: The Complete Guide
• Mandatory Workplace Health Insurance
• Health Insurance 2026

Sources

• ameli.fr — Complémentaire Santé Solidaire
• Service-Public.fr — CSS
• Légifrance — Decree n°2019-621 of 21 June 2019
• DREES — Études et statistiques santé
• Médiateur de l'Assurance
• ACPR — French Prudential Authority
• CNIL — French data protection authority

Last updated 28 May 2026. checkeverything.fr is an information portal; this article is for general guidance only and does not constitute medical, legal, financial, or insurance advice. CSS income thresholds and contribution amounts are revalorised annually on 1 April — always verify current figures on [ameli.fr](https://www.ameli.fr). For your specific situation, contact your CPAM, an "assistante sociale", or a France Services point.