Health Insurance in France

The French Healthcare System Explained

If you live in France or plan to move there, health insurance is one of those things you need to figure out early. The good news: every legal resident gets covered by the public system (called Securite sociale or "la Secu"). The less good news: that public coverage only pays about 70% of most medical bills, and sometimes less for dental and optical care.

That's where supplementary insurance comes in. Called a "mutuelle" or "complementaire sante", it covers the gap between what the state pays and what you actually owe. Around 96% of French residents have one, according to DREES (the health ministry's statistics arm).

The system works on reimbursement: you pay the doctor, then the state and your mutuelle reimburse you. If you have a Carte Vitale (the green chip card), most of this happens automatically within a few days. Without one, you'll be dealing with paper forms.

Securite Sociale: The Foundation

The Securite sociale is France's mandatory public health insurance system, administered by regional health insurance funds called CPAM (Caisse Primaire d'Assurance Maladie). Through the PUMA system (Protection Universelle Maladie), introduced in 2016, all legal residents are automatically entitled to health insurance coverage, regardless of their professional situation. You can manage your account and find your local CPAM office through ameli.fr, the official Assurance Maladie website.

The public system reimburses approximately 70% of most medical costs based on official rates called "tarifs de convention." The actual reimbursement percentage varies depending on the type of care. Long-term chronic conditions (ALD, or Affections de Longue Duree) may receive 100% coverage for related treatments.

Since December 2024, the base rate for a GP consultation in metropolitan France is €30 (€36 in overseas departments). The Securite sociale reimburses 70% of this, which comes to €21. After subtracting the €2 participation forfaitaire (a flat fee you always pay), you receive €19 back. Teleconsultations with GPs are set at a frozen rate of €25 for the next five years.

Who Is Eligible for PUMA?

To be eligible for PUMA (Protection Universelle Maladie), you must meet one of the following conditions:

• Work legally in France (as an employee or self-employed person)
• Reside in France in a stable and regular manner for more than 3 months per year
• Be a dependent family member of someone who meets the above criteria
• Be a student enrolled in a French educational institution

The Carte Vitale

Once registered with CPAM, you'll receive a Carte Vitale, the green chip card that is essential for accessing healthcare in France. When you present this card to healthcare providers, it allows direct electronic transmission of your health insurance information, so reimbursement processing happens automatically without paper forms.

The Carte Vitale typically takes 2-3 weeks to arrive after your registration is processed. Until you receive it, you'll need to submit paper claim forms (feuilles de soins) manually to receive reimbursement. Most pharmacies, doctors' offices, and healthcare facilities have readers to process your Carte Vitale instantly.

Keep your Carte Vitale updated, especially after major life changes such as marriage, divorce, childbirth, or a change of address. You can update your card at pharmacies equipped with updating terminals or at your local CPAM office.

Your Medecin Traitant (Designated Doctor)

One thing that trips up newcomers: France expects you to register a medecin traitant, a designated GP who becomes your primary point of contact. You're not locked in forever (you can switch anytime), but having one matters financially.

If you see a specialist without a referral from your medecin traitant, the reimbursement rate drops from 70% to 30%. There are exceptions for gynecologists, ophthalmologists, psychiatrists (for patients under 26), and dentists, which you can visit directly. This system is called the "parcours de soins coordonnes", and it's the French way of keeping healthcare organized.

To register your medecin traitant, you and your chosen GP fill out a simple form together (declaration de choix du medecin traitant), which gets sent to CPAM. Most GPs are happy to take on new patients, though finding one in rural areas can be harder.

Mutuelle: Supplementary Health Insurance

A mutuelle, also called complementaire sante, is private supplementary health insurance that covers the costs not reimbursed by the Securite sociale. While not legally mandatory, having a mutuelle has become standard practice. About 96% of residents maintain supplementary coverage (DREES, 2024).

Without a mutuelle, you would pay the remaining 30% of covered medical costs out of pocket, plus any additional fees charged by providers above the official rates. These costs add up fast, especially for dental care, optical care, hospital stays, or specialist visits. If you're considering switching your mutuelle, the Hamon Law gives you the right to cancel after the first year.

What Does a Mutuelle Cover?

Coverage varies depending on the contract level you choose, but typically includes:

Types of Mutuelles

There are three main types of supplementary health insurance in France:

How Much Does a Mutuelle Cost?

The cost varies based on your age, family situation, desired coverage level, and whether you have employer contributions. As a general guideline for 2026:

• Basic coverage: €30-80 per month for individuals, €80-150 for families
• Intermediate coverage: €80-120 per month for individuals, €150-250 for families
• Comprehensive coverage: €120-200+ per month for individuals, €250-400+ for families

Premiums tend to increase with age, particularly after 60, as healthcare needs typically grow. However, French law prohibits insurance companies from canceling policies or increasing premiums beyond standard age-based brackets. You won't be penalized for pre-existing conditions.

100% Sante: Zero Out-of-Pocket Healthcare

The 100% Sante reform, rolled out between 2019 and 2021, guarantees that every French resident with a mutuelle can access certain dental, optical, and hearing care at zero out-of-pocket cost. No copay, no remaining balance. Your Securite sociale and mutuelle together cover 100%.

What's Included

The catch: the products covered under 100% Sante are from a specific "basket" with set specifications. Higher-end options (designer frames, premium hearing aids) cost more, but the baseline is genuinely functional.

This matters especially for people who have been avoiding dental or optical care because of cost. If your mutuelle is a "contrat responsable" (which most are), you're automatically eligible.

Mental Health Coverage

Mental health coverage in France has improved in recent years. The public system covers psychiatric consultations at the standard reimbursement rate (70% for Sector 1 psychiatrists, who charge €57 since January 2026).

For psychologists (who are not psychiatrists), France launched the MonPsy program. Through this program, your GP can refer you to a participating psychologist for up to 8 sessions per year, reimbursed by the Securite sociale. The first session costs €50 and follow-up sessions cost €40 each. No mutuelle needed for these.

Outside of MonPsy, psychologist sessions (typically €50-80 per session) are only covered if your mutuelle specifically includes them. Many higher-tier mutuelles reimburse 3-5 sessions per year, but check your contract.

For psychiatric emergencies, hospital emergency rooms (urgences) provide immediate care, and mental health crisis centers (centres medico-psychologiques, or CMP) offer free consultations, though waiting times can be long.

CSS: Healthcare Coverage for Low-Income Residents

The Complementaire Sante Solidaire (CSS) is a government-provided supplementary health insurance program for low-income residents. It replaced the previous CMU-C and ACS systems in November 2019. CSS covers the portion of healthcare costs not reimbursed by the Securite sociale, eliminating the ticket moderateur (patient co-payment) and protecting beneficiaries from extra billing charges when using approved healthcare providers.

Who Is Eligible for CSS?

Eligibility for CSS is determined primarily by household income and residency status. Income thresholds are updated annually. For current thresholds, check complementaire-sante-solidaire.gouv.fr.

To be eligible, you must also be a legal resident of France for more than 3 months and be covered by the Securite sociale through PUMA. Applications are made through your local CPAM office, and if approved, coverage typically begins on the first day of the following month.

What CSS Covers

CSS provides comprehensive coverage including all services covered by standard mutuelles, plus specific protections against extra billing. Beneficiaries receive a CSS attestation card that they present along with their Carte Vitale to healthcare providers, so there's direct billing without upfront payment for most services.

Employer-Provided Health Insurance

Since January 1, 2016, all employers in France are legally required to offer group health insurance (mutuelle collective or mutuelle d'entreprise) to their employees. This obligation, established by the ANI (Accord National Interprofessionnel), means every salaried worker has access to supplementary health coverage.

The employer must contribute at least 50% of the premium cost, with the employee paying the remaining 50% through salary deductions. Many employers choose to contribute more than the minimum as part of their benefits package. The employer's contribution is tax-deductible for the company and exempt from certain social charges.

Minimum Coverage Requirements

Employer-provided health insurance must meet minimum coverage standards defined by law, known as the "panier de soins minimum ANI." This minimum basket of care must include:

• 100% reimbursement of the ticket moderateur for consultations, prescriptions, and medical procedures covered by Securite sociale
• Minimum reimbursement for dental care: €125 per year for prosthetics, 125% of the official rate for conservative care
• Optical care: At least €100 per year for simple correction, €150 for complex correction
• Hospital daily room rate: Minimum €50 per day

Can You Opt Out?

Participation in employer-provided health insurance is generally mandatory, but certain situations allow you to request an exemption:

• Already covered by another professional health insurance (including through a spouse's employer)
• Covered by CSS (Complementaire Sante Solidaire)
• Part-time employee working less than 15 hours per week
• Fixed-term contract or temporary work contract of less than 12 months

To opt out, you must provide proof of your alternative coverage to your employer. Keep in mind that opting out means you lose the benefit of the employer's 50% contribution, so it's only worth it if you have equivalent or better coverage elsewhere at no or lower cost.

Healthcare Costs in France (2026 Tariffs)

Understanding how costs work is one of the most important parts of the French healthcare system. While France offers universal coverage, you still need to know about reimbursement rates, official tariffs, and potential extra charges. All tariff information below comes from service-public.fr and the 2024-2029 medical convention.

Official Tariffs and Reimbursement Rates

Specialist Consultation Rates (2026, Sector 1)

Extra Billing (Depassements d'Honoraires)

Many specialists and some GPs charge more than the official Securite sociale rates. These extra charges (depassements d'honoraires) are your responsibility unless your mutuelle specifically covers them. Doctors are classified into sectors:

• Sector 1
  Conventional rates: These doctors charge the official rates with no or minimal extra billing. They represent about 60% of general practitioners but only 30% of specialists.
• Sector 2
  Extra billing allowed: These doctors can set their own fees above official rates. Extra charges can be substantial, especially in major cities and for specialized care.
• Sector 3
  Non-conventional: These doctors don't participate in the conventional sector and charge fully private rates. Reimbursement is minimal or non-existent.

When choosing a doctor or specialist, check their sector classification and fee schedule. Most good mutuelles partially cover extra billing up to certain limits, but understanding these costs upfront helps avoid surprises.

Health Insurance for Expats in France

Moving to France as an expat requires understanding how to access the healthcare system and what coverage you're entitled to. The process varies depending on your country of origin, employment status, and length of stay.

EU/EEA Citizens

If you're from an EU/EEA country or Switzerland, you can use your European Health Insurance Card (EHIC) for temporary stays and emergency care. If you're moving to France permanently or for an extended period, you should register with CPAM to receive full coverage under PUMA.

EU citizens who work in France are automatically enrolled in the French social security system from their first day of employment. If you're not working (retired, student, or not economically active), you need to demonstrate legal residence for at least 3 months to access PUMA.

Non-EU Citizens

Non-EU expats need legal residency status (titre de sejour) before they can access the French healthcare system. Once you have legal residency and have been living in France for more than 3 months, you become eligible for PUMA. The waiting period for full coverage is typically 3 months from registration.

During this waiting period, maintain private international health insurance to cover any medical needs. Many expats keep their international insurance for the first year in France while they navigate the system.

Registering with CPAM

To register with CPAM as a new resident, follow these steps. You can find your local CPAM office at ameli.fr/assure/adresses-et-contacts.

Finding English-Speaking Doctors

If you don't speak French well enough for medical conversations, several options exist:

• Doctolib.fr: France's largest appointment booking platform. Filter by language when searching for doctors.
• SOS Medecins: House call service available in most cities. Some doctors speak English.
• Your embassy: Most embassies maintain lists of English-speaking doctors in major cities.
• Hospital international departments: Larger hospitals in Paris, Lyon, Marseille, and other major cities have international patient departments with English-speaking staff.

Private International Health Insurance

Some expats, particularly those on short-term assignments or with specific coverage needs, opt to maintain private international health insurance instead of or in addition to the French system. This can be useful if:

• You need coverage during the initial waiting period for PUMA
• You want the option to seek treatment in your home country
• Your employer provides international coverage as part of your expat package
• You prefer English-language support and direct billing arrangements

For most long-term residents, integrating into the French healthcare system through PUMA and obtaining a local mutuelle offers the best combination of coverage, cost, and everyday convenience. Insurance is also mandatory for other aspects of life in France; see our guide on home insurance requirements for more.

Frequently Asked Questions