Health Insurance in France: How It Works in 2026

The French Healthcare System in One Page

French health insurance runs on two levels. The mandatory public layer, called Securite sociale, is administered by regional CPAM offices (Caisse Primaire d'Assurance Maladie). Since 2016 it works on a residence-based principle: PUMA (Protection Universelle Maladie) automatically covers anyone living in France in a stable and regular way for more than three months. You don't need to be a French citizen.

The public layer pays a defined percentage of an official tariff, not of the actual bill. That tariff is set in the medical convention negotiated between Assurance Maladie and health professional unions. The current convention covers 2024-2029. Anything above the tariff (extra billing, room supplements, comfort items) is your problem, unless a mutuelle or the CSS picks it up.

A Carte Vitale (the green chip card) ties everything together. Present it at the doctor or pharmacy and the reimbursement flow runs automatically: Assurance Maladie first, then your mutuelle via the Noemie data link.

Securite Sociale: The Public Foundation

You manage your file on ameli.fr, the official Assurance Maladie portal. The first step after arriving is to register with the local CPAM, get a permanent social security number and request your Carte Vitale. Reimbursements usually land in your bank account within 5 to 7 days of a visit.

The headline 70% figure is an average. In practice:

• GP / specialist visit (Sector 1): 70% of the official tariff, minus a 2-euro participation forfaitaire.
• Hospital stay: 80% of the official cost, plus a daily fee (forfait journalier hospitalier) of 20 euros per day not covered by Securite sociale.
• Medication: 15%, 30%, 65% or 100% depending on the drug's medical service rating.
• Long-term illness (ALD): 100% of treatment related to the chronic condition, on the official tariff.

The Medecin Traitant Rule

France runs a coordinated-care model. You declare a medecin traitant (a GP, or sometimes a specialist), who acts as your front door to the rest of the system. The choice is free, you can switch any time. The form is one page and the GP transmits it to CPAM electronically.

Skip the medecin traitant and your reimbursement drops from 70% to 30% on the same specialist visit. Direct access without penalty remains for gynecologists, ophthalmologists, dentists, psychiatrists if you are under 26, and emergency situations. This is the famous parcours de soins coordonnes.

Finding an English-speaking GP is easiest in Paris, Lyon, Marseille, Bordeaux and the major university towns. Doctolib lets you filter by spoken language. Embassies and consulates keep curated lists as well.

Mutuelle: The Top-Up

A mutuelle (or complementaire sante) covers what Securite sociale does not. There are three legal families: mutuelles regulated by the Code de la mutualite (non-profit, member-governed), institutions de prevoyance regulated by the Code de la Securite sociale (non-profit, jointly run by employer and employee representatives), and insurance companies regulated by the Code des assurances (for-profit). All three are supervised by the ACPR.

Most contracts on the market are contrats responsables, which means they comply with a legal specification: they cover the ticket moderateur, respect the 100% Sante baskets, cap extra-billing reimbursement for non-OPTAM doctors, and limit how often optical equipment is renewed. Responsible contracts get tax advantages, which is why they dominate the market.

Reading a guarantee table without falling for the percentages

Percentages are expressed relative to the official tariff (Base de Remboursement, or BR), not your bill. A 100% BR guarantee means the mutuelle covers the ticket moderateur, no more. A 200% BR guarantee means it adds up to one extra BR for extra billing. For optics, dentistry or alternative medicine, look for fixed annual amounts in euros and check waiting periods (often 3 to 6 months on optics, up to a year on dental prosthetics).

Indicative cost of an individual mutuelle (2026)

• Basic cover: 30-60 euros per month for a single adult under 35.
• Intermediate cover: 60-110 euros per month with decent dental and optical limits.
• Comprehensive cover: 110-200+ euros per month for seniors or families with high needs. Premiums legally rise with age.

ANI 2013: Mandatory Group Mutuelle for Employees

The Accord National Interprofessionnel of January 11, 2013, transposed into the law of June 14, 2013, made it mandatory from January 1, 2016 for every private-sector employer in France to offer a group mutuelle. The employer covers at least 50% of the premium; the employee pays the rest through payroll deduction.

The contract must meet a legal minimum (the panier de soins ANI): full ticket moderateur on most acts, full forfait journalier hospitalier, at least 125 euros per year for dental prosthetics, and minimum optical refunds depending on the complexity of the lenses. Most employers go well beyond that baseline.

Can you opt out?

Yes, but only in specific cases. You can request an exemption if:

• You are already covered as a dependent on your spouse's employer mutuelle (mandatory family contract).
• You receive the CSS.
• You are on a CDD shorter than 3 months or a short mission contract.
• You were already employed before the company mutuelle was introduced.

You must provide proof each year. Opting out costs you the employer's 50% contribution, so it is only worth it if you have equivalent or better cover already.

Portability when you leave a job

Under article L.911-8 of the Code de la Securite sociale, if you leave a job and qualify for unemployment benefits (ARE), you keep your former employer's mutuelle, free, for a period equal to your contract of employment, up to a maximum of 12 months. Cover and benefits are identical; your former employer keeps paying its share.

100% Sante: Zero Out-of-Pocket Baskets

Phased in between 2019 and 2021, the 100% Sante reform guarantees zero out-of-pocket on a defined basket of optical, dental and hearing equipment, when you hold a contrat responsable mutuelle.

Premium options (designer frames, top-tier hearing aids, implants, adult orthodontics) sit outside the basket. They are covered by your mutuelle within the contract limits, never fully.

CSS: Cover for Low-Income Residents

The Complementaire Sante Solidaire (CSS), effective since November 1, 2019, replaced CMU-C and ACS. It is free below a first income threshold and capped at 1 euro per day per adult between the first and second thresholds. Apply via your CPAM or on ameli.fr; thresholds are published on complementaire-sante-solidaire.gouv.fr.

CSS covers the ticket moderateur, the hospital daily fee, dental, optical and hearing care at regulated tariffs, and most prescription co-payments. Third-party payment is automatic, so you pay nothing upfront with approved providers.

Mental Health: MonPsy and Beyond

Psychiatric consultations are reimbursed at the standard rate (Sector 1 psychiatrists charge 57 euros in 2026, reimbursed at 70%). For psychologists, the public MonPsy programme funds up to 8 sessions per year, on referral from your GP. The first session is set at 50 euros, follow-ups at 40 euros. No mutuelle needed for those eight.

Outside MonPsy, private psychologist sessions (50-80 euros) are covered only if your mutuelle says so. Many mid-to-upper tier contracts reimburse three to five sessions per year. For immediate help, hospital emergency rooms and the free centres medico-psychologiques (CMP) provide crisis access, though waiting times can be long.

Your Right to Switch (Hamon-style Cancellation)

Since the law of July 14, 2019, you can cancel any individual mutuelle contract at any time after the first 12 months. No fee, no reason required. The cancellation takes effect one month after your insurer receives the request. You can send a signed letter, an email if your contract allows, or use your online member area. Full procedure in our Hamon law guide.

Group employer contracts are different. You can usually exit only on a life event (leaving the company, retirement, marriage, divorce). When you leave employment, ask about portabilite (up to 12 free months) before signing a new individual mutuelle.

If You Have a Dispute

Always start with a written complaint to your insurer. If the answer is unsatisfactory, you can refer the case for free to an external mediator:

• The Mediateur de l'Assurance for insurance companies under the Code des assurances.
• The Mediation de la Mutualite Francaise for mutuelles under the Code de la mutualite.
• The tribunal judiciaire as a last resort.

The mediator must be contacted within one year of your written complaint. All complementary insurers are also supervised by the ACPR, the French prudential authority attached to the Banque de France.

Quick Notes for Expats

• EU/EEA citizens can use the European Health Insurance Card (EHIC / CEAM) for short stays.
• Once you settle (3+ months of stable residence), you apply to PUMA through your local CPAM.
• Until the Carte Vitale arrives (2 to 6 weeks), you receive an attestation de droits to claim reimbursement on paper forms.
• Non-EU expats with a long-stay visa start PUMA registration after the validation of the visa as a residence permit.

For a detailed step-by-step, see our companion guide on health insurance setup for new arrivals.

Frequently Asked Questions