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If you're feeling lost in a sea of unfamiliar French healthcare terms like CMU, PUMA, and mutuelle, you're not alone. Whether you’re a retiree, a new arrival, or planning your move to France, getting your head around how healthcare in France works is key to staying healthy and avoiding overpaying for cover.
This guide breaks it all down in plain English so you can confidently choose the right health insurance solution and understand what you're signing up for.
How Healthcare in France Works: The Basics
The French healthcare system is a universal, public-private mix that is considered one of the best in the world. Everyone living in France long-term must have health insurance, either through the state system, a private provider, or a combination of both.
The French model is built on:
👉Public health coverage via social security
👉Complementary private insurance, also called a mutuelle
👉Special administrative terms like PUMA and CMU, which define how you access that coverage
Let’s look at what those acronyms actually mean.
What Is CMU?
CMU stands for Couverture Maladie Universelle (Universal Health Coverage). It used to be the system that allowed people who were not employed in France to access state health insurance.
If you've read older expat forums or guides, you may still see CMU mentioned, but here’s the catch: CMU was replaced by PUMA in 2016.
Today, if someone says “CMU,” they usually mean basic access to the state healthcare system in France, but the term is outdated. The real term you should understand now is PUMA.
👉 Related Reading: Why Most Expats Overpay for French Healthcare and the 3 Steps to Fix It
What Is PUMA?
PUMA stands for Protection Universelle Maladie. It’s the current system that guarantees access to healthcare in France for everyone who legally resides in the country for over 3 months.
Under PUMA:
👉You can access public health coverage, even if you're not working
👉You register through the CPAM (Caisse Primaire d'Assurance Maladie)
👉Once accepted, you get your Carte Vitale, the green health card used for reimbursements
PUMA makes it possible for expats, retirees, students, and other non-working residents to benefit from the excellent French healthcare system.
You are eligible for PUMA if:
✅You’ve been a legal resident in France for at least 3 consecutive months
✅You plan to live in France for more than 6 months a year
✅You’re not already covered by another EU system (in some cases)
👉 Related Reading: Why France’s Healthcare System Makes It Ideal for Retirees
What Is a Mutuelle?
Even with public coverage, healthcare in France is not completely free. The state typically reimburses around 70% of the base rate of medical costs. That’s where the mutuelle comes in.
A mutuelle is a top-up insurance policy that covers all or part of the remaining costs of your medical expenses. These policies are essential if you want:
➡ No surprise medical bills
➡ Full coverage for hospital stays
➡ Better reimbursement for dental, optical, and specialist care
Mutuelles vary in price depending on age, health needs, and level of cover, but the monthly premium is often worth it for peace of mind. Most people in France, expats and locals alike, have one.
You can even customise your mutuelle to suit your lifestyle, whether you’re focused on maternity care, chronic conditions, or simply want a no-frills safety net.
👉 Related Reading: The Benefits of Having a Mutuelle in France
What About Private Medical Insurance?
If you're moving to France on a long-stay visa, it's mandatory to have private health insurance that covers you as a resident, not as a traveller. This is a legal requirement for your visa approval and is intended to ensure you have comprehensive medical protection from day one.
Once you have lived in France for at least three consecutive months and meet residency criteria, you can apply for PUMA, the public healthcare system. At that point, many expats choose to combine public coverage with a mutuelle for full protection.
In the meantime, private health insurance is essential, not just to comply with visa rules, but to give you peace of mind. It can also offer additional benefits such as:
➡ Full English-speaking support
➡ Access to private clinics and medical specialists
➡ Faster appointment times
➡ Worldwide cover, including medical repatriation and emergency care
Whether you're relocating permanently or beginning your French journey, having the right private insurance is your first step to accessing the excellent French healthcare system.
👉 Explore Our Plans: Private Medical Insurance for Expats in France
Step-by-Step: How to Get Covered in France
1️⃣ Enter France with a legal visa or permit
2️⃣ Spend 3 months establishing residency (utility bills, rental contracts, etc.)
3️⃣ Apply for PUMA through your local CPAM
4️⃣ Receive your provisional number, then your Carte Vitale
5️⃣ Choose and purchase a mutuelle to top up your public cover
Bonus Tip: Start your mutuelle application while waiting for your Carte Vitale. It’s faster than you think.
Key Terms You Should Know
PUMA: Your gateway to the French public healthcare system
Carte Vitale: Your green card for automatic reimbursements
Mutuelle: Private top-up insurance for the 30% public doesn't cover
CPAM: Local social security office that handles your registration
CMU: Old name for the public healthcare access, replaced by PUMA
Frequently Asked Questions
Do I need a mutuelle if I have PUMA?
Yes. PUMA only covers about 70% of the base rate of healthcare costs. A mutuelle ensures you’re not stuck with the remaining fees, especially for hospital stays, dental work, or specialist visits.
How long does it take to get my Carte Vitale?
It typically takes 6 to 12 weeks from the date of your application. You’ll receive a temporary social security number before the physical card arrives.
Can I get reimbursed without a Carte Vitale?
Yes, but it’s more manual. You'll need to submit paper forms and treatment invoices to CPAM for reimbursement.
To wrap it all up
Healthcare in France is world-class, but understanding how it works is crucial for expats. Once you know what PUMA, mutuelle, and CMU mean, and how they relate to your situation, you can make informed decisions, save money, and feel secure.
If you're unsure about your eligibility or which coverage is best for you, we’re here to help. At FAB French Insurance, we simplify the process and help you get the right cover, fast.
👉 Ready to get started? Explore our expat medical insurance options now.
