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If you're self-employed in France, one of the most important questions you'll face is: how do I get health insurance? Whether you're a freelancer, consultant, or running your own small business, understanding how health insurance works as a self-employed person is essential. Unlike in some countries, France has a comprehensive public health system that covers residents through a mix of public funding and individual contributions.
In this guide, we'll walk you through everything you need to know about getting health insurance as self-employed in France. We'll explain how the public system works, what PUMA and URSSAF are, and whether you need private insurance. We'll also show you how to register for coverage, what is reimbursed, and how to make sure you’re fully protected.
How Health Insurance Works for the Self-Employed in France
France operates a universal healthcare system that guarantees access to medical care for all residents, including those who are self-employed. The system is primarily public and administered by the Caisse Primaire d’Assurance Maladie (CPAM), the local branch of the national health insurance system.
The Role of CPAM and PUMA
As a self-employed worker (or travailleur indépendant), you are eligible for health coverage under the Protection Universelle Maladie (PUMA) scheme. Introduced in 2016, PUMA ensures that anyone legally residing in France on a stable and continuous basis has access to state healthcare.
CPAM is the body that manages your healthcare entitlements under PUMA. Once you’re in the system, CPAM reimburses part of your healthcare costs, such as GP visits, specialist appointments, hospital stays, and prescribed medications.
👉Read more on this with our article CMU, PUMA, and Mutuelles Explained (In Plain English!)
Social Contributions Through URSSAF
To finance this system, the self-employed must contribute through cotisations sociales, social security contributions. These are paid to URSSAF (Union de Recouvrement des Cotisations de Sécurité Sociale et d’Allocations Familiales), the agency responsible for collecting social contributions.
Your cotisations are calculated as a percentage of your declared income and include multiple components:
➡️ Health insurance contributions
➡️ Retirement contributions
➡️ Family benefits
➡️ Disability and death insurance
➡️ Training contributions
This means your monthly or quarterly payments to URSSAF don’t just cover healthcare, they fund your entire protection sociale package.
What Happens After You Register
Once you've declared your activity with URSSAF and they’ve processed your file, several things happen:
1️⃣ You are automatically affiliated with the French healthcare system through PUMA.
2️⃣ CPAM opens your file and will either issue you a social security number (if you don’t have one yet) or link your URSSAF registration to your existing one.
3️⃣ You’ll receive an attestation de droits, confirming your rights to healthcare under the system.
4️⃣ You can then apply for your Carte Vitale, the green card that allows automatic reimbursement of healthcare costs.
Keep in mind that if you’re newly self-employed or new to France, there can be a waiting period of several months before you receive your Carte Vitale. During this time, you're still entitled to care, but you may need to pay upfront and submit paper reimbursement claims.
Equal Access for the Self-Employed
One of the strengths of the French system is that self-employed individuals receive the same level of healthcare access and reimbursement as salaried workers. Once registered, you’re fully entitled to:
➡️ Consultations with GPs and specialists
➡️ Hospital treatment
➡️ Prescriptions
➡️ Maternity care
➡️ Mental health support
➡️ Preventive healthcare
The only difference is how you fund your access, salaried workers split their social charges with their employer, while the self-employed are fully responsible for their contributions.
Do I Need Private or Public Health Insurance?
The good news is that public health insurance (via PUMA and CPAM) covers most of the essential healthcare services in France. However, it doesn’t cover everything. Typically, the state reimburses around 70% of the standard rate of most medical costs, with some exceptions for hospital stays and chronic conditions where reimbursement rates may be higher.
This means you're usually left with out-of-pocket costs, which can add up. To cover this, most residents take out a mutuelle, which is a private top-up insurance. A mutuelle covers the remaining costs not paid by the state. Some expats and professionals also opt for private health insurance plans that offer more flexibility, international coverage, or English-speaking support.
In short:
✅ Public insurance (PUMA + CPAM) is mandatory and forms the base of your coverage.
✅ A mutuelle is strongly recommended to avoid unexpected costs.
✅ Private insurance is optional but may offer more comprehensive or tailored support.
Registering for Health Coverage as a Freelancer or Auto-Entrepreneur
When you become self-employed, registering with URSSAF is the first step. This is typically done when you declare the start of your activity on autoentrepreneur.urssaf.fr or through your Centre de Formalités des Entreprises (CFE), depending on your professional status.
Once you register your activity:
1️⃣ URSSAF begins calculating your cotisations based on your declared income.
2️⃣ You’ll automatically be affiliated with the French social security system.
3️⃣ CPAM will send you an attestation de droits and assign a social security number.
4️⃣ Once enrolled, you can apply for your Carte Vitale, the card used for automatic reimbursements.
It can take several months to receive your Carte Vitale, so it's advisable to maintain private coverage during this transition.
Understanding PUMA and Social Contributions (URSSAF)
PUMA guarantees access to healthcare for all legal residents in France, regardless of employment status. Whether you are salaried, self-employed, or currently without work, it ensures that you have access to essential medical services through the public health system. However, for self-employed individuals, access to PUMA is funded through mandatory social security contributions, which are managed and collected by URSSAF.
As a travailleur indépendant, you are required to make regular contributions (cotisations) to fund not just your healthcare, but a broader range of social protection benefits. These contributions are based on your declared income and cover several key areas:
➡️ Health and maternity
➡️ Retirement pensions
➡️ Family allowances
➡️ Disability and death insurance
➡️ Workplace accident coverage
➡️ Vocational training contributions
URSSAF calculates your contribution rates based on a percentage of your net income, with rates varying depending on your professional status (e.g. auto-entrepreneur vs. profession libérale). The more you earn, the higher your contributions will be, but this also increases your entitlements.
Even if your income is low or fluctuating, you are still entitled to PUMA coverage. If your revenue is below a certain threshold, you may not pay into all branches of the system, but you will retain access to essential healthcare. In such cases, you could also be eligible for Complémentaire Santé Solidaire (CSS), a state-funded top-up insurance scheme designed to help lower-income individuals afford the remaining costs not covered by the public system.
What Does French Public Health Insurance Cover?
French public health insurance is generous by international standards. Once registered, you'll have access to a wide range of services such as general practitioner and specialist visits, hospital care, maternity and childbirth, mental health services (limited unless referred), basic dental and eye care and prescriptions.
Most services are reimbursed at around 70%, with hospital stays reimbursed up to 80% or more. However, certain things like private rooms, glasses, or dental prosthetics often come with higher out-of-pocket costs unless covered by a mutuelle.
👉 Go further with our article Does French Health Insurance Cover Dental and Eye Care?
Is a Mutuelle (Top-Up Insurance) Required?
Technically, no, a mutuelle is not legally required. But in practice, it’s almost essential.
Because the public system doesn't cover 100% of medical costs, having a mutuelle ensures you're not hit with large unexpected bills. Many doctors charge above the standard rates, which means your 70% reimbursement is based on a lower amount than you actually pay.
Mutuelles come in a wide range of coverage levels. Some cover just the basics (the state’s leftover 30%), while others offer premium benefits, like full dental and optical reimbursement, private hospital rooms, or alternative medicine.
Choosing the right mutuelle depends on your needs, health history, and budget. Some plans are designed specifically for travailleurs indépendants and may include income protection or other extras.
How to Choose the Right Health Insurance Plan in France
Choosing the right health insurance as a self-employed person in France depends on your administrative status, healthcare needs, and budget. For most people, this means combining mandatory health insurance (public or private, depending on your situation) with a mutuelle (top-up insurance) to ensure full protection.
Which Health Insurance Do You Need?
If you're applying for a long-stay visa or residency permit (carte de séjour) in France, having valid health insurance is not optional, it’s a legal requirement. In fact, over 80% of failed applications are rejected due to insufficient or non-compliant insurance. Whether you're planning to join the public system later (PUMA) or remain privately insured, your policy must meet specific French criteria.
To avoid delays or rejections, it’s best to choose private medical insurance designed specifically for expats. These policies offer:
✅ Full residency-compliant coverage
✅ Bilingual support
✅ Fast policy delivery and certification in French and English
Not sure what you need? Use our quick online calculator to check your insurance requirements. 👉 Find the right cover
Mutuelle Top-Up Insurance
While public health insurance covers around 70% of most medical expenses, the remaining costs can quickly add up, especially if you see specialists, need dental or vision care, or require hospitalisation. A mutuelle helps cover these costs and gives you peace of mind.
When comparing mutuelle options, consider your specific needs:
❓ Do you see doctors frequently?
❓ Do you need enhanced dental or optical coverage?
❓ Are you interested in alternative therapies like osteopathy or acupuncture?
❓Are you planning for pregnancy or family care?
Next, evaluate the level of reimbursement for common treatments and hospital stays, your monthly premiums, any waiting periods or exclusions and whether you’ll receive customer service in English.
At FAB French Insurance, we work with a trusted network of over 30 insurers, offering solutions tailored for freelancers, remote workers, and small business owners. We’ll help you compare policies and find the plan that fits your health needs and your budget. 👉 Ready to explore your options? Get your mutuelle quote here
What If I’m New to France or Just Became Self-Employed?
If you've recently arrived in France or are transitioning from salaried work, the process of switching to self-employed coverage is important. Here's what to do:
1️⃣ Declare your new self-employed status with URSSAF. This triggers your new social contributions.
2️⃣ Inform your local CPAM that your employment status has changed.
3️⃣ Apply for a new Carte Vitale or update your existing one if needed.
4️⃣ Consider interim private coverage while your registration is being processed.
Even if you're not yet fully registered, you may still be eligible for healthcare under PUMA if you're a resident. However, proper registration ensures your services are reimbursed correctly.
To wrap it all up
Getting health insurance as self-employed in France may seem complex at first, but once you understand how PUMA, CPAM, URSSAF, and mutuelles work together, it becomes much more manageable.
The key is to register early, declare your income correctly, and make sure you have top-up coverage to avoid high out-of-pocket costs. With the right support, the French system offers excellent healthcare and solid financial protection, even for independent workers.
Need help choosing a plan? Get in touch with FAB French Insurance and we’ll guide you through your options step-by-step.
