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France is globally recognised for its high-quality healthcare system, but for many expats and newcomers, understanding how to access and pay for specialist care in France can feel overwhelming. Whether you need a dermatologist, gynaecologist, French dentist, or vision specialist, navigating the French referral system and reimbursement rules is essential to avoid unnecessary expenses.
Let’s break down the difference between general practitioner (GP) and specialist care, when a referral is required, what’s covered by Assurance Maladie (French state health insurance), and how to avoid out-of-pocket surprises.
General Practitioner (GP) vs. Specialist: Do You Need a Referral?
In France, your declared GP (médecin traitant) is the entry point to most specialist care. Following the coordinated care pathway (parcours de soins coordonnés) ensures full reimbursement levels.
When a Referral IS Required:
➡️ Dermatologists
➡️ Cardiologists
➡️ Orthopaedists
➡️ Gastroenterologists
➡️ Rheumatologists
➡️ Allergists
When You Can See a Specialist WITHOUT a Referral:
➡️ Gynaecologists (for routine gyn care, contraception, pregnancy follow-up, abortion)
➡️ Ophthalmologists (for prescriptions, contact lenses, and glaucoma follow-up)
➡️ Psychiatrists (for ages 16–25)
➡️ Stomatologists (for dental-type procedures)
➡️ Dentists (always outside of parcours, no referral needed)
Failing to follow the pathway can drastically reduce your reimbursement. For example, a standard GP visit costs 30 €. If you go outside the pathway or don't declare a GP, Assurance Maladie may only reimburse 8,40 € instead of 19 €.
Declare your GP to CPAM to ensure optimal coverage. Your doctor can help you complete the form.
Dental Care in France: What’s covered and what’s not
Dental consultations and routine care, like fillings, extractions, and scaling, are reimbursed at 60% of the official base rate by Assurance Maladie. Adult check-ups are reimbursed, but not automatically free; free preventive visits are offered under the M’T dents program, which is limited to those aged 3 to 24.
Crowns and bridges: Many are now fully covered under the 100% Santé reform if you choose eligible materials and price-capped options. Ceramic crowns for visible teeth may be included, while others may require out-of-pocket payments.
Implants: Not reimbursed by Assurance Maladie. Only the crown portion might be, depending on the type.
Orthodontics: Covered only for patients under 16, and only with prior approval. Adults are typically not reimbursed.
Without a complementary plan (mutuelle) that includes dental coverage, you'll pay the full difference.
🔗More information about dental costs in France in our complete article Does French Health Insurance Cover Dental and Eye Care?
Vision and Eye Care in France
You can consult ophthalmologists directly for prescriptions and glaucoma care. Specialist consults are reimbursed at 70% of the base fee, minus the 2 € participation.
Glasses and lenses: The 100% Santé optics program covers Class-A frames and lenses with no out-of-pocket if you have a qualifying complementary plan. This includes basic but functional options. Premium brands or materials may still cost extra.
Opticians can renew prescriptions under conditions. Orthoptists can issue first-time prescriptions for ages 16-42 within set guidelines.
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Maternity Care in France
France offers robust maternity care, with the following covered by Assurance Maladie:
✅ Prenatal visits
✅ Ultrasounds
✅ Hospital or clinic delivery
✅ Postnatal checkups
From the sixth month of pregnancy, 100% of maternity-related expenses are reimbursed. However, using a private clinic or non-conventioné provider may lead to out-of-pocket costs unless your mutuelle covers them.
Mental Health Services
Under the “Mon soutien psy” program, you can access up to 12 sessions per year with a conventioné psychologist without a GP referral. This program supports mental health access under standard reimbursement conditions.
Other Common Specialists
➡️ Physical therapists (kinésithérapeutes) – referral needed
➡️ Speech therapists (orthophonistes) – referral needed
➡️ Rheumatologists and allergists – referral needed
Be aware of sector types:
➡️ Secteur 1: Charges standard fees, fully reimbursed at base rates
➡️ Secteur 2: May charge higher fees (dépassements d’honoraires)
Always ask your specialist about their fees in advance.
Reimbursement Summary (In-Pathway, Sector 1):
➡️ GP: 30 € consult, 70% reimbursed minus 2 € = 19 € back
➡️ Specialist: Base rate varies, 70% reimbursed minus 2 €
➡️ Dentist: 60% of the base rate reimbursed
➡️ Eye exam: 70% of base rate reimbursed
➡️ Glasses/lenses: Covered up to full cost under 100% Santé (Class-A only)
Outside the pathway or with extra fees, your reimbursement drops or becomes ineligible. Always follow the referral system when required.
Emergencies: In urgent cases, you can visit emergency services without referral. Note: a fixed fee (forfait patient urgences) of 19,61 € applies for non-admitted patients, unless you qualify for an exemption.
Quick Checklist to Access Specialist Care
✅ Declare your GP to CPAM
✅ Get referrals where required
✅ Ask if the provider charges standard or extra fees
✅ Use Doctolib.fr to book appointments
✅ Ensure your Carte Vitale is valid
✅ Have a mutuelle to cover what Assurance Maladie doesn’t
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