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The French healthcare system is known for its high quality, efficiency, and affordability. However, navigating the system as an expat can be overwhelming without a clear understanding of how it works. Whether you’re moving to France permanently or planning a long-term stay, knowing how to access medical care, register for health insurance, and use the Carte Vitale is essential.
This guide provides a detailed overview of the French healthcare system, including public health insurance (Assurance Maladie), the Carte Vitale, and the registration process for expats.
Overview of the French Healthcare Structure
France’s universal healthcare system is regarded as one of the best in the world, providing high-quality medical services at significantly lower costs compared to countries like the United States. This system ensures that all legal residents—including expats—have access to affordable healthcare, with the government heavily subsidising medical expenses. The healthcare system in France is primarily funded through payroll taxes, employer contributions, and government funding, making it accessible to both employees and self-employed individuals.
Public vs. Private Healthcare in France
The French healthcare system is a hybrid of public and private services, offering a combination of state-funded medical care and private top-up insurance.
✔ Public Healthcare (Assurance Maladie): The backbone of the French healthcare system, Assurance Maladie covers a substantial portion of medical costs, including doctor’s consultations, hospital treatments, and prescription medications. It ensures that patients receive necessary healthcare services at a reduced cost, with reimbursement rates typically covering 70% of the base rate.
✔ Private Healthcare (Mutuelle): While public health insurance covers most healthcare expenses, it does not reimburse everything. This is where private complementary insurance (mutuelle) comes in. A mutuelle covers the remaining medical costs, such as co-pays, hospital room upgrades, and specialist fees. Many residents, including expats, opt for a mutuelle to avoid out-of-pocket expenses.
The Role of Assurance Maladie
Assurance Maladie is the state-run health insurance system that ensures residents have financial protection against medical expenses. Instead of a single-payer system where the government pays for all healthcare, France operates on a reimbursement model. Patients initially pay for medical services out-of-pocket and then get reimbursed by Assurance Maladie. The system applies to all legal residents, including expats who meet residency criteria.
Key Features of the French Healthcare System
Several essential features make the French healthcare system highly effective and structured:
✔ Carte Vitale: The national health insurance card that automates reimbursements for medical expenses. When presented at medical appointments or pharmacies, it allows direct digital transmission of medical fees to Assurance Maladie, leading to faster refunds.
✔ PUMA (Protection Universelle Maladie): Introduced in 2016, PUMA ensures continuous healthcare coverage for all legal residents in France. It replaces previous systems where individuals had to be employed to access public healthcare.
✔ Complementary Health Insurance (Mutuelle): A voluntary yet highly recommended top-up insurance that covers medical expenses not reimbursed by Assurance Maladie. Many employers provide mutuelle plans, but expats and retirees must secure individual policies for full coverage.
How Public Health Insurance Works (Reimbursement Rates, Carte Vitale)
France uses a co-payment system where the state reimburses a portion of medical expenses, and the remainder is either paid out-of-pocket or covered by a mutuelle.
Standard Reimbursement Rates
In France, public health insurance does not cover the full cost of medical services upfront. Instead, it operates on a reimbursement system, where patients initially pay for their treatment and later receive partial or full refunds from Sécurité Sociale based on standardised rates (base de remboursement de la Sécurité sociale or BRSS).
The reimbursement rate depends on the type of medical service received. The Sécurité Sociale applies a fixed reimbursement percentage to the official base rate for each medical act. Here’s how it works:
✔ General medical consultations: Reimbursed at 70% of the base rate. If the consultation is outside the coordinated care pathway, reimbursement drops to 30%.
✔ Paramedical services (such as physiotherapy, speech therapy, and nursing care): Reimbursed at 60%.
✔ Medical equipment and small devices (e.g., crutches, orthotic supports): Reimbursed at 60%.
✔ Medical transportation (ambulances, taxis for medical visits with a prescription): Covered at 65%.
✔ Medications: The reimbursement rate varies based on the type of medicine 100% for essential life-saving drugs, 65% for standard prescription medications, 30% or 15% for non-essential or low-coverage medications
✔ Hospitalisation: Reimbursed at 80% for stays up to 30 days and 100% from the 31st day onward.
Since most medical expenses are only partially reimbursed, many residents in France opt for complementary health insurance (mutuelle) to cover the remaining costs and reduce out-of-pocket expenses.
The Carte Vitale
The Carte Vitale is an essential component of the French healthcare system, acting as a digital health insurance card for all residents enrolled in Assurance Maladie. This smart card securely stores your health insurance details, allowing healthcare providers to electronically submit medical expenses for reimbursement, eliminating the need for manual paperwork.
How Does the Carte Vitale Work?
When you visit a doctor, specialist, or pharmacist in France, simply present your Carte Vitale at the reception. The healthcare provider will scan the card, and the system will automatically forward the billing information to Assurance Maladie. Within five days, the reimbursed amount will be transferred directly to your bank account, making the process seamless and efficient.
Why Is the Carte Vitale Important?
Without the Carte Vitale, patients must pay for medical services upfront and manually submit paper forms (feuille de soins) to claim reimbursement, which can significantly delay the process. By using the card, reimbursements happen faster and more efficiently, reducing financial strain.
Who Needs a Carte Vitale?
Anyone covered by French public health insurance should apply for a Carte Vitale, including expats who qualify for PUMA (Protection Universelle Maladie). Having this card ensures easy access to the high-quality, affordable healthcare France is known for.
Registering for Public Healthcare in France as an Expat
Expats who plan to reside in France long-term can access public healthcare through Protection Universelle Maladie (PUMA) after three months of continuous residence. However, eligibility and requirements depend on your situation, such as employment status, retirement, or financial independence.
Who Can Apply for PUMA?
To qualify for public healthcare in France under PUMA, you must meet one of the following conditions:
✔ Your principal residence is in France, and you are not covered by social security in another European country.
✔ You have lived in France for less than five years, are not engaged in paid employment, are below retirement age, and do not receive social security benefits from another European country.
✔ You are a retiree or receiving a disability pension from your home country. In this case, you will need to provide an E121 (S1) form issued by your home country's health authority.
✔ You are salaried in France, in which case your employer will declare your employment to Urssaf (the French social security agency), automatically affiliating you to the public healthcare system.
If you do not qualify for PUMA under these conditions, you will need to purchase private health insurance until you have been a resident for at least five years, or until your financial or personal situation changes (e.g., gaining employment, divorce, or long-term illness).
Step 1: Gather Required Documents
To apply for Assurance Maladie, you must prepare a complete file, including:
✔ A valid passport or residence permit
✔ Proof of address in France (e.g., recent utility bill, rental agreement)
✔ Proof of three months of residency (e.g., bank statements, utility bills, rental receipts)
✔ A translated birth certificate (official French translation may be required)
✔ Proof of employment (if applicable) – work contract or recent payslips
✔ Proof of financial resources if you are not working
✔ French bank details (RIB – relevé d’identité bancaire) for reimbursements
For retirees or individuals receiving a foreign pension, additional documents are required:
✔ E121 (S1) form, issued by your home country
✔ Marriage certificate (if applicable)
✔ Birth certificates of all family members included in the application
Step 2: Submit Your Application
Once you have gathered all the necessary documents, send your completed application to the Caisse Primaire d’Assurance Maladie (CPAM) office in your region. Processing times can take several months, so it is advisable to apply as soon as possible after establishing residency in France.
For salaried employees, your employer’s declaration to Urssaf initiates the affiliation process. However, you will still need to submit additional paperwork to CPAM, including your first payslip.
Step 3: Receive Your Temporary Social Security Number
Once your application is processed, you will receive a temporary social security number, which allows you to access healthcare services while waiting for your permanent Carte Vitale.
Obtaining a permanent Carte Vitale requires an additional step—your identity documents must be verified by Insee (France’s national statistics institute). This verification can take several months, so ensure you keep all medical receipts for reimbursement during this waiting period.
Step 4: Obtaining Your Carte Vitale
After receiving your permanent social security number, you will receive instructions on how to request your Carte Vitale. This is your health insurance card, which simplifies medical payments and reimbursements. Once you have it:
✔ Present it at medical appointments, pharmacies, and hospitals to have charges processed electronically.
✔ Your reimbursements will be credited directly to your French bank account, usually within five days.
✔ If your doctor or pharmacist uses the tiers payant system, you won’t have to pay upfront for the portion covered by Assurance Maladie.
Step 5: Consider a Mutuelle for Full Coverage
While Assurance Maladie covers a percentage of medical costs, it does not reimburse 100% of expenses. Many expats choose to supplement their public health insurance with a mutuelle, a private top-up insurance plan that covers the remaining costs, such as:
✔ The portion of doctor’s fees and hospital charges not reimbursed by the state
✔ Dental and vision care, which have lower reimbursement rates in the public system
✔ Private hospital rooms and specialists with higher consultation fees
At Fab French Insurance, we specialise in helping expats find the perfect mutuelle to suit their unique needs. Get in touch today to find your perfect mutuelle. If you are not eligible for public healthcare under PUMA, securing private health insurance is mandatory until you can qualify for the system. We can help you with this too.
Common Myths & FAQs
Myth 1: “French healthcare is free for all residents.”
Reality: While France’s healthcare system is highly subsidised, patients are still responsible for co-pays and uncovered expenses unless they have a mutuelle.
Myth 2: “Expats can’t access French public healthcare.”
Reality: Expats who have been in France for three months can apply for PUMA coverage and benefit from Assurance Maladie.
Myth 3: “You can’t see a specialist without a GP referral.”
Reality: While France operates a coordinated care pathway, meaning patients should see a GP before consulting a specialist, you can go directly to certain specialists (gynaecologists, psychiatrists, ophthalmologists) without a referral.
FAQ 1: “Can I use my European Health Insurance Card (EHIC)?”
Answer: Yes, but the EHIC only covers temporary stays. If you plan to live in France long-term, you must register with Assurance Maladie.
FAQ 2: “Can I keep my foreign health insurance?”
Answer: Expats staying longer than three months should enrol in PUMA. Private international insurance can be useful for the transition period but does not replace French public coverage.
FAQ 3: “How long does it take to get a Carte Vitale?”
Answer: The process can take up to six months, so it’s essential to apply as soon as possible. In the meantime, medical expenses can still be reimbursed using paper claims (feuille de soins).
To Wrap it All Up
The French healthcare system is one of the most comprehensive and accessible in the world, but navigating it as an expat requires proper documentation and an understanding of reimbursement policies.
To ensure smooth access to healthcare, expats should apply for Assurance Maladie early, secure a Carte Vitale, and consider a complementary health insurance plan (mutuelle). By being prepared, you can enjoy the benefits of high-quality medical care in France without unnecessary stress or unexpected costs.
Private health insurance is a mandatory requirement to get your VISA or carte de séjour (residency permit). 82% of failed applications are turned down because of the insurance so it’s best to work with insurers that know the French requirements to avoid any unpleasant surprise. Get an estimate now.
