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France is known for its excellent healthcare system, combining public coverage through Assurance Maladie with optional private insurance (mutuelle) to reduce out-of-pocket costs. However, many expats moving to France often assume that the public system alone will fully cover their medical expenses, or they end up purchasing overpriced private plans that don’t match their actual needs. This leads to one of the most common mistakes expats make: significantly overpaying for healthcare.
Navigating French healthcare as a foreign resident requires a clear understanding of how the system works, what is covered by the state, and where the gaps lie. Making informed choices about your coverage, especially when it comes to selecting the right level of complementary insurance, can help you avoid unnecessary expenses while ensuring proper protection for you and your family. This guide explains why overpayment happens and the simple steps to fix it.
Why Expats Often Overpay for Healthcare
Misunderstanding How the French Healthcare System Works
One of the primary reasons expats overpay for healthcare in France is a lack of understanding of how the system operates. The French healthcare model is not fully state-funded like the NHS in the UK, nor is it entirely private like in the US. Instead, it is a co-payment system (Tiers Payant) that 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 that we like to refer to as an index that is called BRSS (base de remboursement de la Sécurité sociale).
For example, general practitioner visits are typically reimbursed at 70% of the standard tariff by the state. Without additional coverage, you are responsible for the remaining 30%, plus any potential excess fees charged by the practitioner if they are outside the official tariff system. Many expats mistakenly believe they are fully covered after enrolling in Assurance Maladie, only to find out they still owe significant amounts for routine care, hospital stays, and specialist visits.
For more on how the system works, see our detailed guide on French Healthcare Basics for Newcomers.
Overlooking the Importance of a Mutuelle (Top-Up Health Insurance)
A mutuelle is a complementary health insurance plan designed to cover the portion of medical expenses not reimbursed by Assurance Maladie. Despite being optional, having a mutuelle is practically essential for avoiding high out-of-pocket costs—especially for hospital stays, dental care, optical services, and specialist appointments.
Many expats delay getting a mutuelle, assuming they won’t need it immediately or choosing to “wait and see.” Unfortunately, this can lead to significant medical bills if they require care. Others may choose a basic mutuelle without checking if it adequately covers their specific needs, particularly if they plan to use private clinics or need coverage for dependents.
Choosing the Wrong Level of Coverage
Not all mutuelle plans are created equal. Policies range from basic coverage, covering only the legal minimum, to high-tier options that cover private rooms in hospitals, higher specialist fees, and extensive dental or optical care.
Expats often make the mistake of selecting either the cheapest available plan (which may not cover their actual healthcare needs) or overpaying for premium packages that include services they don't require. Understanding your health profile, including any pre-existing conditions and the likelihood of needing certain types of care, is crucial when choosing the right level of coverage.
Paying Out-of-Pocket for Services That Could Be Covered
Without the right mutuelle or due to poor understanding of how reimbursement works, expats frequently pay out-of-pocket for services that could otherwise be partially or fully reimbursed.
This includes:
👉 Dental care like crowns and implants
👉 Specialist consultations with non-sector 1 doctors
👉 Hospital stays, especially private rooms
👉 Optical services (glasses, contact lenses)
The 3 Steps to Stop Overpaying for French Healthcare
The key to avoiding excessive healthcare costs lies in understanding how the system works, choosing the right supplementary coverage, and regularly reviewing your insurance plan. Here’s how to take control of your healthcare budget with three essential steps.
Step 1: Understand What the State System Covers (and What It Doesn’t)
The Assurance Maladie, or French state healthcare system, provides partial coverage for most medical expenses. However, it does not cover everything and this is where many expats fall into the trap of overpaying.
The Role of Assurance Maladie
Assurance Maladie generally reimburses the below of the official base rate:
70% of the basic tariff for general practitioner visits
60% for paramedical services (such as physiotherapy)
80% for hospital stays up to 30 days (100% thereafter)
Between 15% and 100% for medications, depending on their classification
These reimbursements are based on fixed government rates, not the actual fees charged by healthcare providers. Many doctors charge higher than the official rates, particularly sector 2 specialists.
Common Gaps in Coverage
👉 Private hospital room supplements
👉 Dental care, especially prosthetics and orthodontics
👉 Optical services (glasses and contact lenses)
👉 Specialist fees exceeding the standard tariff
Without top-up insurance, these gaps can lead to significant out-of-pocket costs. Understanding where the state system stops is the first step in managing your healthcare expenses wisely.
Step 2: Choose the Right Mutuelle for Your Needs
A mutuelle, or top-up health insurance, bridges the gap between what Assurance Maladie reimburses and what you actually pay. But not all mutuelle plans are created equal, and choosing the wrong one can either leave you exposed or cost you more than necessary.
How to Evaluate Mutuelle Plans
Mutuelle policies typically fall into three categories:
👉 Basic: Covers only the state-defined remainder, suitable for those with minimal healthcare needs.
👉 Mid-Range: Includes better dental, optical, and specialist coverage.
👉 Premium: Offers full coverage, including private rooms, high specialist fees, and enhanced dental/optical benefits.
Many expats mistakenly believe that any plan will do, but healthcare needs vary widely based on age, lifestyle, family situation, and pre-existing conditions. A “one-size-fits-all” solution rarely delivers the best value.
Get your top up health insurance quote (mutuelle) here.
How to Compare Offers Effectively
👉 Assess your actual healthcare usage: How often do you visit doctors? Do you need dental or optical care?
👉 Consider future needs: Are you planning a family or nearing retirement?
👉 Check for exclusions: Some policies may not cover certain treatments or pre-existing conditions.
👉 Don’t just look at price — balance cost with coverage.
Working with an independent broker familiar with the French system and expat needs can make the comparison process easier and more effective.
Step 3: Avoid Common Pitfalls and Review Your Coverage Regularly
Your healthcare needs can change over time. Whether it’s due to a new job, a growing family, or reaching retirement age, failing to adjust your coverage can result in either overpayment or gaps in protection.
Why Annual Policy Reviews Matter
Healthcare providers change their offerings frequently, and so do your personal circumstances. An annual review helps ensure your plan still matches your needs and prevents you from paying for services you no longer require.
Adjusting Your Coverage as Your Situation Changes
👉 New family members: Check maternity care and child healthcare options.
👉 Retirement: Ensure coverage for chronic conditions and age-related care.
👉 Freelancing or business ownership: Verify that your mutuelle aligns with your work status.
How Working with a Specialist Broker Can Save You Money
Choosing the right coverage isn’t always straightforward. A specialist broker who understands both the French healthcare system and expat-specific situations can guide you through the process, helping you avoid costly mistakes and find the best value plan.
At Fab French Insurance, we work with over 30 insurers to match your healthcare needs with the most suitable coverage — because no two expat situations are the same. Get in touch for personalised advice and stop overpaying for your healthcare in France.
Bonus: The Hidden Costs Expats Often Miss
Even when expats believe they have their French healthcare fully covered, there are several hidden costs that can still catch many by surprise. These additional expenses often fall outside standard reimbursement rates from Assurance Maladie and can quickly add up if you’re not properly insured. Understanding these hidden costs and how to plan for them is key to avoiding unexpected financial strain.
Dental and Optical Coverage
One of the most common gaps in the French healthcare system relates to dental and optical care. While basic dental treatments like fillings are partially reimbursed by Assurance Maladie, major work such as crowns, implants, bridges, and orthodontics for adults are either poorly covered or not covered at all. Similarly, optical expenses such as eyeglasses, contact lenses, and eye exams often come with limited reimbursement under the public system.
Without a mutuelle that specifically includes enhanced dental and optical options, expats may end up paying hundreds or even thousands of euros out of pocket for these services. When selecting a top-up plan, it’s essential to carefully review the dental and vision benefits especially if you or your family have ongoing needs in these areas.
Hospitalisation Fees and Private Room Charges
While hospital stays are generally covered at 80% by Assurance Maladie (increasing to 100% after 30 days), many patients are surprised to discover that private hospital room charges and certain specialist fees are not included in this reimbursement. For example, requesting a private room during your hospital stay can cost between 50 € to 150 € per night, depending on the facility.
Additionally, sector 2 specialists (those allowed to charge beyond the standard tariff) can significantly increase your hospital bill. A good mutuelle plan will cover these extra charges, but basic or entry-level policies may not, leaving expats responsible for the difference.
Long-Term Care and Chronic Conditions
Another hidden cost that expats often overlook is the expense associated with long-term care and chronic health conditions. While France provides 100% coverage for certain affection longue durée (ALD) or long-term illnesses like cancer, diabetes, or severe heart disease, this does not automatically include extras such as specialised equipment, physiotherapy, home assistance, or private nursing care.
If you’re managing a chronic condition or are approaching retirement, it’s vital to ensure your healthcare plan covers these long-term needs adequately. Some mutuelle policies offer long-term care riders or supplementary coverage for these scenarios, which can significantly reduce your financial exposure over time.
Frequently Asked Questions (FAQ)
Can I rely only on Assurance Maladie?
Assurance Maladie provides a solid foundation for healthcare coverage in France, reimbursing a percentage of most medical costs. However, it rarely covers 100% of expenses outside of specific cases like long-term illnesses (ALD) or certain hospital stays beyond 30 days. Most routine doctor visits, specialist consultations, dental care, optical services, and hospitalisation fees come with out-of-pocket costs. Without a mutuelle (top-up health insurance), you will likely face significant personal expenses. This is why relying solely on Assurance Maladie is not advisable for most expats.
How much should I expect to pay for a good mutuelle as an expat?
The cost of a mutuelle in France varies depending on your age, health needs, and level of coverage. On average, basic plans may start around 30€–50€ per month while comprehensive or premium plans can exceed 150 € per month, especially if dental, optical, and private hospital rooms are included.
Is healthcare free in France if I have a residency permit?
No, healthcare is not fully free in France, even with a residency permit. While having a carte de séjour allows you to access Assurance Maladie, this system operates on a reimbursement basis and does not cover all healthcare costs. You will still be responsible for paying upfront for certain services and seeking reimbursement afterward. To minimise personal expenses, securing a complementary mutuelle is highly recommended.
To wrap it all up
Navigating the French healthcare system as an expat can feel overwhelming at first, but understanding how Assurance Maladie works is key to avoiding unnecessary costs. Many expats overpay simply because they misunderstand their options or stick with a one-size-fits-all insurance plan that doesn’t meet their real needs.
The smartest way to protect your health and your wallet is to take a proactive approach:
👉 Understand what the state healthcare system covers and its reimbursement rates.
👉 Choose the right mutuelle that matches your lifestyle, age, and health priorities.
👉 Review your policy annually to make sure it still aligns with your personal circumstances.
The French healthcare system offers excellent care when managed properly, but navigating the layers of coverage can be complex, especially for newcomers. That’s why working with a knowledgeable, bilingual broker who understands the challenges expats face is often the easiest way to ensure you're not overpaying while still getting the coverage you need.
👉 Want personalised advice to find the right healthcare plan in France? Get in touch with our expert team at Fab French Insurance — we specialise in supporting expats with healthcare solutions that make sense.
