A guide to healthcare in France
A guide to accessing the French healthcare system, including mandatory French health insurance, finding a doctor or specialist, going to hospital and emergency services.
The French healthcare system consists of public and private hospitals, doctors and other medical/health providers who provide healthcare for every French resident/citizen regardless of age, income or status. Most health costs are covered by the state through a public health insurance scheme but you do have to be registered with a doctor and go through this doctor for most treatments to be covered by the French public healthcare system.
The system is funded partially by obligatory contributions into the state health system (Sécurité Sociale), which are usually deducted from your salary. As at 2014, employees paid 7.5 percent and employers paid 13.10 percent of the salary towards health costs. The system is also partially funded by central government and the patient, too, pays a small amount.
When you see a doctor or have medical treatment a percentage of the cost – usually about 70 per cent of standard GP fees for example – will be reimbursed for most people through the state via the CMU, the state health insurance scheme, so long as you are referred by your ‘attending doctor’ (see below). In the case of some major or long-term illnesses, 100 per cent of the costs are covered.
The remainder of the charge must be paid for either by the patient or through any supplementary health insurance. This is why most people also take out top-up health insurance (l'assurance complémentaire santé) often organised by a 'mutual society' (mutelle), or insurance provider. When you take out one of these policies, note that some may not cover accidents resulting from dangerous sports and they may not offer immediate cover either. Certain other charges must be paid for by the patient, for example, a EUR 1 out-of-pocket charge per GP visit.
State health coverage (CMU) in France
By law, all residents in France must have health insurance. In order to be eligible for coverage under the French social security system (CMU) you must be living in France in an on-going basis, hold a valid residence permit (see Expatica's guide to French visas, and pay French social security contributions through paid employment.
If your household income falls below a certain threshold (which depends on number of people in the household), you may also be eligible for free supplementary health insurance coverage (CMU-C) or for help in taking out a supplementary private heath insurance (Aide pour une Complémentaire Santé or ACS). If you’re living in France but your application for legal residence has not been finalised you may be eligible for State Medical Assistance (Aide Médicale d’Etat or AME). For more detailed information, see the CMU website (in French with some English language pages).
If you’re not eligible for CMU, you’ll have to take out private health insurance from a local or expat health insurance provider. Some of the largest international health insurers include Bupa Global, AXA PPP International, Cigna Global and Globality Health.
If you’re self-employed, see the Regime Social des Indépendants (RSI) for information on registration, contributions and reimbursements.
How to register for CMU
If you’re employed and you living long-term in France or spend more than 183 days a year living in France, you have to be affiliated/registered for CMU through your local CPAM (Caisse Primaire Assurance Maladie) office. You can find your local CPAM office via the Ameli website (in French). The CPAM office will also handle your reimbursements.
You’ll need to show certain documents, including your passport or national ID card, proof of your long-term residence, marriage or birth certificates if family are to be included, evidence of income and proof of address in France. If you’re self-employed you should contact your local Regime Social des Indépendants office.
French Health Insurance Card
Everyone over the age of 16 resident in France needs to have a Carte Vitale. Once you are registered with the social services you will be issued with yours. This is a plastic health insurance card bearing your photo and embedded with a chip containing your name, address, social security details and details about any exemptions for payments, but no medical information.
You’ll need to take this with you to any health appointment – GP, specialist, hospital or even pharmacy – with a card reader. It allows you to be reimbursed directly from the insurance fund for the consultation or treatment within a week. It should deal with voluntary insurance too.
French healthcare for EU/EEA/Swiss citizens
European Health Insurance Card (EHIC)
If you have an EHIC card issued by an EU-member state and you are in France on a holiday or other temporary visit – that is, you are not a resident in France – you can use your EHIC to access state healthcare in France the same as anyone covered under the French state system. You don’t have to be registered with a médecin traitant (see below) to get a referral to a specialist. If you’re a resident in France you have to register with the social security system to access state heath care.
UK citizens and form S1
Up until April 2014, UK citizens under retirement age were able to access free state healthcare in France for two and a half years by completing a UK social security form S1 before leaving the UK. This is no longer available. If you already hold a S1 card you can use it until the cover it provides runs out; if you do not, you will have to take out private medical insurance until you reach retirement age when you can get an S1.
Going to the doctor in France
Primary health care in France is provided by a network of family doctors or GPs (médecins généralistes). These doctors are mostly self-employed and work either alone or in group practices. You can choose your own GP and register with him or her as your ‘attending doctor’ or médecin traitant. You can search online to find a doctor in France working within the state system.
The médecin traitant can refer you onto other doctors and specialists, holds and maintains your medical records, and co-ordinates follow-up treatments. If you are referred by your médecin traitant around 70 percent of costs for other medical consultations or treatments will be reimbursed. If you choose your own specialist then your medical fees may be higher and you’ll be reimbursed much less by the state system.
You don’t need a referral to see a gynaecologist, paediatrician or ophthalmologist but can consult them directly. If you’re under 26 you can also see a psychiatrist without a referral from your médecin traitant.
Registering with a doctor in France
You can nominate any doctor to be your médecin traitant. Both you and the doctor have to complete, sign and get the doctor’s stamp on the Cerfa form Déclaration de Choix du Médecin Traitant and send it to your CPAM (Caisse d'Assurance Maladie) office.
You can change your médecin traitant at any time simply by completing another form and submitting that to the CPAM office.
When you visit a doctor in France, you have to pay a fee upfront for the consultation. Most GPs in France have signed contracts with the national heath insurance scheme to provide medical services at nationally agreed rates and by law, the doctor’s fees must be posted on the surgery walls. These may vary according to whether it’s an evening or weekend visit or a home visit. You’ll be automatically be reimbursed a percentage of the fee by the state-run health insurance provider, leaving a small amount of money payable by yourself.
The amount you’ll be reimbursed depends on whether the doctor is in secteur 1 or secteur 2. Secteur 1 doctors’ tariffs are fixed while secteur 2 doctors can charge what they want – yet patients will still be reimbursed a percentage of the standard rate. Some consultations are reimbursed 100 percent, for example, children’s compulsory check ups, or if you’re on CMU (Couverture Maladie Universelle or Universal Health Insurance Coverage) because of a very low income or serious illness.
Going to see a specialist in France
Specialists may work exclusively in their own practice, a group practice, in a clinic or a hospital or in a combination of settings. Some work in both the state and private sector.
Specialists charge higher fees than GPs. There are official rates which have been set by the health service but some specialists can charge more, in which case the patient will either be reimbursed at the official rate, or more if the health insurance provider has allowed for this.
Remember, you will only be reimbursed at the full rate if you have been referred to the specialist by your own GP. You can visit a specialist without that referral but the consultation will only be reimbursed at the basic GP rate, regardless of how much the visit cost you.
Hospitals in France
There are two types of hospital in France: state-run hôpitaux and privately run cliniques. Cliniques are often state approved and work for the national health service. Your GP can refer you to either a state hospital or private clinic. Around 80 percent of hospital charges are reimbursed by the CMU but the ‘board and lodging’ costs of a hospital stay are not, which is where top-up insurance is useful.
Pharmacies in France
Prescription costs in France
You can take a prescription to a pharmacy (pharmacie), a shop displaying a large green cross outside. You will be asked to pay a proportion of the cost of the medication, depending on the drug and your insurance cover; the state health care system pays the rest. The amount reimbursed varies according to the type of medicine and may be 15, 30, 65 and 100 percent.
Pharmacy opening hours
In larger towns and in shopping centres, pharmacies are usually open Mondays to Saturdays from 8.30am to 7.30pm, although in smaller towns they may close for lunch between 12pm and 2pm. One pharmacy will open on Sundays. To find this duty pharmacy, look in the window of other pharmacies, in the local newspaper, call 32 37 or look online.
Visiting the dentist in France
You can search online to find a dentist in France. You are free to go to any dentist you like and don’t have to go to the same person for all of your treatment. Most dentists work within the state health system, and costs are reimbursed in the same way as other medical treatment. You have to pay upfront, and charges (or a percentage of them) are reimbursed later. You should get a written quote before having any treatment.
Dental charges for most adults are reimbursed at 70 percent; children’s check ups at 100 percent. However, some procedures – orthodontics for example – are not covered under the state system and you will have to pay for this.
Pregnancy and birth in France
As soon as you suspect or know that you’re pregnant, you should make an appointment with your doctor. Once the pregnancy is confirmed, the doctor will organise blood tests and take a medical history and issue a three-part document declaring the pregnancy (déclaration de grossesse). You have up to the 14th week of pregnancy to send the declaration of pregnancy form to the Health Insurance Fund (Casse d’Assurance Maladie or CAM) and Family Allowance Fund (Caisse d’Allocations Familiales or CAF) in order to receive health benefits. For detailed information about all aspects of pregnancy and birth in France, see Expatica’s guide to having a baby in France.
In an emergency in France
In a medical emergency go the A&E or ER (les urgences) of the nearest hospital. You can also call 112 (114 for hearing assisted), which is the free pan-European emergency number for any type of emergency, or one of the following numbers which are also free from any phone:
- 15 – SAMU (Service d'Aide Médicale d'Urgence) for serious medical emergencies with ambulances and specialist medical teams.
- 18 – sapeurs pompiers are the fire brigade but they also respond to car accidents and emergency medical situations.
- 17 – police (commissariat de police or gendarmerie).
- 112 – sea and lake emergencies (calling from land).
- Besoin une ambulance: I need an ambulance
- J’ai eu un accident: I’ve had an accident
- Ma localité est …: My location is…:
- Crise cardiaque: Heart attack
- Très malade: Very ill
- Je suis en train d’accoucher: I’m in labour
- Où est-ce qu’on peut trouver un cabinet médical? Where can I find a doctor’s surgery?
- Au secours : Help
For more information:
- You can phone the Ameli English-speaking advice line for information about French health insurance: call 3646 from within France; +33 811 70 36 46 from abroad.
- Cleiss (Centre des Liasons Européennes et Internationales de Sécurité Sociale) for information about healthcare whilst you’re in France and the social security system.
- For information on the state health insurance scheme CMU see the CMU website (in French with some English language pages).
- To find any kind of health professional or hospital, see this page of the Ameli website.
Expatica / Bupa Global
Bupa Global offers international health insurance to expats in more than 190 countries worldwide.
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Updated from 2011.
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