Discover public and private health insurance in France, including the costs, who is covered, and how it works for students and pensioners.
Healthcare is one of the most important things to factor into any move abroad, especially if you’re retired, have children, or require proof of coverage for your visa. Luckily, if you’re living in France, you have access to a high-quality, comprehensive healthcare system. Read on to find out why the vast majority of French residents have private health insurance on top of their public healthcare.
This article includes information on the following:
- The French healthcare system and health insurance
- Who needs health insurance in France?
- French public health insurance
- How to apply for public health insurance in France
- French private health insurance
- How much does French health insurance cost?
- Health insurance for unemployed and low earners
- Healthcare vocabulary in French
- Useful resources
Cigna Global provides international health insurance to over 180 million customers and patients around the world. Their global network of 1.65 million hospitals and healthcare providers offers expats access to medical support in over 200 countries and territories. Cigna plans can be tailored to suit the needs of you and your family in France and beyond.
The French healthcare system and health insurance
France has a universal public healthcare system known as protection universelle maladie (PUMa). In 2016, PUMa replaced France’s previous healthcare system, couverture universelle maladie (CMU), both simplifying coverage and extending service to even more residents.
The new scheme makes it much easier for internationals to access state French health insurance (l’Assurance Maladie). However, most French residents also take out complementary healthcare insurance to cover additional costs, through private insurers.
Who needs health insurance in France?
Health insurance is mandatory in France. Even if you’re self-employed or from another country, if you live in France, you must be insured by either a public or private scheme. Newcomers from other nations may need to show proof of international health insurance, like Allianz Care, as part of the visa application process.
Because state healthcare in France does not cover 100% of all costs, top-up insurance is very common. An estimated 95% of the French population has this complementary private insurance, usually through their employers, or by taking out a standalone policy with a company known as a mutuelle.
French public health insurance
Since 2016, PUMa guarantees health coverage to all legal residents who work or live in France for at least three months. Universal healthcare access is a right of all residents, regardless of age, medical history, and record of social security contributions (cotisations sociales).
Who does public health insurance cover?
Anyone with stable and regular residency in France for at least three consecutive months per year can register for health insurance. Your family or principal home must be in France, and you intend to live there for at least six months (183 days) a year. Children in France are automatically eligible for healthcare, regardless of nationality.
For visitors and short stays, EEA (European Economic Area) and Swiss citizens can typically use their European Health Insurance Card (EHIC). Non-EEA citizens should get insurance from a provider with an international scope, like Cigna Global.
Employees working in France are eligible for health insurance through their social security contributions (cotisations sociales). Freelance sole traders (micro-entrepreneurs) and limited company business owners (Société à Responsibilité Limitée) can access medical insurance in France through the independent social security system. State healthcare still covers unemployed residents, and low-earners are eligible for subsidies.
For pensioners living in France, their healthcare costs are covered by the state automatically upon retirement and acceptance of a pension through the National Old-Age Insurance Fund (Caisse Nationale d’Assurance Vieillesse – CNAV).
France considers foreign students short-term residents as far as health insurance is concerned. Therefore, students need to secure insurance from their home country (unless they have an EHIC) before they can enroll in a French university.
What does public health insurance cover?
France operates a co-payment system for public healthcare, with a percentage of all medical costs reimbursed through state health insurance. The percentage you receive depends on the type of treatment you had. For example, it’s usually 70% for doctors, dentists, midwives, and most specialists.
Reimbursement for staying in a French hospital is 80% of the costs. For prescriptions, it can be up to 100% for expensive medications. Vaccines are covered at 65%, with certain ones (like COVID-19) at 100%. Public insurance covers eye care and hearing aids at 60%. Mental healthcare and sessions with a psychologist are covered under a special treatment process that begins with visiting a general doctor for a recommendation.
For more on how much healthcare costs in France, see this table from l’Assurance Maladie for the official 2023 coverage and reimbursement rates.
How to apply for public health insurance in France
The first step to getting health insurance in France is to join the social security system or visit your local CPAM (Caisse Primaire d’Assurance Maladie) in order to get your carte vitale (health card). You must present the carte vitale any time you receive medical treatment to be quickly and easily be reimbursed for your healthcare costs within one week.
Employers typically register their employees with social security and arrange healthcare formalities for them, but it’s worth double-checking. A special social security scheme applies only to self-employed people working in France.
After activating your health insurance, you may need to manually apply for the carte vitale. After you receive it, you must update your carte vitale each year by inserting it in the green box at a local CPAM office, hospital, or pharmacy.
For more information on how to apply as an unemployed or retired individual, or someone with modest income, see the appropriate section below.
Registering with a doctor
Residents covered by state medical insurance must register with a family doctor (médecin traitant) to get reimbursement for their medical costs. This comes with full freedom of choice, so your doctor can be located anywhere and in any kind of practice.
You can officially register with your doctor either by simply presenting your carte vitale in the physician’s office or by mail (in French). Once you’ve registered, you will receive a declaration de médecin traitant.
Failure to register with a doctor can lead to penalties, like higher medical fees and lower reimbursement rates. Patients age 16 or younger can visit any doctor without fear of financial penalty.
French private health insurance
Many French residents top up their coverage with a private health insurance policy known as a mutuelle. Some mutuelles cater to workers with specific professions and others to English speakers.
Employers often offer a place in a mutuelle as part of your benefits package. Students can choose coverage from their parents’ mutuelle or their own.
The advantages of getting private health insurance coverage
French public health insurance covers almost all types of medical treatment, but only at a certain percentage of the cost. Anytime you visit a doctor, dentist, or other professional, you’ll be reimbursed for a set amount and left with about 10-40% to pay from your own pocket. Private health insurance can help cover the remaining costs that public healthcare does not.
Expats moving to France from outside the EEA for work or study may need to prove they have appropriate private coverage before they can enter the country. In this sense, private coverage can help you during the transition period before you get a carte vitale.
How does private health insurance work in France?
In France, private health insurance acts as a complement to your existing public coverage, paying all or part of what you are not reimbursed by the state.
French employers sign up their employees for complementary, or top-up, health insurance, so they don’t have to do anything to receive it. However, you may pay a monthly premium for the insurance, splitting this cost with your employer (who must pay at least 50% by law). Check with your HR department to see what happens to your private coverage if the contract ends, as this varies by company.
Private insurers reimburse the remaining amount of your general healthcare costs, including hospital treatment and emergency room visits. Reimbursements only refer to state-fixed tariffs, such as the standard charge for a consultation with a doctor. For prescriptions, private insurance may offer partial or total refunds.
Some specialists carry a surplus charge that the individual must pay if their mutuelle doesn’t cover it. Keep this in mind when you see policies that claim 100% coverage, as that can be misleading. The mutuelle does not cover surplus amounts, and therefore, this is payable by the individual.
Companies that sell health insurance
Some of the largest health insurance companies that operate in France as well as globally include:
How much does French health insurance cost?
Anyone working in France has social contributions (cotisations sociales) automatically deducted from their salary or wages to cover health insurance. Visit Cleiss (Centre des liaisons Européennes et internationales de sécurité sociale) for the full list of health insurance contribution rates as of 1 January 2023. The French government amends the percentage of cotisations sociales deductions yearly.
Several factors influence health care costs, such as income level and household size. It averages out at 8% of your net income above a minimum threshold set by the state.
Private care costs depend on the type of coverage required and factors such as the applicant’s age; however, few mutuelles ask for your health details before approval. It’s always good to research and compare plans before moving to obtain the best insurance coverage.
Health insurance for unemployed and low earners
In France, unemployed individuals have their healthcare costs covered by the state in the case of illness or maternity. Coverage is not automatic, however, so you must manually apply for it with an official form (in French).
Individuals working in France but making below a certain amount of money per year are still entitled to state healthcare. On top of that, you can likely receive additional complementary insurance to cover any co-payments. This special top-up insurance available to those with modest incomes is known as complémentaire santé solidaire (complimentary solidarity health).
To assess your eligibility for complementary healthcare, use this calculator from l’Assurance Maladie.
Healthcare vocabulary in French
Below are some French medical terms to help you set up your health insurance in France, find a doctor, or visit a hospital.
|health insurance||l’assurance médicale|
|healthcare||services de santé|
For more, this online voice pronunciation guide can help you on your journey to learning French.
- L’Assurance Maladie (AMELI) – the French government’s health insurance department
- Cleiss – France’s 2023 social security contribution rates
- Service-Public.fr – official French government site dedicated to public information about social healthcare