Health insurance in France for foreign expats

The French healthcare system is considered to be among the best in the world¹. It offers low-cost, high-quality, accessible care to all its citizens and long-term residents. 

The French government dedicates over 10% of its GDP (Gross domestic product) to public healthcare². This has helped the country improve its quality of care, medical innovation and the overall numbers of doctors, nurses, midwives and specialists.

Both public and private hospitals are usually well-equipped with modern facilities, and you shouldn’t have to wait too long for an appointment to see a doctor – often an appointment will be made that same day. France also offers free check-ups to citizens over the age of 16 with a view to catching issues early. And, because the country is at the forefront of medical research, there are often a wider range of treatment options and medications available compared to other countries.

France’s universal healthcare system is called Protection Universelle Maladie (PUMA). It ensures healthcare is available to all French citizens, regardless of age, wealth or status. 

If you’re moving to France, you’ll be eligible to register with PUMA and get healthcare cover through the state-run public health insurance scheme – L’Assurance Maladie. You’ll just need to have lived in the country for three consecutive months, with the intention of spending at least six months of the year there. 

It’s mandatory for all French residents to have some form of health insurance,  L’Assurance Maladie is the minimum requirement. If you’re going to be working in France, this will be paid for through automatic salary deductions, while low-income or unemployed workers can apply for free cover.

This state health insurance usually covers around 70% of GP costs, 80% of hospital visits and even the full cost of some medications. You’ll usually be asked to pay your medical bill up-front and then be reimbursed the appropriate amount through the state insurance scheme. Many French citizens then take out private health insurance to cover their remaining costs, while anyone not registered to the PUMA scheme needs to get a private healthcare policy instead.

Like a lot of other European nations, the French healthcare system is insurance-based. It’s a requirement for all French residents to have some form of health insurance, whether that be public, private or both. Expats who have lived in the country for more than three months are subject to the same requirements as the locals and the public healthcare system is accessible to all. There are different ways of accessing it, depending on your situation.

1. As a resident: 

Once you’ve been a resident in France for at least three consecutive months, you can register for public healthcare through your local Caisse Primaire Assurance Maladie (CPAM) office. Along with a passport, you’ll need to show proof of your address in France (such as a utility bill) as well as proof of residence.

2. As an employee: 

If you’re employed in France, you’ll have access to PUMA (Protection Universelle Maladie) through the French social security system (L’Assurance Maladie). The social security system will also cover things like maternity, paternity and disability. Contributions will be taken directly from your salary and your employer should organise this for you when you start in your role. They’ll also be able to advise whether there’s anything else you need to do once you’re registered, such as register separately for PUMA.

If you’re a freelancer, sole trader or you own a limited company, you’ll still need to make social security contributions in order to access the French public healthcare system. You can arrange this through your local CPAM office once you’ve registered as self-employed at the Centre de Formalités des Entreprises (CFE). You’re able to do this as soon as you arrive, rather than after three months and it can be a timely process so the sooner the better.

4. Children: 

Up until they’re 18, children are eligible for free healthcare in France through their parents or guardians. Children in France also have regular routine check-ups and screenings to monitor their general wellbeing and look for signs of various conditions or diseases.

5. Retirees: 

All retirees are eligible for L’Assurance Maladie, but you have to wait the full three months before you can register. In the meantime, you’ll need private health insurance to be covered for any consultation or treatment. It’s also important to remember that health insurance is mandatory for all French residents, so you’ll need private cover to get a visa within the first three months. Find out about our short-term healthcare plan, which can be taken out for between three and 11 months.

When you do come to register for L’Assurance Maladie, you’ll have to fill out a specific form called the ‘demande d’ouverture des droits’ and send it to your local CPAM office. This will enable you to set up social security contributions through your pension income or if you’re from another EU country, attribute your health insurance to the social security system of your home nation. 

The French healthcare system can seem quite complex to begin with and it might be very different to what you’re used to, but once you know a few key details you should find that it’s not too confusing. 

Carte vitale

When you’ve registered with the French healthcare system, PUMA (Protection Universelle Maladie), you’ll receive a carte vitale. This is the French health insurance card, also known as a ‘green card’. It’ll have your photograph on it and an electronic chip, which holds your insurance and social security details. You need to bring this card along to any appointments. The insurance system is highly computerised in France, so cards can usually be scanned at the point of treatment to make it easier for you to be reimbursed later.

Reimbursements 

Depending on what kind of consultation you’ve had, you’ll usually be asked to pay for your treatment at the end of your appointment. 

If they don’t have a card machine, they’ll give you a form (called the feuille de maladie), for you to complete and send off yourself. This makes the process of getting a reimbursement a bit longer, but forms are usually processed within around 10 working days and you’ll be reimbursed directly into your bank account.

There are set prices for most services, which have been put in place by the state. Most doctors, both public and private, adhere to these prices. Any additional charges won’t be included or considered during the reimbursement process, so make sure you’re clear on exactly what’s covered and if there are any extras to pay. A private healthcare policy can help to cover any excess costs, as well as the percentage that isn’t covered by the public healthcare scheme.

Dental cover

The cost of your dental care will also be covered by the public health service. This has its own set of fixed prices and separate reimbursement percentages depending on the type of treatment you have. Generally, more routine dental services like check-ups, fillings and extractions follow a similar process to what you might experience at a doctor’s office. Complex procedures, however, tend to have separate rates that offer a lower percentage of reimbursement. 

Pharmacies and medicine

You shouldn’t find it too difficult to spot a French pharmacy (or ‘pharmacie’) as they usually have a big neon green cross outside. They tend to be open for six days of the week (Monday to Saturday) from 8.30am to 7.30pm, though some close for a couple of hours around lunchtime and each region has one that stays open out-of-hours (including Sundays).

In a similar way to consultations and treatment, the French healthcare system covers a percentage of the cost of medications. This is usually around 65% but could be as little as 15% or as much as 100% (while certain medications for chronic conditions aren’t covered at all). When you take your prescription to the pharmacy, you’ll still present your insurance credentials, but you’ll find the payment system is slightly different. Instead of paying the full amount up-front and then seeking a reimbursement, you’ll only pay the amount that isn’t covered.

It’s worth remembering that healthcare in France is not free and that health insurance is mandatory. The public health insurance (L’Assurance Maladie) is available to all expats after their initial three months, so you can register for that without having to get private healthcare cover. 

The public system covers a significant percentage of your treatment costs, however there’s still a percentage that you’ll have to cover yourself. A popular option for many is to take out a supplementary private policy to cover the remaining costs.

The French state system doesn’t cover psychiatrists, chiropractors or osteopaths, while certain medications aren’t covered or have a low percentage of reimbursement So it might be worth considering private cover which will cover you if you develop a chronic illness or condition

Whether or not you need dental insurance in France depends on your individual needs, budget, current dental health and the extent of dental care you might need.  

For dental care such as routine check-ups, fillings and extractions, around 70% of the official cost is reimbursed to you by the French public healthcare system.³ For more complex procedures, however, they tend to have separate rates that offer a lower percentage of reimbursement. Because of this, many choose to take out private health insurance to cover the costs that the public system does not. 

Although dental insurance isn’t mandatory in France, it can be highly beneficial, especially if you think you’ll need significant dental work in the future. For many, private health insurance provides peace of mind and financial protection against high dental costs.

As France is part of the EU, you can use your European Health Insurance Card (EHIC) or Global Health Insurance Card (GHIC) for medical treatment. If your care is deemed medically necessary, you'll have access to state medical care and receive treatment on the same terms as French nationals. However, EHICs and GHICs only cover you for state healthcare, so you'll still be responsible for the cost of private healthcare.

The emergency number in France is 112, the same as any other country in Europe. This number can be used to call for all types of emergency services.