Healthcare and insurance in france

Explore the French healthcare system, a global leader in quality, accessibility, and affordability. This comprehensive guide details France’s unique universal hybrid model, combining public funding (Sécurité Sociale/PUMa) with private supplementation (mutuelle) for nearly 100% coverage. Learn about eligibility and registration for expatriates, including vital information on the Carte Vitale and key documents for CPAM. Discover the role of private health insurance in covering gaps and accessing enhanced services. Understand how doctors, hospitals, pharmacies, and specialized care (dental, vision, women’s, children’s, senior, mental health, and alternative medicine) are integrated, ensuring high-quality care for all residents.

The French Healthcare System: An Overview

High-Quality, Accessible, and Affordable

The French healthcare system is widely regarded as one of the best in the world, renowned for its exceptional quality, broad accessibility, and remarkable affordability. This comprehensive system ensures that all legal residents, including expatriates, receive high-standard medical care without facing financial hardship. The system’s excellence stems from its careful balance of public funding, private supplementation, and patient choice, creating a healthcare environment that prioritizes both medical outcomes and financial protection.

A Universal Hybrid System for All Residents

France operates a unique universal hybrid healthcare system that combines state funding with individual and private insurance contributions. This dual approach provides comprehensive care coverage to an estimated 96% of all French residents, including foreign nationals who have established legal residency. The hybrid nature allows for both public healthcare access and private healthcare options, giving patients flexibility in their care choices while maintaining universal coverage principles.

1. Public Healthcare System (Sécurité Sociale / PUMa)

Overview and Funding

The public health insurance system operates under the name Sécurité Sociale, though it was modernized in 2016 with the introduction of Protection Universelle Maladie (PUMa), which replaced the previous Couverture Universelle Maladie (CMU). This reform simplified coverage procedures and expanded access to state universal healthcare for a broader range of residents, significantly improving the system’s efficiency and inclusivity.

Solidarity and State Funding Mechanisms

The French healthcare system operates on the fundamental principle of solidarity, ensuring that the sickest patients typically pay the least to prevent financial hardship during medical crises. This principle creates a safety net that protects vulnerable populations and maintains social cohesion. The solidarity-based approach means that healthcare costs are distributed across society based on ability to pay rather than medical need, creating a more equitable system for all participants.

Employer and Employee Contributions

Healthcare funding comes primarily through tax contributions deducted from salaries, including the contribution sociale généralisée (CSG), which amounts to 9.2% of an employee’s salary as of 2025. Employers make substantial contributions to the public health insurance fund, paying either 7% or 13% depending on the employee’s salary level. This dual contribution system ensures stable funding while distributing costs between workers and businesses, creating a sustainable financial foundation for the healthcare system.

Coverage and Reimbursement

The public system operates through a co-payment structure where the state covers a major portion of medical expenses, with patients responsible for the remaining percentage. This system ensures healthcare accessibility while encouraging responsible usage of medical services.

Standard Reimbursement Rates and Co-Pay System

Standard reimbursement rates vary by treatment type, with the public system typically covering 70% of fees for doctors, dentists, midwives, and most specialists. Hospital costs receive more generous coverage, with 80% reimbursement for the first month and 100% coverage thereafter for treatment costs. However, patients pay a flat daily fee for bed occupancy (approximately €18) that is not reimbursed. Each doctor visit includes a small patient fee, such as €1 or €7.50 for general practitioner visits.

Chronic Illness and Special Medical Coverage

Patients diagnosed with chronic illnesses, including diabetes and cancer, receive 100% coverage of their medical bills, encompassing surgery, therapy, and medications. This comprehensive coverage ensures that serious health conditions do not create financial burdens, allowing patients to focus on recovery without economic stress.

Prescription Medications, Vaccines, and Specialized Services

Prescription medication reimbursement operates on a tiered system, with expensive medications receiving up to 100% coverage, others reimbursed at 65% or 35%, and some non-essential products receiving no reimbursement. Vaccinations are covered at 65%, with certain vaccines like Covid-19 receiving 100% coverage. Eye care and hearing aids receive 60% coverage, while certain glasses became 100% reimbursed starting in 2020, with adults eligible for one free pair every two years and children receiving one pair annually from 2021. Dental prostheses became fully reimbursed starting in 2021.

2. Eligibility and Registration for Expats

Eligibility Criteria

The French healthcare system welcomes expatriates under specific conditions designed to ensure genuine residency and integration into French society. Understanding these criteria is essential for successful healthcare access.

Who Qualifies for Coverage and When

All legal residents, including expatriates, can access the healthcare system after residing in France for at least three consecutive months with the intention of staying for a minimum of another three months (totaling six months or 183 days per year). Expatriates employed by French companies gain immediate medical coverage without the three-month waiting period. Self-employed expatriates who make necessary contributions and those who have reached official retirement age in their home country are also eligible. Children in France automatically qualify for healthcare coverage regardless of nationality and remain covered by their parents’ insurance until age 18.

Special Rules for EU, UK, and Non-EU Citizens

EU citizens can use their European Health Insurance Card (EHIC) for short-term visits, but longer stays or residency require registration with the French social security system. UK citizens can use their Global Health Insurance Card (GHIC) for similar purposes. Expatriates from outside the EEA or EU who do not contribute to the French public healthcare system must obtain comprehensive private health insurance for their entire stay, with proof of healthcare coverage often required for French visa applications.

Role of Cleiss and Bilateral Healthcare Agreements

The Centre des liaisons Européennes et internationales de sécurité sociale (Cleiss) serves as the official authority providing information and managing bilateral social security benefits, including healthcare for international residents. Cleiss can advise on specific situations and assist with the S1 form for transferring healthcare rights from EU/EEA countries, making the transition smoother for eligible expatriates.

Registration Process

Navigating the registration process requires patience and proper documentation, but understanding the steps helps ensure successful enrollment in the French healthcare system.

How to Register with CPAM and Required Documents

The registration process begins at the local Caisse Primaire d’Assurance Maladie (CPAM), where foreign residents apply for a social security number. Many employers assist by registering their foreign employees directly. Required documents typically include identification (passport, visa), birth certificate, proof of French residence (lease agreement, utility bills), and proof of income or employment contract. The S1106 (Cerfa 15763) form may also be required depending on individual circumstances.

Navigating French Healthcare Bureaucracy

The CPAM bureaucracy can present challenges, often requiring patience with unanswered calls or emails, and sometimes necessitating traditional mail correspondence. Persistence and proper documentation help overcome these administrative hurdles, and many expatriates find success by visiting CPAM offices in person when possible.

Carte Vitale

The Carte Vitale represents the key to accessing French healthcare services efficiently and serves as proof of insurance coverage.

What It Is and How It Works

Once affiliated with l’Assurance Maladie, patients receive a Carte Vitale, a credit card-sized health insurance card featuring the holder’s photo and an embedded chip. This card contains administrative information, including private insurance details, chosen doctor information, and records of work-related illnesses or accidents. The card links directly to the health insurance provider, enabling seamless healthcare access.

Usage, Updates, and Alternatives

The Carte Vitale must be presented at all medical appointments to access free healthcare or claim reimbursement. At most facilities, it functions like a debit card connected to CPAM and mutuelle accounts for direct payment, eliminating upfront payment requirements. When providers lack the electronic system, they provide a feuille de soins (paper form) for manual reimbursement submission, though this process takes longer. The card requires yearly updates or updates whenever personal details change to maintain accuracy.

3. Private/Supplementary Health Insurance (Mutuelle)

Purpose and Benefits

Despite the high quality of public healthcare, most French residents and foreigners obtain private supplementary health insurance to maximize their healthcare coverage and access.

Filling Gaps in Public Coverage

Private supplementary health insurance, known as mutuelle or l’assurance complémentaire santé, serves the primary purpose of covering remaining costs not reimbursed by the state system, ensuring 100% coverage for medical expenses. This supplementation eliminates financial gaps that might otherwise create barriers to healthcare access.

Advantages of Having a Mutuelle

A mutuelle provides several significant advantages including elimination of co-pays (the 10-40% out-of-pocket gap), coverage of “excess fees” (dépassements d’honoraires) charged by private sector specialists that exceed state-set rates, and access to better or more timely private health services. Additional benefits include perks like private hospital rooms, more comprehensive maternity care, coverage for premium glasses, and services not fully covered by public healthcare such as complex dental treatments, certain medications, chiropractors, osteopaths, and psychologist consultations.

International Plans for Frequent Travelers

International health insurance plans offer continuous coverage across multiple countries, proving beneficial for expatriates who travel frequently or plan future relocations. These plans provide healthcare security during the initial three-month waiting period before public healthcare eligibility begins.

Cost and Providers

Understanding the costs and options for private health insurance helps expatriates make informed decisions about their healthcare coverage.

Average Prices and Employer Contributions

The average cost of private health insurance for one person is €40 per month, though prices vary widely from €15 to over €200 monthly depending on coverage level, options, and applicant age. Unlike some countries, pre-existing conditions generally do not affect health insurance costs in France. Many French employers are legally required to provide mutuelle coverage to employees, often sharing costs with workers.

Popular Insurers and Low-Income Support Programs

Key international health insurance providers operating in France include Allianz Care, Cigna Global, and APRIL International. Comparison websites and insurance brokers can help identify suitable plans. Low-income earners may qualify for state-funded complementary coverage called Complémentaire Santé Solidaire (CSS), while other options include joining a French spouse’s plan or purchasing independent policies.

4. Healthcare Professionals and Services

Doctors (GPs and Specialists)

The French healthcare system provides patients with significant freedom in choosing healthcare providers while encouraging coordination through primary care relationships.

Choosing and Registering with a Treating Doctor

Patients enjoy freedom in choosing their doctor, but registering with a “treating doctor” (médecin traitant) is highly recommended. This doctor manages medical history, coordinates follow-up treatments, and provides specialist referrals. Failure to register can result in lower reimbursement rates, making this relationship financially beneficial as well as medically advantageous.

Appointments, Referrals, and Online Booking Tools

While some specialists can be accessed directly (gynecologists, pediatricians, ophthalmologists, or psychiatrists for patients under 26), referrals are generally required for others to ensure higher reimbursement rates. Without referrals, fees may be higher and reimbursement lower. Wait times for general appointments are typically manageable, but specialists may have longer waits, ranging from three weeks for pediatricians to 80 days for ophthalmologists. The online platform Doctolib.fr is widely used for finding doctors, dentists, and therapists, displaying available appointments and allowing preferred language selection.

After-Hours and Emergency Medical Access

Out-of-hours medical care is available in cities through Maisons médicales de garde (MMG) or SOS Médecins, which sends doctors to patients’ homes. In rural areas, the emergency number 15 (SAMU) should be used for urgent medical needs, ensuring that healthcare access remains available around the clock.

Hospitals

French hospitals provide comprehensive care through both public and private facilities, all working within the broader healthcare system framework.

Types of Hospitals and Emergency Services

French hospitals include primarily state-owned hôpitaux and privately run cliniques (private hospitals), both often operating within the public healthcare system. Emergency services are efficient and reliable, managed by the Service d’Aide Médicale d’Urgence (SAMU). The general European emergency number is 112, while the local SAMU number is 15. Overcrowded emergency rooms can create long waiting times for non-life-threatening cases.

Language Access and Options for the Uninsured

In Paris, some hospitals have bilingual staff, including the American Hospital of Paris and Hertford British Hospital. Outside the capital, English-speaking staff may be harder to find. Uninsured individuals cannot be denied healthcare in France but will be expected to pay all costs personally. Low-income foreigners in irregular situations might be eligible for Aide médicale d’Etat (AME) after three months of residency.

Pharmacies and Medication

French pharmacies play a crucial role in the healthcare system, providing both prescription medications and health advice.

Getting Prescriptions and Emergency Pharmacy Access

Pharmacies are abundant and easily identified by their illuminated red or green cross. They maintain a monopoly on medicine sales, including basic painkillers. Many medications require a doctor’s prescription (ordonnance), and pharmacists are highly qualified to offer recommendations for minor ailments. Emergency pharmacies (pharmacie de garde) are available in every town or district on Sundays and after hours, with addresses listed on other pharmacy doors or online at 3237.fr.

Travel Tips and Vaccination Advice

Travelers should carry original prescriptions and generic names for personal prescription medications when entering France. Routine vaccinations are recommended before travel to ensure optimal health protection and compliance with any entry requirements.

Dental and Vision Care

Dental and vision care receive significant coverage under the French system, with recent improvements expanding access to essential services.

Basic Coverage and Reimbursement Policies

Basic dentistry including consultations, cavity treatments, and extractions is covered by the state, though more complex or cosmetic treatments typically require private insurance. However, dental prostheses (crowns, bridges) became fully reimbursed starting in 2021. While basic dental procedures are affordable compared to US prices, sophisticated work can be expensive, making private insurance valuable for comprehensive coverage.

Prosthetics, Check-Ups, and Children’s Benefits

Certain glasses became fully reimbursed starting in 2020, with adults entitled to one free pair every two years and children receiving one pair annually from 2021. Children receive free dental check-ups every three years between ages 6 and 18, ensuring early prevention and treatment of dental issues.

Women’s, Children’s, and Senior Healthcare

France provides specialized healthcare services tailored to different demographic groups, ensuring comprehensive care across all life stages.

Comprehensive Women’s Health Services

Gynecologists are directly accessible without doctor referrals, facilitating women’s healthcare access. Pregnancy care is comprehensive, with coverage for multiple prenatal examinations and hospital births in public facilities typically 100% free. Abortion is legal up to 12-14 weeks and state-funded in public hospitals for those with social security coverage.

Pediatric Care and Vaccination Programs

Children receive 20 compulsory health screenings up to age 16 and follow detailed vaccination schedules to ensure optimal health protection. Minors are exempt from co-payments, making healthcare completely accessible for families regardless of economic circumstances.

Senior Care and Support Services

France maintains high life expectancy rates, and retirees receive priority for health check-ups and vaccinations. While universal healthcare covers most costs, private insurance remains common among seniors for 100% reimbursement, more comprehensive care, and quicker specialist access. Financial support (APA) and retirement homes (EHPAD) are available for extensive care needs.

Mental Healthcare

Mental health services are integrated into the broader healthcare system, providing both public and private treatment options.

Access Through CMP and Private Providers

State mental healthcare is provided through centre medico psychologique (CMP), generally requiring a doctor’s referral for access. This system ensures coordinated care and appropriate resource allocation for mental health services.

Reimbursement and Insurance Considerations

Private psychiatrists and psychologists are reimbursed at the same rate as medical services when referrals are obtained, but private health insurance is necessary for reimbursement of private treatment without referrals. This structure encourages coordinated care while providing options for those preferring private treatment.

Alternative Medicine

France recognizes and supports various forms of alternative and complementary medicine, integrating them into the broader healthcare framework.

Homeopathy, Acupuncture, and Complementary Therapies

The French healthcare industry recognizes alternative and complementary medicine including homeopathy, acupuncture, herbal medicine, water cures, and chiropractic treatments. This recognition reflects France’s holistic approach to health and wellness, accommodating diverse treatment preferences and cultural approaches to healing.

When and How They Are Covered

Treatments like homeopathy, acupuncture, osteopathy, and chiropractic can be covered by universal health insurance when performed by qualified professionals, ensuring quality and safety standards. However, private health insurance is typically needed for comprehensive coverage of alternative therapies, providing broader access to these complementary treatment options.

See also: French Health & Childcare