Moving to France is an exciting journey, but one of the most critical aspects of settling in is understanding the French healthcare system. Whether you're an employee, a student, a retiree, or a freelancer, accessing Assurance Maladie, the French public health insurance system, is essential for ensuring you receive medical care when you need it.
This guide covers the fundamentals of healthcare in France for expats, from how the system works to waiting periods and how to register for Assurance Maladie.
Overview of the French Healthcare System
France has one of the best healthcare systems in the world, providing universal coverage for legal residents. The French medical system is a hybrid model funded by social security contributions, employer payments, and patient co-payments.
Public vs. Private Healthcare
- Public Healthcare (Assurance Maladie) – The state-run system covers a large portion of medical expenses, from doctor visits to hospital stays.
- Private Healthcare (Mutuelle) – Many residents opt for a mutuelle, a private top-up insurance plan that covers additional costs not reimbursed by Assurance Maladie.
Key Features of French Healthcare
- Carte Vitale – A smart card used for automatic reimbursements.
- Tiers Payant – Direct billing that allows certain patients to avoid paying upfront (mainly used where it could be capital intensive like at the pharmacy, hospital, for tests, etc.)
- PUMA (Protection Universelle Maladie) – Ensures all legal residents have access to healthcare.
How Public Health Insurance Works in France
French healthcare operates on a reimbursement system—you pay upfront for doctor visits and medical treatments, and the government reimburses a portion of the costs (unless you go somewhere that has the Tiers Payant mentioned above).
Reimbursement Rates
In France, public health insurance does not cover the full cost of medical services upfront. Instead, it 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)
The reimbursement rate depends on the type of medical service received. The Sécurité Sociale applies a fixed reimbursement percentage to the official base rate for each medical act.
Reimbursement rate for different medical services:
- General practitioner visits: 70%
- Specialist consultations: 70%
- Prescription medications: 15% to 100%
- Hospitalisation (up to 30 days): 80%
- Long-term illness treatments: 100%
The remaining costs, known as co-payments, can be covered by a mutuelle (top-up health insurance).
Who is Eligible for French Public Healthcare?
- Employees working in France
- Self-employed individuals
- Students
- Retirees residing in France
- Long-term visa holders who have lived in France for at least three months
Waiting Periods for Accessing Healthcare
One important thing newcomers should know is that there can be waiting periods before accessing public health insurance in France.
- Expats with employment contracts – Immediate access through their employer’s contributions.
- Self-employed individuals (micro-entrepreneurs, freelancers) – May have a waiting period of up to three months before accessing coverage.
- Non-working expats (retirees, spouses, etc.) – Must prove at least three months of uninterrupted residency before applying.
For those not immediately eligible, private health insurance is required to cover medical expenses usually for the whole year but definitely until they are officially registered in the system.
How to Sign Up for Assurance Maladie
Step 1: Gather the Required Documents
To apply for Assurance Maladie, you’ll need to provide:
- A valid passport or residence permit
- Proof of residence in France (rental contract, utility bill)
- Proof of three months’ residency (bank statements, bills, or rental receipts)
- A birth certificate (translated into French if necessary)
- A work contract (if employed) or proof of financial resources (if not employed)
- A RIB (French bank details) for reimbursements
Step 2: Submit Your Application to CPAM
The Caisse Primaire d’Assurance Maladie (CPAM) is the local health insurance office that processes applications. You must send your completed application and documents to the CPAM office in your area. Processing can take several months, so apply as early as possible.
Step 3: Receive a Temporary Social Security Number
Once your application is approved, you’ll receive a temporary social security number, which allows you to start using the system while waiting for your Carte Vitale.
Step 4: Apply for the Carte Vitale
The Carte Vitale is an electronic health card that simplifies medical reimbursements. After receiving your permanent social security number, you will receive instructions on how to request your Carte Vitale. It typically arrives a few weeks later by mail.
The Role of Private Health Insurance (Mutuelle)
While Assurance Maladie covers a large portion of medical expenses, it does not cover everything. Many residents take out a mutuelle, a complementary private insurance plan, to reduce (or void) out-of-pocket costs.
What Does a Mutuelle Cover?
- The remaining percentage not covered by Assurance Maladie
- Dental care (which is only partially covered by public insurance)
- Optical care (glasses, contact lenses)
- Private hospital rooms and additional specialist fees
Common Healthcare Services in France
Visiting a General Practitioner (Médecin Généraliste)
In France, your general practitioner (GP) plays a key role in coordinating your healthcare. You should register with a doctor as your médecin traitant (primary care doctor) to receive higher reimbursement rates.
Specialist Appointments
To see a specialist, it’s usually recommended to first consult your GP for a referral. This helps ensure you receive maximum reimbursement.
Pharmacies and Prescription Medications
French pharmacies are highly regulated, and many medications require a prescription. When you present your Carte Vitale, Assurance Maladie reimburses a percentage of the medication costs.
Emergency Care in France
In case of an emergency:
- Dial 15 for SAMU (emergency medical services)
- Dial 112 for general European emergency services
- Visit the nearest hospital emergency room (urgences)
If you need non-urgent medical assistance, you can call SOS Médecins, a home visit service available in most major cities.
FAQs About Healthcare in France for Expats
Do I need private health insurance to live in France?
If you are not immediately eligible for Assurance Maladie, you must have private health insurance.
Can I use my home country’s health insurance in France?
EU citizens can use the European Health Insurance Card (EHIC) for short-term stays. Non-EU nationals will need private insurance.
How long does it take to get a Carte Vitale?
Once you’ve applied to French social security it takes 6-month on average to get your numbers and then it can take an extra several months to receive your Carte Vitale, so keep all medical receipts for reimbursements in the meantime.
Navigating the French Healthcare System as a Newcomer
Understanding the French medical system basics is essential for expats moving to France. Whether you are employed, self-employed, or retired, securing Assurance Maladie ensures affordable healthcare.
To avoid gaps in coverage, apply as soon as possible after arriving in France, and consider getting a mutuelle to minimise out-of-pocket expenses. With its high-quality medical care and well-structured system, France offers one of the best healthcare systems in the world, ensuring peace of mind for both residents and expats alike.
Private health insurance is a mandatory requirement to get your VISA or carte de séjour (residency permit). 82% of failed applications are turned down because of the insurance so it’s best to work with insurers that know the French requirements to avoid any unpleasant surprises. Visit Fab French Insurance today and get a quote on your health insurance.