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France’s Hybrid Healthcare System: Public and Private

Good news for expats: All legal residents of France are eligible to join the country’s healthcare system. This overview article explains how to qualify for medical insurance, how much to pay for your treatment, what your carte Vitale is and how it works.

At a Glance: 

  • Health insurance in France is a mixture of public and private healthcare.
  • Patient fees are minimal thanks to state reimbursements.
  • Remember to top up your state coverage with a private mutuelle insurance package!
  • Your carte Vitale tracks all your records and prescriptions.

Healthcare Policy in France 

The French healthcare system is often considered one of the best in the world: it’s well serviced with more than one doctor to every 1,000 citizens and helps keep life expectancy at a high 81.8 years. The system is a hybrid which is financed partially by the state and partially by individuals or private insurers. Taxes from employees and employers are collected to prop up the generous state-funded section of the system.

Even though recent unemployment levels and an aging population have put the system under some strain, the French are wedded to their healthcare policy, and it looks unlikely to change any time soon. Having a high-quality healthcare system comes at a price, though. France spends more than 11% of its GDP on healthcare, but this doesn’t necessarily mean it is an expensive system for those using it.

How Much Do You Pay?

Healthcare in France is not free at the point of delivery, so don’t forget your credit card when heading to the doctor’s. You will be expected to pay upfront for treatment, although you will be able to claim most of the money back afterwards.

If you are registered in the state healthcare system, the social security fund will reimburse a certain percentage; private insurers or the individual patient will be expected to cover the remaining costs. The amount reimbursed by the government is usually a generous figure, with an average 70% of expenses being returned to the patient, or 100% in case of serious or chronic illnesses, such as cancer or AIDS. The costs borne by the patients themselves are known as le ticket modérateur in French.

For example, if you make a doctor’s appointment, the state will usually pay back around 70% of the related costs. As a visit to a primary care physician usually costs around 25 EUR, this means the social security fund will pay 16.50 EUR, leaving the patient with a final bill of 8.50 EUR. Medicine prescribed by a doctor and purchased at a pharmacy can be reimbursed at rates varying between 15% and 100% of the price, depending on how effective or necessary the medication is deemed.

The French system works according to the so-called principle of solidarity: the sickest will usually pay the least, which prevents them from being financially disadvantaged because of poor health. When it comes to costs not paid for by the state, most French citizens take out an additional policy to top up their coverage. This insurance plan can normally be sourced from a non-profit company and is known in French as l’assurance complémentaire santé or mutuelle.

The policy normally costs between 50 and 60 EUR a month and will mostly cover the rest of the bill, but you will still be left with some charges. These insurance companies are forbidden, for example, to pay for the 1 EUR charge for a consultation, and most policies refuse to cover you for injuries obtained during extreme or dangerous sports. However, if you are employed in France, you are very likely to be well covered nonetheless: since the start of 2016 it has been compulsory for private companies to offer this kind of top-up insurance to their employees. 

Are You Insured?

If you are covered by France’s universal healthcare system, you will be protected by the 2016 PUMA scheme (Protection Universelle Maladie). If you are a legal resident in France, you will be eligible for health coverage, regardless of your employment status. This marks a change from the previous system, where dependents were insured via the wage earner’s state coverage. Once you are in the system, you should be covered for as long as you live in France, regardless of any changes in employer, address, or family status.

However, to qualify for this coverage, you must still meet the residency requirements. An expat moving to France will not be immediately introduced into the insurance pool. To qualify, you must have lived in France for three months or be working in the country, as well as planning on living in France in a “stable and regular” manner for at least six months of the year.

By entering into the French state healthcare system, you will also be able to apply for a European Health Insurance Card (EHIC). This entitles you to emergency treatment in any EU country without having to pay any upfront fees.

If you are an EU citizen and have an EHIC card from your home country, you can use this for a while to pay for some healthcare coverage. Your EHIC card will work in France for three to five years, but it will only be valid for urgent treatment in case of emergency. It’s therefore still advisable to sign up for some kind of official insurance scheme if you are staying in France on a long-term basis.

The Carte Vitale

Once you are in the French healthcare system, you can get yourself a carte Vitale. The electronic carte Vitale was introduced to replace paper prescriptions, store patients’ records more effectively, and streamline the state system. The card contains the administrative information needed by medical professionals for sorting out prescriptions and medication. It is linked to your insurer, which means that information can be relayed directly and reimbursements should be completed within around five days. There is no charge for applying for a card, and it should be provided through your insurance company.

Once you have a carte Vitale, it’s important to keep it up to date. You need to update your card around once a year or if you change any details such as employer, address, doctor or whether or not you are a parent. To update your card, you need to use a terminal, which can be found at various health facilities as well as at your insurer’s office or a local pharmacy. 

Going Private

With such a reputable state-funded system, full private health insurance is deemed unnecessary by most residents of France. Private coverage will be much more expensive than the hybrid system and certain doctors only work within the state system, meaning you may not be able to use them if you have private health coverage.

Very few people opt for full private coverage in France as this is a far more expensive alternative to the hybrid social security scheme. However, those that do take this route can expect a tax break as they will be exempt from health-related tax contributions as they don’t have to pay in to a system they will not be using. This group can therefore expect to save around 8% on any annual income over 10,000 EUR.

While the option of going private may seem to make sense for those earning enough, it is worth bearing in mind that pre-existing conditions may not be covered. Moreover, if you are not already an EU national, you will not be automatically eligible for an EHIC card, as you would be under the state system.

Early retirees are one of the few groups who may need private healthcare — at least on arrival — in France. This group must be legally residing in France to qualify for the state system. Therefore they need to have lived in the country for three months with sufficient income and health coverage. To cover this three-month gap, EU nationals can use their EHIC card, but private healthcare may also be an option worth considering. 


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