Health Insurance and Healthcare in France Explained

Jump right in:

• How healthcare works in France
• An overview of private health insurance
• How to find a doctor or dentist
• Giving birth in France

• The universal system is a hybrid, and France’s healthcare costs are financed partially by the state and partly by the individual or private insurers.
• Taxes from employees and employers contribute to the health care system.a

The French healthcare system explained

People in France pay high tax rates, and the country spends more than 11% of its GDP on its mandatory healthcare. Patients spend comparatively very little on healthcare since most of it is subsidized by the government.

What does the public healthcare cover?

• The healthcare system will typically cover 70% of the fees and 80% of hospital costs.
• If you have a major illness, 100% of the expenses are covered.
• The remainder is covered by either the individual or by supplementary private health insurance. There is a small fee that is paid for by the patient: 2 EUR (2.30 USD), for example, per doctor visit.

This is because France operates on the principle of solidarity: the sickest will usually pay the least, preventing them from becoming financially disadvantaged.

• 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.

How to get public health insurance as a foreigner?

To qualify for this coverage, you must meet the residency requirements. An expat moving to France will not be immediately introduced into the insurance scheme.

To qualify, you must:

• work in France; or
• if you are not working, have lived in France continuously for at least three months.

For residence based coverage, you may be asked to show that you have lived in France for at least six months during the previous 12 months.

If you plan to work in France, you will be covered by the public healthcare system through your employer. Most employers also provide a complementary health insurance plan (mutuelle), which will cover out-of-pocket costs.

Until you are eligible, it is advisable to pay for private insurance.

Application steps

• If you work in France your employer reports your employment, but you may still need to submit an application to obtain a French social security number and activate your rights. 
• If you do not work in France, you can apply through PUMa after living in France for at least three months.

Step 1: Complete form S1106 — Demande d’ouverture des droits à l’Assurance maladie.

Step 2: Attach the documents required for your situation.

Step 3: Submit the application to the CPAM.

Required documents

• Passport or identity card;
• valid residence permit;
• birth certificate, especially when requesting your first French social-security number;
• proof of address;
• French bank details (RIB);
• employment contract or payslip, when applying through work;
• proof of at least three months residence, when applying through residence.

France health card: Carte Vitale

Once you are in the French healthcare system, you can get yourself a carte Vitale (health insurance card). The card contains the administrative information needed by medical professionals such as any other private insurance you might have, your doctor, and details of any work-related accidents or illnesses. It is linked directly to your health insurance provider.

The actual application of applying for the carte Vitale is made in conjunction when you apply for your social security number, done at your local Caisse Primaire d’Assurance Maladie (CPAM). For information on this, check out our working article.

You need to update your card once a year or whenever you change any details such as the employer, address, doctor, or have become a parent. To update your card, you can do so at any local pharmacy or at CPAM office kiosk.

You can also download your Vitale card both on Android and iOS.

European Health Insurance Card (EHIC)

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 medical treatment while visiting another EU country, for free or at a reduced cost.

If you are an EU citizen and have an EHIC card from your home country, you can use this to access France’s healthcare system. But if you are a resident or are staying in France long-term, you will need to register with the French social security system and health insurance to access healthcare.

What are the documents needed for a hospital visit?

• If you go to the hospital, you will need to show your carte Vitale, EHIC, or some proof of insurance. If you are at a public hospital, you will also need to bring a copy of the notice you would have received stating you are entitled to state health care.

• If you are not insured at all, you cannot be denied healthcare in France, but you will be expected to pay for everything yourself. In this case, you may also be eligible to apply for assistance under Aide médicale d’Etat (AME), which is a social benefit that helps cover medical expenses for low-income foreigners (non-residents) in irregular situations in the country. To be eligible, you must have lived in France for at least three months.

• If you have forgotten your Carte Vitale, you can still receive treatment and care. You will be given a feuille de soins (a document containing information about medical costs incurred) to fill out. Afterward, you will be able to send the form to your health insurance provider to be reimbursed.

Does the public healthcare cover dental care?

Yes!

Many dental prostheses (crowns, bridges and dentures) are fully covered under the 100% Santé programme. However, more expensive options may require paying part of the cost.

Everyone who is 3 to 24  years old and is covered by the French health insurance system can get a free dental check-up every year. You have to book an appointment with a participating dentist and present your Carte Vitale.

Eye and vision care

Under the same 100% Santé programme, some glasses are free. Adults can get one free pair every two years and children can get one free pair each year.

Are there English-speaking hospitals?

There are a few hospitals in Paris with bilingual doctors and medical staff. Institutions such as the American Hospital of Paris and Hertford British Hospital are options for English-speaking expats. Outside of the capital, bilingual hospitals may be harder to find, and it cannot be guaranteed that your doctor will speak English. In this case, it is advisable to bring a French-speaking friend with you or learn some basic phrases related to your condition before your visit.

What if you get sick outside of working hours?

If you require assistance after hours, some doctors remain on duty in all big cities and even in some smaller ones.

To access this service known as Maisons médicales de garde (MMG), you will need to call 116 117 (15 in some regions). There is information available online for those living in Paris as well as some other major cities. At an MMG, there is usually an extra fee incurred for treatment out of office hours, but this can often be reimbursed through France’s social security system thanks to private health insurance.

There is a secondary out-of-hours service run by SOS Médecins which will send a doctor to your home in under an hour. If you are eligible, you will be reimbursed any visit costs under the usual French health insurance rules.

In rural areas, there is often no out-of-hours medical care. In this case, call Service d’Aide Médicale Urgente (Urgent Medical Aid Service) by dialing 15 for emergency medical treatment.

Private insurance in France reimburses the 20% to 30% gap left by the state's universal healthcare (PUMa). It helps to get people 100% coverage and avoid paying anything out of pocket (or at least be reimbursed if they do have to pay something upfront).

In the case that someone cannot access the state system or is ineligible, they may be required to take out a private health insurance policy. Private coverage is much more expensive than the hybrid system, and not everyone qualifies for it.

Do you need private health insurance in France?

• Private health insurance is a good option for those with chronic illnesses, as the state will not cover things like chiropractors, osteopaths, or psychologist consultations.
• It is also beneficial for some types of prescription medication because the state will only cover a percentage of what they consider “essential” medication.
• If you are a duly registered self-employed worker in France, then you will have access to France’s medical insurance through France's public healthcare system (Assurance Maladie).
• If you are a student in France, it is best to take out private insurance to cover the remainder.

How get private health insurance in France

Most French citizens do take out an additional policy to top up their coverage for costs that are not covered by the state. This is a way to ensure that you are 100% covered. This health insurance coverage can usually be sourced from a non-profit company and is known in French as l’assurance complémentaire santé or mutuelle.

Non-profit options include:

• MGEN
• Harmonie Mutuelle
• Macif

Other private insurers in France:

• AXA
• Allianz
• Generali

You can buy complementary health insurance, known as a mutuelle, directly from an insurer. Compare the offers before choosing a policy.

How much does private health insurance cost?

The cost for private health insurance depends on a few factors including the applicant’s age and health details.

In France, the average cost of health insurance for one person is 30-70 EUR (35-80 USD) per month.

Of course, prices vary depending on the policy too: the stronger the policy is, the more you will pay for your health insurance.

There are many types of health insurance plans. Some cater to specific job occupations while others are specifically designed for expats and English speakers. It is best to shop around, ask for recommendations, compare prices online, and find a policy that best fits your needs.

How to find a family doctor

When you sign up for health coverage, you need to pick a so-called “treating doctor” or médecin traitant. If not, you risk being penalized with higher medical fees and being reimbursed at a lower rate. Children will typically have the same doctor as their parents, but this is not obligatory.

Doctors’ offices are known as cabinets. These practices are often joint enterprises between multiple doctors. You can ask at your nearest pharmacy where the closest office is, or you can locate a doctor’s office online.

Both the Australian and American embassies in France have a published list of English-speaking doctors on their websites. For expats who have more confidence in their French, you can source a local doctor using the Pages Jaunes and searching for “médicin”.

How to find specialists

Your médecin traitant will keep track of your medical history and can refer you to specialists or other doctors if needed.

While it is possible to bypass the médecin traitant and source your own specialist, the reimbursement rate will be lowered if you do not follow the pathway system, and you should expect higher healthcare fees.

However, there are exceptions to this rule if you want to consult an ophthalmologist, pediatrician, gynecologist, or are in emergency situations, and in those cases, you will be spared any financial penalty for finding your own specialist without a referral.

How to find a dentist

Since dentists are free to set their own rates, it is best to pick out a few different dentists and compare prices. Ensure they have a good reputation and the right experience.

To find a destist you can also use:

• Doctolib
• Pages Jaunes
• Ameli directory

Whether you are a non-resident or a permanent resident giving birth in France, with France’s universal healthcare system in place and its endless check-ups and services available throughout and well beyond the pregnancy, you need not worry.

Citizenship

If you plan to give birth in France for citizenship, be aware that the child may only acquire French nationality at birth if one of the parents is also French. Otherwise, non-French children who are still residing in France at 18 years of age are eligible to obtain French citizenship, provided that they have lived in France for at least five years since the age of eleven. A child can also get citizenship earlier, at the age of 16, if requested by the child, and provided that they have also lived in France for at least five years since the age of eleven.

Process & benefits of giving birth in France

Following the first prenatal examination, you will be given a three-page document known as your declaration de grossesse (proof of pregnancy). This is needed to claim social security and health insurance coverage. It is crucial that you send these documents off to Caisse d’Assurance Maladie and Caisse d’allocations familiales no later than your 14th week of pregnancy. Otherwise, you risk losing some of your benefits. Your health insurance fund will then send you a pregnancy guide with dates for medical examinations and maternity leave (For more information on parental leave benefits, check out our Working section).

• Mothers in France are entitled to a postnatal examination within the first eight weeks following birth, which will include ultrasound scans and delivery preparations and, if necessary, physiotherapy. For this purpose, your gynecologist will provide you with a maternity record book, called the carnet de santé maternité, where each medical examination and its details will be recorded.
• The child will continue to have examinations up until they turn six years old.
• Local maternal and child health clinics are also available to provide vaccinations, health, and nutritional advice.

Other benefits to giving birth in France, aside from the healthcare benefits, are the three payments new mothers receive from the CAF, which is the Family Allowance Fund. The benefits available depend on your income, residency status and family circumstances.

Costs of having a baby in France

Public health insurance for hospital births (excluding deliveries in private hospitals) covers all expenses for the first twelve days spent in the hospital, meaning the birth will likely be completely free. The average hospital stay after childbirth is three days.

Furthermore, mothers discharged within five days are entitled to home visits from a midwife.

If you choose to deliver in a private hospital, giving birth in France without insurance can exceed 5,000 EUR (5,600 USD) in private hospital fees alone.

• If you choose to give birth at home be aware that it is tricky to get full insurance in this case, due to the risks that a home birth entails. Nevertheless, your social security will partially cover the costs of giving birth at home, and the delivery will still take place with a midwife present.

Cause for celebration: after the birth

Following birth, babies must be registered within three working days. This is known as the Déclaration de Naissance and can be done at the local town hall, known as the mairie.

Paternity leave

Fathers get 28 days of paternity leave:

• 3 days of birth leave, these days are mandatory (counted in working days, if a child is born on the weekend the days will be counted from the following Monday); (Compensated by the employer)
• 25 days of paternity leave. The first 4 days must be taken immediately after the 3 days of birth leave. The 21 days can be taken continuously or split into two periods. (Compensated by the social security system).

Maternity leave

• 6 weeks if prenatal leave. This period is meant for soon to be mothers prepare for the birth.
• 10 weeks of postnatal leave. This period starts immediately after birth and is meant for women to recover both emotionally and physically.

In some cases, it is possible to rearrange these periods.

Unwanted pregnancies

Abortion is legal up to the end of the 14th week of pregnancy, or 16 weeks after the first day of the last menstrual period. Exceptions can be made if continuing the pregnancy endangers the pregnant woman or if the baby has a serious condition at the time of diagnosis. Abortion and the related medical care are covered at 100% by France’s public health insurance, with no upfront payment for those eligible. Emergency contraception, known as contraception d’urgence, is available from pharmacies without a prescription.